Pink eye

Sick days are hard.

I'm on a tough couple of rotations coming up - I have 2 weeks of 24 hour shifts of my own, a week of nights, and another 2 weeks of 24 hour shifts I picked up for another resident's maternity leave, not to mention some 12 hour shifts in between all that. Future Kicks is going to be happy - less 24 hour shifts for next year - but presently I'm looking at the upcoming calendar and thinking....blegh.

We've been pretty lucky when it comes to Baby's health though. We've walked through the day care door for the past 4 months despite the warning signs of RSV, pneumonia, and strep and come out with multiple runny noses but nothing else. 

Yesterday he was a bit crabby but hadn't slept much and was. not. having. the peas we were trying to introduce. I thought he had a booger in his eye, but didn't think much of it as he pretty much has boogers everywhere all the time. However, this morning one of his eyes was matted shut and it took multiple wipes to get the goo off. Was it pink? I thought so, but the lighting in our house isn't great so I couldn't be sure. I just kept staring at him for a few minutes trying to decide. It definitely wasn't clear cut pinkeye but I wasn't sure. 

I took a minute to evaluate the week's schedule. It was about 6:15. I had a meeting at 7:30 with my PD, I was the walk in clinic resident this AM, and I had block ed this afternoon. Nothing that couldn't be rescheduled or easy to fill. Tomorrow and the next day were 12 hour shifts at the hospital that could be much harder to fill and impossible to leave mid-shift. I knew I had two options and I had to make the choice quick.

1) Take him to daycare and roll the dice that it wouldn't get more pink. 

2) Call in sick today even though it was a soft call on pink eye with the hope of nipping it in the bud today and having a doctor's note to return to daycare tomorrow

I opted for #2 because it's much more difficult to leave mid-clinic shift than to not go in at all. Took him in right away this AM. Of course under the bright lights of the office, those eyes looked clean and white. The FP there recommended I stay home with him today and gave me a note saying safe to go back to daycare tomorrow. 

Now I'm home. I feel really guilty about calling into work, but trying not to. The meeting will be easy to reschedule, it's generally easy to fill walk in clinic, and the only one who loses if I miss out on block education is me. I still think I made the right choice and I am going to finish out the day at home (doctor's orders as above :)) 

I'm reflecting today on how utterly hopeless it is to try and schedule a sick day. 

I also feel somewhat stupid for bringing him in to clinic. After all, I am a family doctor who diagnoses pink eye in kids all the time. As soon as I brought him in, I knew that his eyes would be clean. I remember looking at him on the table early this morning thinking "I am a mother-effing doctor. How am I not able to tell if it's pink eye or not?". I've read about the fallacies of trying to diagnose your own kid and the scary stories of doctor parents never bringing their kids in, so I'm probably overcompensating the other way. 

How do you guys feel about bringing your kiddos into the doctor? Do you think you do it too much or not enough?

In the end - I'm going to enjoy our day off together, put the guilt aside, and rejoice that it's not pinkeye (yet). 

Last Week

My little family had a tough week last week. In addition to the usual chaos of single-working-mom-with-two-kids life, which includes (but is not limited to) two morning drop offs during the week, ballet, play rehearsal, soccer, swim class, my own personal interviews for a potential promotion at work, and a snow day during the week (oh how I could do a single lengthy post on the chaos of being a doctor mom with two kids on a snow day!), three year old E got sick. And we landed in the hospital.

I should mention that my seven year old daughter, M, has immunity of steel. She had the usual colds, fevers, early childhood sicknesses until roughly 18 months old, and then she’s been rock solid since. I can’t remember a time in 5 years that she’s seen the pediatrician other than for a wellness physical.  

And then there’s E. He’s had an ongoing solidly built relationship with our pediatrician which has landed him in her office so many times we all stopped counting. Sometimes I see her so much (and I like her SO much!) I think I should take her out for coffee or something!  For a while it was bi-weekly, for a new cold, fever, cough.  Between the ages of 6 months and 16 months, this kid was hospitalized three times for respiratory problems.  The frustrating thing was he would get overtaken by a cold which would turn into brochiolitis, land in the hospital with hypoxemia, get treated with oxygen (and time) and get better, but no one could really put a name on it.  It wasn’t asthma. He got tested for CF (oh, that was a harrowing day!), amongst other things, and the pediatricians landed on a diagnosis of “tracheomalacia” and told me he’d grow out of it.  So for 2 solid years, we walked on eggshells with this little guy and his tenuous health.  And, slowly, he seemed to get better and the “colds” got less frequent, and I slowly let go of some of my anxiety about him getting sick.

Last week, he wasn’t himself on Monday and had a low grade temperature. I didn’t think much of it because he wasn’t coughing and thought he’d rest a little on our “bonus” snow day. On the morning after the snow day, he still had a low grade temp so I kept him home from school but I needed to be at work. I was precepting for three residents, two of my colleagues were away on vacation, and there was just absolutely not a single soul (believe me, I racked my brain!) who could precept those residents for me. So, I brought E to work with me -- he was psyched! He sat at my desk, drew pictures, played on the computer, got fawned all over by my colleagues, and enjoyed the bonus graham crackers and apple juice in the ‘supply’ closet! He was really acting fine, even a little energized by being at my office, but a slow, barking cough began to emerge.

We left my office midday and went to the pediatrician (it was a covering doc as our usual pediatrician was out that day! Sigh.) to find he had since spiked a fever, and his room air pulse ox was 92%.  He had a right lower lobe pneumonia [ok, this is the part where I confess I listened to his lungs when he was in my office -- which I try to NEVER do, except I did this time -- and thought I also heard a pneumonia but tried to leave that to his real doctor to decide!]. They gave him nebs in the office (I told them they never work, but they always say it’s worth a try) and his pulse ox remained at 92%.  So, we left with our amoxicillin prescription and a word of caution: “You know what to do. You are a doctor. If he gets worse overnight, don’t even call us. Just go to the ED. If you are worried tomorrow, bring him in again.”

I should have known. It always gets worse.  This kid gets sick fast.  So he got his first dose of amoxicillin, and I waited.  You know that waiting -- the kind of waiting moms do -- where we are so worried, need to be distracted so we don’t obsess, then we second guess our judgement, try to convince ourselves it will be ok, exercise some magical thinking that all will be fine as soon as the antibiotics kick in, and the time can’t pass quick enough.  I put E to bed at 6 pm because he was so tired and miserable, and the next 3 hours were unbearable. He would sleep for 5 minutes, cough uncontrollably, wake up and cry, and then be so tired he’d fall asleep again, and then do the same thing over and over. It went on like this for so long. Did I mention I also was getting my 7 year old fed, showered, ready for bed? Oh yeah, that too!

At 9:30, while holding E in my bed, trying to get him to calm so that he could get some much needed rest, he woke and cried and said “Mama, I need help. I need help.”  So, that’s it.  I sped into action: clothes on, coats, boots, hats, gloves for kids, I woke up M, I put both kids in the car (10 degrees outside!), dropped off M at a friend’s house to sleep over, and drove to the ER.  E’s dad eventually met us there -- another story.

In the ER, E’s room air pulse ox was still 92% but when he fell asleep, he got hypoxemic to the low 80s.  I’m guessing it’s why his sleep was so fitful.  So, we got admitted. And we spent 3 days in the hospital. From the gurney in the ER, I sent emails and texts to my clinic manager, medical director, and colleagues to cancel all my patients and my meetings, and the interviews for the promotion that I’ve been working toward.  The rest of the week was a wash.  In fact, all the stress and chaos of ‘everything else’ just melts away when you have a sick kid. I told myself, “I’ll catch up. It will be ok. Everything else will wait.”  And it did. Time stood still with him in my arms. All I needed was him to get better.

E is fine now. He is back to preschool, and back to his usual self. M had a few days of being bonkers because her routine was off as we figured out how to move all the pieces of the family puzzle while I stayed with E in the hospital (thank goodness for good friends!). But, she was truly a champ during it all. And, we are back to ballet and soccer and swim class and play practice and birthday parties and the crazy of morning school drop off, and I’m back to patients and meetings and interviews. And somehow we are all staying afloat. And we are making sure to do it all with lots of hugs and giggles and a few dance parties mixed in -- the chaos is there, it’s never going away, and we are trying to keep it ‘light’ for now because that’s all this doctor mama can take at the moment.