influenza city & a change of heart

It’s flu season again. It should be said in the manner of ‘It’s Groundhog Day’ from that great eponymous Bill Murray movie (it was great, there shall be no correspondence entered into thank-you very much). Usually that statement doesn’t mean much, maybe the potential for a bit of a runny nose, someone sneezing or coughing a little bit too much at the water-cooler, but that’s it. No big deal right? Last Thursday I was sitting at home watching the news, enjoying my last evening off before a long run of shifts in St Elsewhere’s Children’s A&E:

‘Next up on Ten news, a 4 year-old child dies of Influenza.’

My heart sank. Not only for the poor child and family, but also (and I’m ashamed to admit it) on a very selfish, base level because I knew, just knew, that my run of shifts would be hellish. The helpful health representative came on the news stating:

‘Any child who is lethargic, has a fever, cough, or maybe even diarrhoea and vomiting should go straight to the emergency department…’

Now, I’m not a parent, but as far as I am able to tell, that pretty much includes every child around. I realise they have a job to do and the symptoms of influenza are vague at best and there is no real way of predicting which child will have a horrible response to the virus, but honestly, have a heart. I got up off the couch to head out and meet some friends for dinner. Half an hour later, I received the call of dread.

‘Hi Ben, it’s so and so from the emergency dept. Ummm, we were wondering whether you might be able to come in and give us a hand?’

30 children had been brought in to the emergency department in the time between the news report finishing and the call. When there are only a few doctors on, that makes a huge difference. Since that news report we have been hammered. Every day we almost reach the all-time record for number of patients seen in the department and then we finally broke it. We are history makers now, and not in a good way. For six straight shifts I have seen children with various viral infections, all of which pretty much mimic influenza, all of which we can only treat symptomatically (don’t get me started on ‘Tamiflu’ people). It’s not to say that the parents are being silly or over cautious, they’re not. They’re acting on the information they have been given and, like any parent, are concerned. Nonetheless, it gets wearing after a while.

—————–

Anyway, during this time we almost had a death in the department, fortunately a relative rarity in the world of kids emergency medicine. Our medical emergency phone rang:

’13 month old child, status epilepticus. Fever of 40 degrees. Given 4mg of Midalzolam (a sedative drug) with no resolution.’

Hmmm, easy enough in an adult. Sadly, I am still a little bit rusty on Paediatric medicine. The last time I actually practised in a mixed adult and children’s A&E was 3 years ago. We set up the resuscitation room, preparing various medications, intravenous fluids and, if things weren’t going well, equipment to induce the child into a coma and place them on a life-support machine.

He came in with the ambulance. A little baby. I could hear his breathing before they even came through the doors. Rapid, too rapid, partially obstructed, a horrible, gut-wrenching, somewhat terrifying sound. This little mottled body was shutting down in front of us, arms pointed straight out wrists flexed towards the bed, legs stiff with toes pointing like some sick ballerina (extensor posturing to those in the know) and his back arched. He was still fitting. It’s scary enough in adults as it looks so out of control and dramatic, but in a small 13 month old baby it’s simply terrifying and a little eerie. His tearful, pale, distraught parents came into the resuscitation as well, both nurses at our hospital. They knew what was going on and how seriously their child was.

As in most emergency departments, resuscitations are a calm, controlled event. People (unless they are in over their depth) don’t yell. Things get done smoothly and quickly. This was the first paediatric resuscitation I had been involved in for a long time, so I stayed controlling the child’s airway and helping him breath. My absolute godsend of a consultant was there getting intravenous access, controlling medications and talking to the parents. There was little choice, we sedated, paralysed and then I intubated. I don’t think my hands have shaken so much in a long time.

We watched his little mottled body being wheeled off to ICU, parents in tow. The sound of the ventilator pushing air rapidy into his body faded down the corridor.

It was Influenza Type A – the same virus that had killed a 4 year old a few days before. I looked at the screen filled with patients waiting ‘Fever, Fever, Fever, Fever’ for the first time in days I didn’t begrudge the worried parents, I didn’t sigh and roll my eyes at every well child that had been brought in. I thanked my lucky stars that they had parents who cared enough to make sure.

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~ by Dr Ben on August 10, 2007.

5 Responses to “influenza city & a change of heart”

  1. that just made me cry.

  2. Have you saved this post? I remember this as the leading story on the news a few weeks back. Hope the little boy gets better. It would have been painful seeing countless not very sick children.

  3. Hi Clare – I don’t know if this child was on the news or not. As for getting better, I responded to an emergency call from the ward. He has been off life support for a few days but he had been fitting again for an hour when we were called. He’s still pretty unwell.

    Um, sadly it seems Paediatrics is pretty much seeing not very sick kids…with a few notable exceptions of course.

    Eliza – sorry, didn’t mean to.

  4. Oh Ben, thank fuck for doctors like you. Seriously, no sychophantic nonsense, I mean it.

    When Poetboy contracted meningitis, there was a huge hoo ha about it [meningitis symptoms] in the news and so similarly to the Influenza A situation here, parents were rushing their babies to the doctor at the first sign of Nappy Rash. Poetboy was four months old. His tiny body was shutting down before my eyes and the doctors were prepared to call it a virus and to call me neurotic. Fast forward twenty four hours and Poetboy is on Life Support in Great Ormand Street. Other doctors (like you) who took the time to recognise that every child is different and maybe, just maybe, this one is really sick; saved my baby’s life, when they checked him with fresh eyes and without judgement. Thank you for being just as you are.

  5. Femme, that’s really generous, thank-you. I have to admit though, it wasn’t just me involved…

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