I must admit that my feelings towards Sam's next MRI was very different than the one he had gone through the previous November. It was different for two reasons - memories of the last time and memories of my own time. Back in November, little did we know, Sam was already starting to deal with heart failure. We hadn't seen the full symptoms of this - he held his own on oxygen saturations, was seemingly happy, and was eating and gaining weight. But in retrospect, I think Sam's reaction to the MRI was a foreshadowing of what would happen the following month - and our second stay at PCMC. Sam reacted very poorly. It took hours for him to come out of the anesthesia and when he was out of it, he was miserable. He had developed a terrible gargling sound as he breathed...something we chalked up to being intubated and his throat being scratched up. From that point on, the gargle stuck around until Sam's heart failure reached critical mass. I wasn't overly excited to see him be put under again, and to wonder what child might emerge this time.
Second, and more selfish, I was reminded of my own very recent MRI experience - not one that I ever expected to go through but a direct result of our constant efforts to find out the genesis of Sam's difficulties. As we stepped, day by day, towards Sam's next MRI, I could feel myself tense up for the little one. I was half relieved he would be under anesthetic. I was half saddened that he'd be alone and strapped into the loud MRI machine, and that I would have to say "see you soon" to my little man. It wasn't all bad, though. Elisa and I, after 5 months of relative calm (since the embolization), were ready to get started with Sam's next steps. We wanted the oxygen to really be gone. We wanted to be told that Sam was on the mend, as opposed to just being out of the woods. We wanted a normal, happy, healthy little man. In our minds, and in the previous words of our doctors, that path included a summer embolization. We were emboldened by the fact that Dr. Tosky had hoped for 2 months before another procedure, and would be thrilled with six months. We'd be getting that six months. Sam had held his own, like we knew he had the strength to do.
For all the good, however, Elisa and I were back to having stomach aches and anxiety the night before his scheduled April MRI (April 23, to be exact). The plan was simple. a MRI on the Wednesday, and then a coordinated Neurology appointment where Dr. Brockmeyer and Tosky would come together to discuss next steps and schedule the next embolization. So it was a strange mix of anxiety, balanced with confidence. Fear, balanced with hope. Our psyches were having a personality disorders - how should we feel? What should we expect? This was all compounded by the fact that Sam was slowly recovering from the cold that had strapped the nasal cannula back onto his precious face. There was no way that they wouldn't do the MRI, right? After all, he only had a cough and a little throat noise that just was drainage and a snotty nose. We went in overconfident with the idea that Sam was ready and we would take the next step.
We arrived and checked in. I must say that of all the places in PCMC, one of the most profound to me is the Same Day surgery center. You hear stories. You can see some of the kids and know what they must be dealing with. Others show no signs of wear, and you wonder what surgery they will have to endure. They are all playing, blissfully unaware of what's to come. But you need only look into the faces of their parents to know what stress, worry, and fear look like. I imagine that they looked at me in the same way I looked at them. You notice the gray hairs, the wrinkles and worry lines etched on young faces that don't seem quite as young as they are. Parents with sick children wear stress on their bodies and in their faces. And yet, you feel no sense of judgment. You feel a bond. You understand the stress. You feel the worry. The fear is palpable. In all of my visits to Sam Day Surgery, I always feel the desire to walk around and tell them that I understand. Because I fear, in our own worrying minds, we feel alone. Yet we aren't. We're surrounded by understanding that you just don't find out there in day to day life.
After we got our insurance checked and sat back down, we were called back to start the examination procedures. From our past MRI, we knew the drill. Get his weight and measurements. Have a nurse's assistant do the once over. Meet some other nurse. Meet the anesthesiologist, and then head down to MRI for the terrible goodbye. Things progressed just as we expected. Sam got his weight (Yay! He was gaining - he had cleared 17 lbs!) and measurements. The nurse's assistant took blood pressure, oxygen saturation (97!), and heart rate. And then she left to get the "real" nurse...the one that would do the true once over, or at least provide their stamp of approval so we could move along.
And then we met today's nurse. For the sake of blog, I'll just call her Nurse Over. You'll see why shortly. I should have known that we had problems when Nurse Over (abbreviated as N.O.) walked in the room. She commented on Sam's congestion before she even started an exam. I sat quietly in the corner, hopeful that she was just overreacting to the sound. When you actually listened to it, the noise wasn't in his chest or his lungs. It was in his nose. We firmly believed that and expected to be moved right along into the MRI waiting room. But the longer her examination went, and the quieter, she got, I started wondering what was going through good old NO's head.
And then she said it - she didn't think Sam would be having his MRI today. She could hear crackling in his lungs, she said. And she was concerned. Sam happily stared up at her. He squealed. She mentioned that she wanted him to have a breathing treatment. I'm well aware of the Albuterol breathing treatments. From the last two colds, we had gotten very used to the provided breathing machine from Dr. Pete, and putting Sam through 20 minutes of torture (you know...the dreaded idea that an infant had to sit still for almost, but still less than, a whole half hour!). So I was actually pleasantly surprised that she was going this route. At least she wasn't completely overreacting. Sam would have a breathing treatment, we'd move along, and I'd thank Nurse Over for her...uhhh...lack of overreaction with Sam. Away she went, and soon enough, Sam was going through the industrial strength albuterol treatment. How do I get this version? It might have lasted 7 minutes. Sam didn't even have enough time to start complaining. Granted, he was probably trying to adjust to the icy blast of air at three times the velocity, but that's besides the point. 7 minutes passed. The treatment was over. And NO was back.
She was immediately happy with Sam's improved crackling. I even smiled at her. So maybe it wasn't an overreaction. Maybe she was reaching out...she understood that we were just one of those worn and tired parents that she saw the parade of in Same Day Surgery. Elisa asked if we would continue to progress for the day. I was hopeful. And then Nurse Over...well, she earned her blog nickname when she showed that she was the quintessential "over" in overreaction. The MRI would not happen today, if she had anything to say about it. She had arranged for the anesthesiologist to come and do his cursory review, but she didn't think it would be happening. I know what you're thinking. That's not an overreaction, right? No, it was the next thing she snuck in there. "If he didn't show improvement from the breathing treatment, I was going to consider admitting him!"
Ummm...what? Excuse me? Sam was literally smiling and playing with Elisa's hair when those words escaped her mouth. Admitting Sam? Round three of PCMC for a little crackling and a cold that was nearing its end? At that moment, I thought I'd be angry. I thought I would start roaring like the lion. And yet, all I could think about what the group of people still in the Same Day Surgery waiting room. Those that would get to experience NO. And then I felt the rush of fear wash over me when her words really started to resonate. Everything I had considered about Sam and his seemingly innocent "cold" was now in question. Did he need to be admitted? Were things more serious than we had imagined? Would I be delving into a new chapter that i had failed to foresee? Not only did I start feeling my anxiety grow, I remembered another day at PCMC...a day where we had gone in for a routine visit and ended up in the CICU. Nurse Over went to get the doctor. I calmed myself and tried to avoid the temptation to scream at her for scaring two parents that had been through so much.
I didn't have to wait long (or calm myself long, to be sure). The anesthesiologist had come into the room and did a quick scan of Sam. Where earlier I had found myself over confident, now I was bracing for bad news. I was worried that he would mention Sam being admitted as well. I was shocked by the 180 degree turn of this guy. He was confident that we should proceed. It seemed like Sam was getting better. The cold didn't seem overly burdensome. And, while we needed to be more careful with a case like Sam, he felt confident that Sam would be fine. He was the definite "under" of reaction. I think Nurse Over was underwhelmed.
In fact, I'm sure she wasn't. Because as he talked more of proceeding (he gave us the choice, but said we could move forward if we felt comfortable), she was back to listening to Sam. Back and forth, front to back. The stethoscope moved with every sentence out of the doctor's mouth. And then, as we were at the very moment of deciding whether to proceed (most likely, yes), she started talking again. "The crackling is back". I don't think his lungs sound great. You should listen again." The doctor complied with her request, and then as quickly as he had stated that we should proceed, he said he was hesitant to move forward because of the crackling. My head was spinning. I felt like I had reaction whiplash. NO put the stethoscope away. I wanted to take it from her and give her reason to be admitted to the hospital. I resisted...you know, for the sake of our family.
And before I knew it, I was on the phone with MRI, trying to reschedule Sam for 2 weeks out. I was calling our pediatrician to try to get an appointment today, to make sure Sam wasn't as serious as Nurse Over had made it sound. We were leaving Same Day Surgery without an MRI. And with a delay in resolution. We jumped in the car, and headed across the valley to the pediatrician's office. While Dr. Pete wasn't available, his nurse practitioner was She would confirm our fears or confirm my suspicions. Either Sam was in trouble or Nurse Over was the overreactor of the year. Elisa and I vented our worries as we drove. By the time we arrived, we were ready to do bad things to Nurse Over and hope and pray that we wouldn't be trekking back to PCMC for admittance.
Dr. Pete's Nurse Practitioner's name is Mary-Faith. I mean, can you get any more perfect than that? I'll keep myself from making countless puns with the word faith. They're going through my head. Too many of them. But I'll resist. And after all of the fun that NO had put us through, everything we thought about Sam before our visit to Same Day Surgery was immediately confirmed. Sam's crackling wasn't in his lungs. She didn't even hear much tightness. It was the congestion in his nose. He was fine...getting over a cold? Sure. But fine. She tried to tell us that caution is sometimes best, but I could tell she seemed a little surprised that Sam wasn't having his MRI today. She suggested we keep up on more Albuterol treatments. She said that a good two weeks of healing would mean that Sam wouldn't be denied his next MRI. We left with a strange mix of emotions. Grateful that Nurse Over was really overreacting (admit him?!). Sad that our progress to the next embolization and a healthier Sam had stalled. Happy that in 2 weeks, he'd be further past his cold. Sad that it wasn't right now.
We drove home and I started making plans to return to work. I'd planned on taking the two days off to take care of Sam appointments. Now, we were back to square one...all thanks to Nurse Over. And her overactive overreaction. Admit him? You've got to be kidding me. At least Dr. Doom know what's he's talking about when he's gloomy.
At that moment, I vowed to admit Nurse Over if she presided over Sam's check-in just two weeks later. After all, it was the least I could do after she had given us so much.
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