Sunday in the ER

It's been a great weekend. We had a campfire last night and roasted hot dogs and warmed baked beans in the spider pot--we're hoping to learn some of the skills of camping in the safety and comfort of our own yard so that maybe, one day, we might actually enjoy camping--or at least the children might enjoy it! :*)

This morning, we were getting ready for church and Vern sat with James in the chair. They both fell asleep--Vern is still not all the way back up to snuff. While I was finishing getting ready, one of the children came in to say that Daddy wanted to talk to me about James. Evidently James had been coughing a lot more, he was grunkier and he had a lot of nasal drainage. It was still clear, but there was a lot and he acted like he wasn't feeling very good. So, we decided that James and I would stay home.

We were all comfy on the couch and the others were wrapping up and moving towards the van. Katie and Hannah were getting a couple of last minute things when James started gagging. Not too long after he was vomitting and by the time all was done, we thought he felt pretty warm. So we took his temperature. It was 100.5*F and Katie headed out to the van to tell Vern. She came back shortly and said, Daddy says we're all staying home.

The rules of chemo say that if a person on chemo gets a fever of 100.5*F twice in four hours, you need to call the oncologist. If he gets a fever over 101*, call right away. In about 45 minutes, James' fever was over 102*, so we called the on-call oncologist. It wasn't someone I knew (unusual for us), but she was helpful and thorough and we decided that it would be best to take James to the ER in Macon. We were both hopeful, since James's ANC was 1200 on Thursday, that we wouldn't need to be admitted. (ANC=Absolute Neutraphil Count--the measurement of white blood cells that indicates how much immunity a person has. A person with low or no neutraphils--500 or less--is said to be neutropenic.)

So, we packed the cooler, made some drinks to take, loaded James's equipment (feeding pump)and supplies (diaper bag, formula and pedialyte) in the car and headed off to Macon. We hoped for some continuity and that we would have our favorite ER nurse practioner and nurse,since they often work on Sundays.

People on chemo have some priority in the ER. I really appreciate that. We walked in to the ER and went to the desk to sign in. All we usually say is James, the baby we are carrying, is on chemo and has a fever. Everyone is still friendly and helpful, but they sit up straighter and move a little quicker through the initial questions. It is never long before the medical technician comes around the corner from the triage room to call for James.

In triage,we always go through the same drill, since it is mostly different people each time we visit. He is weighed and we give a run down of James' medical history--it is quite long for a three-year-old. Then we list all the meds he is on and the couple he is allergic to. Invariably, the nurse will ask how to spell one and maybe what one or two of the meds are for. Then comes time to take his temperature and we have to say, 'no rectal temps'. 'Why not?' 'Because the doctors say, 'no rectal temps for children on chemo.' They scratch their heads (sometimes they don't actually do it, but you can see that look on their faces!) And then we work together to find some way to get a temperature taken.

Today's nurse asked if we could try getting it under the tongue. I said, "We can try!" We did and succeeded without too much trauma!

The nurse led us back to the pediatric area of the ER and settled us in our room. We had a new-to-us NP and RN, but they were both very nice. The NP works at the same office as our regular pediatrician during the week.

During our time there, James got an IV--since he no longer has a central line. He is a hard stick, like me, and it was no picnic, but it could have been worse. When all was done, he signed 'thank you' to the nurse. He gave blood for lab tests and got fluids and an antibiotic, he got three chest x-rays, one was a repeat. He is such a brave, big boy as they 'take his picture'. He is so good to 'put his hands behind his head' or 'reach for the sky' or show us 'how big is James, sooo big'. The xray tech said that he was better than most of her adult patients. They wanted to use a catheter for a urine sample, but we came up with an alternative that was a little less invasive. He had his ears checked and nearly panicked when the NP wanted to look in his mouth. But Hannah got her little flashlight out of the diaper bag and we were able to enourage him to say,"aaaahh". That was good enough!

We think that his fever is from the upper respiratory/sinus thing that James has going on.

After five hours, we finished all we needed and the docs agreed we could head on home. It was a quick trip and we were surely glad to be back. We enjoyed our Sunday evening popcorn and some of our current read aloud book, _Duncan's War_ by Douglas Bond. It is a very exciting book and we are all enjoying it.

It is always so good to be home. Tomorrow is Monday.

Thanks for checking on us. Please pray for James to fight off his cold/respiratory infection. And please pray for our friends, the Norths, as David battles graft versus host disease that is attacking his lungs.

Love, Stephanie