Friday, December 22, 2006

Word of the Day: Croupy

He had had a runny nose for the last couple of days, so we weren't surprised when he started coughing Wednesday night. But his coughs sounded harsher and rougher than usual, and he was wheezing. He was gasping for air, and he made these horrible strangled sounds as he struggled to draw breaths.

"He's never sounded like that before," R said at some point during the night. Neither of us was sleeping well, listening to him cough and rasp and try to breathe.

We all got up in the middle of the night because he was wide awake, crying in misery, and besides, he had to have his diaper changed. (Toddlers hardly ever poo in their diapers overnight, but when they do, you don't want them sleeping in it.) He sounded ragged and raspy, and both of us were worried. I suggested giving him cough medicine, which he fought viciously. I called the overnight consulting nurse at our local clinic , and left a message, expecting a call back shortly. After all, breathing problems seemed like a fairly urgent priority. Then R went to lay down with Oliver in the bedroom while I slept on the couch, waiting for the call.

At some point, Oliver and R came back out, and he was sobbing, making pitiful weak mewling sounds. I held him for a minute, and he curled against my chest while I rocked him in my arms. He fell asleep for a few minutes, then woke up, miserable. R tried to get him back to sleep by nursing him, by rocking, any way she could, all to no avail.

By 6:30 the nurse still hadn't called back, so we decided to consult Dr. Google. I found a website that suggested several frightening causes for his breathing problems: pneumonia, RSV, croup, and others too terrifying to even recount. The barking cough sounded like the cough described for croup, but neither of us were certain at all. We just knew it was bad. We threw on a coat over Oliver's pajamas and put slippers on his bare feet, and headed to the emergency room.

Oliver started to perk up on the way to the ER, strangely enough. But as we were giving our insurance information to the registration staff, he barked out a couple of coughs and she nodded and said, "that sounds like croup." Croup is a swelling of the voice box (larynx) and trachea, and the barking cough and strangled cries are classic symptoms of croup. The term "croupy" entered our vocabulary at that moment, as did "stridor," which refers to the stranged wheezing breaths we heard for most of the night.

They checked his temperature. Then, with an odd little strap attached to his toe, they checked his oxygen saturation and were pleased with the result - he was still breathing well enough. We didn't have to wait long before we were sent back to exam room 9. There, we undressed Oliver down to his diaper and put him in a toddler-size hospital johnny with Sesame Street characters on it.

Mercifully, we saw a nurse and then a doctor in short order. They asked questions, listened to his chest, and disagreed about whether or not he was actually wheezing. After the doctor and nurse agreed on the diagnosis, they sent him to get a chest x-ray as a double-check.

Now, when adults get an x-ray, they know what happens. You lay down on a table, turn this way and that, and generally do what's required without much fuss. But a sick baby who's barely slept is not a good candidate for x-rays, especially with an x-ray tech who had obviously had little experience with children. I put on the heaviest apron in the world and stood next to Oliver while he sat on a stool, his back against a platform, while the tech gave preposterous instructions. "If he can just sit back a little bit ... maybe if he can turn his body straight ... okay, now I'm going to need you to hold both his hands up..." All this while tears and snot are streaming my little boy's face. We took two x-rays - I thought we were done - and then he decided we needed two more. He called in R for reinforcements, gave her a leaded apron of her own, and the two of us tried to gyrate our baby while he wept and wept and wailed and wailed. Finally, after 4 x-rays, the fiend dismissed us from the x-ray chamber of horrors.

We went back to exam room 9. The nurse came in and announced they would be giving him a dose of Decadron, a steroid to bring down the swelling in his larynx and trachea. "This isn't flavored, and it tastes really bad," the nurse explained, and suggested getting some apple juice ready to chase down the awful medicine. She pulled out an eyedropper the size of my thumb and prepared a massive dose, and then somehow got it down Oliver's gullet, despite his furious head-shaking and thrashing. The nurse suggested that he might have to be admitted for a day or two to get his breathing under control.

Shortly thereafter, the doctor came back in. He started talking about what we would do once we went home with him. He didn't want to admit Oliver, and we were grateful for that. Just seeing the emergency room was bad enough - staying overnight in a hospital, four days before Christmas, was just unthinkable.

A respiratory tech came in soon and hooked up a cool mist for Oliver to breathe. He offered a clear child's breathing mask (complete with funny eyes and nose) and asked if he would wear it. We both thought it wasn't likely, so R just held the hose near Oliver's mouth so he could breathe in the mist.

We waited for the medicine to kick in, and for the mist to help his breathing. Oliver kept trying to nurse when the room was empty, and fell asleep once or twice while his mother nursed him. I fell asleep at some point while we waited, sitting upright in a chair.

Finally, we were given the all-clear by the doctor. He called the clinic that normally saw Oliver and explained the situation, and told us to see our doctor the next day. "Tell them you were in the ED, and that I told you to get a follow-up. That'll get you to the front of the line. You know how it is." The doctor had a child about a year older than Oliver. The nurse had a biracial son nearly Oliver's age. She showed us pictures. Everyone on the staff was kind as possible, and took a liking to our little boy.

We drove home at 10:30, delirious, tired, emotionally wrecked, and starving. We picked up bad fast food on the way home and scarfed it down. Oliver fell asleep in the back of the car and let me carry him up four flights of stairs without waking up. (Note: our elevator was still out of commission from the sudden blackout of the day before. See previous post.) I laid him on the bed, wearing his big winter coat, his slippers, and pajamas. He slept for hours with hardly a motion. We both slept, too, while he was down. We were all exhausted from the ordeal of his first ER visit, right on the heels of the power outage and everything else that had happened that week.

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