Our First Trip to the ER

Well, it was bound to happen.  It’s one of those things in life that you pray and pray and pray never occurs and then one day it just does and you find yourself sitting in an ER Triage room watching your Type 1 child sleep on a hospital bed and you’re fighting every sensory overload you are experiencing and repeatedly telling yourself that it’ll all be okay.

 Last week at daycare, Noah’s teachers started telling us that they thought he was lactose-intolerant.  He kept spitting up his milk and couldn’t keep much lunch down.  Aaron and I did not side with their ideas of lactose intolerance simply because Noah had been drinking milk for a month at home with no problems with spit up.  We assumed he kept spitting up because his little 1-year old tummy was full. He’d eat what he could of the lunch provided, and then he’d be given a bottle.  It was just too much for his little tummy to handle.  So, he started spitting things up on Wednesday and this continued into Thursday.  Then on Thursday night, he threw up all of the supper he had eaten. 

Aaron was home alone with the boys while I was on my way home from the insulin pump class.  Shortly after I arrived home, Aaron started to feel sick.  He exhibited signs of a stomach virus.  This went on until after bedtime.  I was already asleep when Aaron got sick again and asked me to bring him a bowl. The time was 10:45pm. As I was on my way back to the bedroom with the bowl, I heard Michael scream.   Instantly I knew. 

I opened Michael's door and was smacked in the face by the smell of sickness.  He had vomited all over his bed.  He was screaming and scared.  It was only the second time he had ever thrown up in his life (which was about two months ago) and it was a scary thing to a two-year old.  It was a scary thing to a parent of a type 1 child-- vomiting and diarrhea are never good. 

I got him cleaned up and on the couch, which I covered in blankets and towels.  Aaron was stable enough to come out to the living room with us.  Then it all began again.  Michael isn't experienced with vomiting and isn't completely old enough to understand how to handle the situation-- meaning, if it's in your mouth, get it out.  Eventually, I called my dad because I knew he'd have his phone near him.  I asked if my mom could come spend the night at my house just in case I ended up having to take Michael to the ER.  She arrived within the half hour.  Michael had attempted to throw-up about two more times before she got there.  After she arrived, he had two more attempts.  He settled down to sleep on the couch and my mom went to the guest room to sleep.  I settled in beside Michael and had an alarm set for every two hours to check his blood sugar during the night.  I listened to his breathing and knew every time he was about to vomit again.  He probably had about two more attempts at vomiting before he really went to sleep.  The time was 1:40am.   

His appetite was good in the morning.  Blood sugar was okay.  I checked his diaper for ketones.  He had not urinated overnight, so I planned to check for ketones after he ate breakfast.  We thought we were in the clear.  Fortunately, my mom had chosen to stay at my house during the day just to make sure we were all okay. Michael ate well for breakfast, but then had diarrhea.  The diarrhea rendered checking cotton balls a useless event.  Michael ate well at morning snack.  Very shortly after eating morning snack, he vomited again and had more diarrhea.  I continued to put cotton balls in Michael's diapers, and each time, they would get soiled by diarrhea.  I called the diabetes doctor on call.  He told me that if ketones were moderate to large, I'd need to take Michael to the ER.  Ketones were the prime player and I needed to know what they were.  I called our local pediatrician office and they set out a urine specimen bag for us to pick up.  We could attach it to Michael and catch his urine without having diarrhea soil the cotton balls.  My mom left the house to go pick up the urine bag. 

I laid Noah down for his afternoon nap.  He was surprisingly better.  Aaron was worse and was laying in bed all day very sick.  My mom told me to check Michael's diaper every 10 minutes to see if he had urinated on the cotton balls, and to see if I could catch him after he tee-tee'd and before another bout of diarrhea came along.  At lunchtime, Michael wasn't hungry.  He laid on the couch to watch a TV show and I was able to retrieve two cotton balls with a tiny amount of urine on them.  I checked them for ketones.  Large.  My heart sank.  I called my mom and told her that we needed to go to the ER.  I told her I didn't want to take him by myself.  I went to talk to Aaron.  He was able to call his mom to get ready to come over so that she could watch him and Noah since my mom and I were going to have to take Michael to the ER.  I ran around and threw lots of diapers into Michael's bag along with shoes and socks for him and a spare pair of pants for me.  My mom arrived back at my house from the pediatrician's office, and we loaded Michael in the car and headed to the ER.  I drove and my mom sat in the backseat with Michael so that she could catch any vomit in a container we brought, and so that she could do blood sugar checks on our way to the ER.

Michael's blood sugar went from 114 to 110 to 98 on our 15-minute drive.  Yes, we checked him quite a bit on our way because he kept dozing off and was starting to become unresponsive.

When we got to the ER, I carried him inside.  Although lots of people were sitting in chairs, I was not going to do so.  I said to the receptionist, "He's type 1 diabetic.  Two years old.  I'm concerned about DKA."  She said "come on in here and we'll start getting some information." My mom started filling out the electronic documents on a kiosk while I took Michael into a little side room to give information.  When we were almost done giving our info, Michael threw up. All over the counter, all over the floor, all over himself, my bag, and my shirt.  Yep, I totally thought I was prepared since I grabbed 20 diapers and a change of pants for myself, but no shirt.  So here we were covered in vomit. That totally got us a pass to head on back to triage. While in triage, he vomited again.

We quickly got put in a room.  The triage nurse whispered to me and asked me if I'd like him to bring me a scrub top to wear since I had smelly vomit all over my shirt.  I was very grateful and said "Yes, please.  Thank you so much."  Michael was put in a  hospital gown.  They attempted to check his blood sugar with their own lancet device.  Michael wasn't having any of it.  I asked if we could use our own lancet device since Michael was familiar with it.  They agreed.  It worked perfectly.  The plan for the rest of the day was for us to use our own lancet device to get the drop of blood needed for their blood sugar checks.  As the nurse was asking us background questions, Michael was sitting on my mom's lap on the hospital bed.  She interrupted the nurse to say "You've gotta get an IV in him.  His breathing is labored and he's fading out."  I leaned down to Michael's eye level.  I tapped his knee and said "Michael, buddy, look at Mommy."

A very tired two-year-old, who could barely lift his head, looked up at me with sunken eyes that were rolling back in his head.  "Get him an IV!" I said.  I clapped my hands to rush the process.

The nurse went to get the supplies for an IV, and the doctor came in to assess Michael.  Mom and I had the job of holding him "still" for the IV.  It seemed that all of the staff was grateful that Mom is a nurse and knows what she's doing!  After the IV was started, the machine beeped incessantly.  Since the IV was in Michael's elbow crease, and since he was throwing temper tantrums since his blood sugar was dropping, the IV wasn't inserting much, if any, fluid into his veins.  The nurse came back in the room and then left again to retrieve a styrofoam board to hold his arm straight.  This board was wrapped with blue medical tape all down Michael's little arm. 

 
Eventually, Michael settled in on the hospital bed and took a nap.  His cheeks were so flush.  His eye sockets were sunken. 

A tech appeared and wanted to draw blood for a blood culture.  We told her no.  My mom informed her that enough blood was drawn from the IV when they inserted it, and the tech could get a sample for a blood culture from that.  The tech wasn't happy.  I didn't care.  I wasn't going to let random people poke my son on his other arm while he rested.  We could see that the nurse was talking to the tech.  Later the nurse would tell us that the tech was able to get a blood culture from the "green sample" the nurse took at the start of Michael's IV.  We made the right call in not allowing Michael to be poked again.

I checked his blood sugar.  88.  I asked my mom what was in the IV drip.  She looked and noted that it was just fluid, no glucose.  She said they might need to get through the bolus of fluid first before introducing a glucose drip.

Five minutes later I checked his blood sugar again.  84.  My mom opened up our hospital room door and asked that they bring an IV with glucose.

I called the diabetes doctor on call at Children's Hospital.  I felt like things weren't moving quickly enough at the ER and I wanted to be sure we were taking all necessary steps to get Michael's blood sugar where it should be.

Ten minutes later, same regular IV fluid flowing into his veins.  Labored breathing.  I checked his blood sugar.  68.  I opened the door.  My mom went to the nurses station and told them that we were monitoring his blood sugar on our own and it was dropping and he needed a glucose drip quickly.  I held out our blood sugar meter so the nurse could see.

She arrived quickly with a glucose drip.  I felt so much better. 

The doctor stepped in.  My mom told him about Michael's blood sugar dropping quickly and the need for glucose, which is why he was on a glucose drip now.  The doctor looked at us and smiled.  "I did my residency at Children's," he said.  "I'm very well versed in pediatric type 1 diabetes care."

My mom and I both smiled.  "You need to make that the first thing you tell people like us!" she said to him.  "That would have made us so much more at ease!"  He laughed.  I breathed my first real breath since the moment we stepped into the ER.

It was immensely hard for me to sit on the hospital bed and hold Michael while he slept.  The smell of medical tape is a tough one for me.  Michael had so much of it on his arms while we were at the hospital in August when he was first diagnosed.  The smell of this tape also brought back a flood of memories of the time when my dad was in a medically induced coma following his motorcycle accident.  My mom and I had a good talk about how much we remember and how vivid the memories can be when brought on by the smells and sounds of a hospital.

Within 20 minutes, Michael was awake.  The next step was for him to drink fluids and keep them down. He was offered apple juice, water, and gatorade.  "No thanks," he said.  "I'm not thirsty."  Earlier, we had put a urine collection bag on him to catch whatever tee-tee he produced so that we could check for ketones and have a big enough sample for the urine specimen.  We told him he would get to go home and see Daddy and Noah if he drank some water or juice.  "No thanks" he kept saying.

My mom and I alternated who sat in the hospital bed with him.  We attempted letting him watch cartoons on the TV, but turned it off and told him that we'd turn it back on when he drank something.

The doctor came in and said that DKA was ruled out. Praise!  He said Michael was severely dehydrated and the IV fluids would help with that. 

Quite a bit later, Michael decided that he wanted to drink the apple juice.  "Mmm!  Yum!" he said.  He drank the whole 4 oz container.  He kept it down.  Then he drank water.  Then more water.  Then he said "Oh!  I tee-tee!" and sure enough, the edge of the bag, which we stuck out the side of the diaper to monitor, was filling with tee-tee.  I let him finish and then I removed the bag, bounced over to the door, swung it open and waved it in the air and said "we've got a sample!"  The nurse gave a huge smile, clapped her hands, and jumped up to retrieve the bag.

Michael chose to watch a pizza making show on the Food Network.  "Cooking show!  Let's watch cooking show!" he cheered as we sat on the hospital bed again. 

Then he was interested in finding out exactly where all the tubes hooked to his arm were coming from.  Then he recited the numbers he saw on the screen showing heart rate, blood oxygen, etc. 

Shortly after he tee-tee'd, the urine specimen results came back and that was our ticket home.  The nurse and my mom delicately removed the IV.  Michael chose purple medical tape to hold his band-aid in place.  A new tech came in to get vital signs.  She asked Michael if he liked Lightning McQueen, Dusty Crophopper, and Thomas the Train (the girl knew her stuff!).  He chatted with her while Mom sneakily got a blood pressure reading.  We got one more blood sugar check at this time too.  He was comfortably in the 100's.  We changed him out of his gown and into his spare set of clothes. 

We loaded ourselves up with all of our bags, (my Mom's purse, my slightly thrown up on bag, Michael's backpack, and our plastic bag filled with soiled clothes).  We made our way past the nurses station where Michael waved to the doctor and nurses.  I paid our copay and the nurse walked by.  My mom said "Say thank you to your nice nurse, Tammy."  Michael looked at her, and whispered "Thank you Tammy."  She said it melted her heart.

We made it to our car, buckled everyone in, and headed home. 

I was enormously thankful that my son wasn't in DKA.  I was thankful that he was awake and alert and had a blood sugar within normal range.  I was tired and worn out from my family being sick.  I wanted peace in our home-- healing and peace.  No more sickness.  No more fear.  No more roller coaster of blood sugars.  I just wanted rest for my family.  We made it through the hurdle of an ER visit.  Hopefully it was our last.

Until Next Time,

Much love, Reba