Friday, September 2, 2011

A Cautionary Tale About Kids and Their Belly Aches

First, a little history. Sweetie has been having "periodic" belly aches for more than a year now. It started out as a what appeared to be a school-related problem; he seemed to have a tummy ache whenever he had to do something at school he didn't want to do, like a book report or a math test. I basically dismissed it as some ploy to stay home from school and refused to fall for it. But then he started having belly aches on weekends, when it was all about fun. He never really complained; he would just mention in passing that his tummy hurt.  I asked questions like "are you hungry?" "do you need to go to the bathroom?" "did you eat too much?"  More times than not, he would eat or poop and I never heard another word. And then he started having stomach aches during the summer, and at The Ex's house, and at grandma's ... all of the places where he has fun. He doesn't have a great diet but it's not horrible. He poops regularly. I just couldn't figure out what was going on, but it didn't seem too bad so I made a mental note to ask the pediatrician about it the next time we saw her.

He had a checkup last fall, and I mentioned the stomachaches to his doctor. I told her the history, the progression, etc. She asked me some questions about his diet; she asked him some questions about when they happen, where it hurts, how it feels, etc. She palpated his stomach. She concluded he probably isn't eating enough, and directed us to pack more snacks for school, ensure he eats every 2 or 3 hours, and basically make sure he doesn't allow himself to get hungry. Oh, and drink more water. Perfect. Easy. I got this.

Despite doing everything the pediatrician said, the belly aches continued. He would have a tummy ache, and then he would eat. And eat. And eat. Sometimes it would go away, sometimes it wouldn't. I asked questions, I felt his tummy, I asked about bowel movements ... we were doing everything right. Occasionally I would give him some children's Pepto Bismol. In every single case, the stomach ache eventually went away so I wasn't too worried (though I did think it was a little odd). Truth be told, I feared my Sweetie was developing a nervous stomach because he's very sensitive and he's a worrier. 

Now, the cautionary tale. Two nights ago, Sweetie complained of a tummy ache when we got home from his after-school program.  He had a couple of snacks, but apparently that didn't make him feel any better. Then we had dinner, and he ate like a champ. He watched some TV, went to the bathroom, and went to bed. About an hour later, I heard him get up to go the bathroom again, then I heard a strange noise. Wait, is he crying? Why is he crying? He finished his business and ran back into his room, and then I heard the noise again. Yep, he was definitely crying. I went in to see what was wrong and he said his stomach was hurting really badly. I got him some Pepto Bismol, and then sat with him to try to figure out what happened at school, what did he eat, did he go to the bathroom, etc. I found out - for the first time - that his tummy had actually been hurting him for three days. THREE days! He was curled in the fetal position and crying, wincing in pain, and it was clear to me that something more was going on. He was gassy as a baby and loved it when I rubbed his tummy, so I thought I would try that; I touched his belly and he just about hit the roof. I felt for a fever; nothing. I asked him if he felt like he was going to vomit; no. He had eaten, he had gone to the bathroom, he had tried to go to the bathroom again, he had taken Pepto ... nothing worked. I looked at him and said, "Sweetie, is it bad enough that we need to go to the hospital and see a doctor?" and without hesitation, my 8-year-old all-around scaredy cat nodded yes. Uh oh. This is NOT good. I called the advice nurse, who very quickly surmised that we needed to go to the emergency room. 

I am a single mother and I have another child. What the heck was I going to do about Stinker? It was late, everyone I know was already in bed, and most have to get up and go to work in the morning. I thought about taking him with me, but I knew that once Sweetie got to triage, there wouldn't be any place for Stinker to sit or lay down or anything. Nope, taking him with me was simply not an option. So I got the kids in the car and without calling first I drove to my mom's house. I took Stinker inside and put him to bed. As I started to lock the door behind me, my mother appeared and asked what I was doing. Of course she had questions but hello, right then was not the time for me to answer them.

Sweetie and I made the 20 minute drive to the nearest "plan" emergency room at a general hospital. Let me just say up front that now I know why "county" and "general" hospitals get a bad rap ... if our general hospital is any indicator, they deserve it! Just getting there was the most frustrating experience; I couldn't even get to the emergency driveway because the hospital is surrounded by one-way streets, many of which are closed and/or blocked because of the construction of a new hospital across the street. I parked in a 15-minute zone (knowing full well there was no way we would be done in 15 minutes). As we walked up to the door, I saw two uniformed police officers outside, another one at the interior door, and yet a fourth policeman greeted me inside the waiting room.  I was thinking this could not be a very safe ER if this large of a police presence is required. Yikes.

After I got him checked in, we had to sit and wait. While we were waiting, one of the policeman outside came in and announced that my car was about to be towed. Seriously? It was 10:30 at night. I was a single adult with a sick child in the ER was I supposed to move my car?? I wasn't going to take Sweetie back outside, and I certainly wasn't going to leave him there alone. Luckily, after I explained my situation to the officer inside the waiting room, he said he would make sure it didn't get towed. Not surprisingly, after about fifteen minutes of waiting, a wide-eyed Sweetie said, "Mom, I think I'm feeling better. We can just go home." Uh, no, I don't think so.

We finally got into triage and as the nurse was doing her paperwork and asking questions, I casually mentioned that they had spelled Sweetie's name wrong (despite the fact that I had filled out two forms and gave them a copy of his medical card). Apparently that was a mistake because the triage nurse suddenly became obsessed with correcting it. Mid-triage she left the room to track down a supervisor, and then hovered while the supervisor corrected the computer records at a computer in the reception area. Really? It couldn't wait until she got him into a treatment room?

In the treatment room, the first thing to do was the IV. Having had a few IVs in my life, I knew Sweetie was NOT going to like this one bit. Trust me, he didn't. He was scared, of course, so he moved right when the nurse poked him, and the vein disappeared, so she had to try again. Sweetie blew a gasket, yelling and crying and freaking out. At one point I thought he went into shock; his whole body was trembling, his teeth were chattering, he was crying, and he had a vacant stare on his face. Confession? That was the worst moment of my life. As soon as they were done, he started begging them to take it out of his arm. It took at least 10 minutes for him to understand that the IV was not coming out until we were ready to go home. A few minutes later - after the morphine hit - his stomach stopped hurting, and he started to feel better. Aha! There's my Sweetie, acting like his normal wonderful self. He was intrigued by the treatment room, the gadgets and equipment, his IV pump machine, the rails on the bed, etc. Leave it to a kid to find an ER treatment room interesting. He told me he wanted to learn all about everything because he probably wouldn't ever be in an emergency room again so that was the time to look at everything. God bless him for that.

After the doctor examined him, she decided he needed a CAT scan, "which is a 4 to 5 hour process."  Ugh.  It was clear we were going to be there all night!  A couple of hours later, after Sweetie's participation was no longer needed, and after another hit of morphine, he finally crashed.  It took him until 3:00 a.m., but my Sweetie finally fell asleep. I sat there in the room all by myself, waiting for the doctor to return with results. It was surreal. At last the doctor returned to tell me the scan results were "inconclusive" but she was concerned because of the severity of his pain, especially in the lower right quadrant. She talked with the pediatric surgeon on call at the children's hospital a couple of miles away, and they decided to admit him for observation and possible further treatment.  I heard "surgeon" and the rest of what she said turned into that obnoxious droning noise that signifies adults are speaking in the Charlie Brown cartoons.  Wa-wa, wat-wa-wa-wah. What? Did you say surgeon? My kid needs surgery? Now it was my turn to freak, and I did. I cried for the first time since the whole thing started.

An ambulance arrived to transport him. I thought he would be scared, and spent a ton of energy figuring out how I was going to return for my car if I rode in the ambulance with him. They woke him up to move him, and the EMTs were so cool ... they chatted him up and made the ride sound like an adventure. Sweetie told me he could ride by himself and I could just meet him there. What a brave boy he was! By the time I got to the second hospital, he had changed gowns (now a kid-sized one, not the giant one-size-fits-all adult gown he had previously worn), his IV was hooked up to fluids, he had told the nurse he didn't understand why he needed to change hospitals because the other one was just fine, and he was snuggling down for more sleep. Once he slept again I wanted to go home to turn everything off, shower, grab some comfort things for Sweetie, and get a change of clothes for Stinker at my mom's, but the nurse said I needed to stick around in case the surgeon decided to "immediately take him into surgery."

Here's the thing. I try not to be an alarmist. I try not to worry about things that might happen and focus on what is actually happening. At this point no one has told me what was wrong with my son. A nurse mentioned an appendectomy, but no doctor has said anything to me about it. I have no diagnosis, I don't know what's wrong, I don't know if it's serious, and damn, there is that surgeon/surgery thing again. I convinced her to see if she could find out when the surgeon planned to do his rounds and we found out I had time to go home if I hurried. So that's what I did.

The nurse was wrong, and I rushed for nothing. A resident came into the room at about 8:30, examined Sweetie, and said the surgeon would be in within the hour. Wrong. Another resident came in about 10:00, examined Sweetie (and asked the exact same questions I had answered FIVE times by then), and said the surgeon would be in before lunch time. Wrong again. When The Ex showed up at 1:00, I decided to pop our for some food and give them some time together. Wouldn't you know it? The dang surgeon showed up at about 1:30 and I was gone! I caught him just as he was about to leave so I got a Reader's Digest version: There was nothing wrong with Sweetie's appendix, and he never thought it was the appendix. "Basically, the kid is full of poop. Lots of poop. So much poop that it has hardened and his body can't get rid of it. Those stomach aches? The body's efforts to move the poop." Oh my gosh! And he'd been struggling with it for more than a year! And we told him to eat more, which made it worse! My poor baby. I asked how this could happen when he poops regularly and the doc said he isn't pooping completely and everything is dry and constipating, which just makes things worse. I was so relieved it wasn't anything more serious, I began making poop jokes, like he is literally full of crap, too bad this whole experience didn't scare the crap out of him, and we were about to launch Operation Poopstorm. He smiled, but he did not laugh. Party pooper. (Pun intended!)

So he spent yesterday afternoon having unpleasant procedures like enemas and suppositories. The good news? He immediately felt better. The bad news? He didn't "produce" as much as they had hoped, which suggests the blockage is very large and very old. We've been referred to a gastroenterologist for follow up; she immediately prescribed two "super" laxatives for today and tomorrow, and a daily (mild) laxative every day ... indefinitely. We are supposed to see the specialist next week to begin the long journey to total and complete poop evacuation. We're going to help him be a super duper pooper.

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