Babyboy, our hale and hearty 2-year-old, who has been sleeping through the night basically since he was 3 weeks old, awoke this morning at 4 a.m., wailing. I went to lift him out of his crib thinking, wet diaper? bad dream? And was shocked by the heat radiating from his skin, like a potato just out of the oven. I carried him downstairs, and tried to give him some cold juice, which he gulped, sending him into a spasm of dry heaves.
He’s had some loose stools for two days or so, and some farts to go with that, and a not-so-great appetite. He’d had a little birthday barbeque this past weekend, with several two-year-olds… and at least one of them was just recovering from a GI bug that had sent his temps to 103 and his mom cleaning vomit off the floor with some regularity.
So, it seemed clear that Babyboy had got something like that. Luckily, or not so luckily, I had scheduled today off to prepare for our upcoming trip, leaving this weekend for Central America, for my brother’s wedding. The wedding will be in a very nice, upscale tourist area, and we’re staying at a gorgeous hotel. We’re very familiar with this area, as my Dad is from Central America; I speak Spanish, and I’ve traveled extensively throughout the area…
But not with my kids. This is a trip I would not have necessarily made with the kids at 2 years and 6 months, respectively. My husband and I have been much more apprehensive about this trip than we ever have been before. It’s ridiculous: He travels for a living; I’ve done medical “missionary” type work in godforsaken jungly drug-trafficking malaria-ridden enclaves of the world for years. But the idea of a trip to Central America, even to a posh hotel in a tourist area that’s featured in myriad high-end tourist guides, WITH OUR TWO SMALL CHILDREN has us waking up in a cold sweat at night.
Even worse with Babyboy sweating all day. It’s 5 p.m. and even with several doses of Tylenol, his fever has not dipped below 101.1. He’s nibbled on some buttery toast and sipped a few sips of juice; he’s stopped pooping and I haven’t seen dry heaves since dawn. But he’s burning up and he’s not himself.
“Look in his ears, look at his throat!” entreated my husband. “What if he needs antibiotics?”
Now, I completed a Med/Peds residency. I was a board-certified pediatrician until 2011, when my certification ran out. But I see adults. I never practiced outpatient pediatrics. I feel sick at the thought of holding Babyboy down to stick an otoscope in his ears; my stomach curdles at the thought of pressing down on his tongue with a tongue depressor. Actually trying to do these things would make me vasovagal. I know this because I tried.
So I just called our pediatrician’s office, and had a nice long (and I’m sure extremely typical nervous mom) chat with the nurse on duty. I’m sure there’s a note on there that I’m a doctor, and I’m sure I looked like an idiot. It sounds very viral, she said. Try to trick him to take fluids. You can try popsicles, Jello… Ibuprofen can work better than Tylenol for lowering the fever, but can upset his empty stomach. I explained that we were extra nervous as we’re traveling on Sunday. If he’s still having high fevers and not acting like himself, call in the morning and we’ll see him. OK, I said, feeling massive relief, thinking: Someone can see him tomorrow. I don’t have to try to look at his ears and throat.
Now he’s napping. His cheeks are glowing apple-red. He’s in little shorts on the couch, splayed out, with his lovey bear loosely draped over one arm. He looks peaceful, and I hope this fever will run its course. As a doctor, I know it will. As a mom, I worry… And my worst-case scenarios are nightmares populated by the gravely ill children and panicked parents from my memories of pediatrics residency training.
My residency was solid. It had a good reputation. It got the job done. I didn’t kill anyone, and I passed the boards. But the residency was a poor fit for me. Their teaching style was akin to the swimming lesson style the Navy had for my grandfather back in the 1940’s: They threw him in the ocean.
And he sank, and had to be rescued. Likewise, my residency program: We were “farmed” out to small community hospitals, where, for peds, we often covered the inpatient floor, the little low-acuity ICU, the emergency room, and deliveries, with no attending pediatrician on-site. Our supervision consisted of the senior residents. Some of them (and eventually, us) were excellent. Some of them you could depend on to run a code for a kid with seizures, deliver a 30-week premie, and monitor a teenage Type 1 diabetic in ketoacidosis all in one night without any complications, and even with some good teaching. I pulled that off one long call night, towards the end of my time… Our motto was see one, do one, teach one. We learned from each other and taught each other.This is the time-honored, completely inefficient, and yet glacially slow-to-change way of medical training.
Sink or swim. Mostly, we swam, probably because most people will get better no matter what you do to them or how badly you do it.
But sometimes, not so much. There were many nights with not so much. There were badly handled cases. There were complications. Even when we were at the Big teaching hospital and we had great supervision, there were bad outcomes. And there were always awful, tragic, terrible, sad cases that were no one’s fault but God’s.
And I sit here watching over Babyboy remembering them all.
As a doctor, I know the fever will run its course.
As a mom, I worry still.