Going viral

Two weeks ago Miri started getting stuffy.  What with two big brothers, we figured baby’s first cold would hit early, so I wore her in the wrap and nursed a lot and tried to make her feel better.  By Monday, though, she was listless and wouldn’t eat.

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Just after this picture was taken I took her temperature – it was 101.  This, combined with her rapid breathing and refusal to nurse meant a trip to the ER.  I took the kids upstairs to our babysitter Rio, and Rio’s mom Jen drove Miri and me to the ER.  Omer met us there.  By the time we arrived and were seen by one of the nurses, Miri’s temperature had begun to fall again.  The doctors ordered a chest x-ray, pertussis swab, white blood cell count, and urine sample.  After four hours in the ER, it was clear we were dealing with a virus, and the doc recommended a bolus of saline to help Miri get her fluid levels back up.  Miri looked much better once the IV drip finished, so we opted to head home instead of being admitted to the hospital, and booked an appointment with Miri’s pediatrician for the next day.

See?  Totally feeling better.

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We made it through another sleepless, stuffy night, and Miri looked pretty bad in the morning – the fever was gone, but every breath was clearly an effort.  Her stomach and chest heaved, and her head bobbed every time she drew a breath.  One of my friends came over, took one look at Miri, and told me to take her to the ER.  So back we went.  This time we were admitted, and Miri was hooked up leads that monitored her oxygen saturation, respiratory rate, and heart rate.  The IV went back in, the doctor swabbed her for RSV, and fluids were once again started.  This time fluids didn’t make her rebound.  As the day progressed, her oxygen levels started dropping into the low 90s, and then the high 80s.  The doctor recommended a nasal cannula with blown room air to help her bronchioles stay open.  This brought her oxygen saturation back up to near 100% for a few hours, but then it started dropping again.  The doctor then recommended a high flow nasal cannula with 100% oxygen.  Again, this brought the O2 saturation back to normal for a while, but around 1am it began dropping again.  The doctor increased the air pressure to the point where I could hear it whistling into her nose, and went to consult with the NICU attending; Miri’s heart rate hovered in the low 200s and she was taking over 100 breaths per minute.  Both the attending doctors in the pediatric ward and NICU came and examined Miri, and a few minutes later the resident we’d been working with came back and said she recommended transferring Miri to the Kaiser facility in Oakland, since that one had a pediatric intensive care unit.

At this point it was close to 3am, I hadn’t slept, and Miri was looking pretty bad.  I texted Omer, and called my parents, and they booked flights to come out and help.  If Miri were to be in Oakland we’d need all the help we could get to manage the boys.  The ambulance arrived around 4 bearing a pediatric ICU doc and four EMTs.  We were in Oakland by 5, and immediately admitted to the ICU.  The gravity of the situation became apparent to me when the ICU doc wouldn’t let me nurse Miri just in case she had to be intubated.  After arguing back and forth with the doc for a few minutes, I was able to try to nurse her and then we both passed out for a few hours.

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By the time the residents came by for rounds at 9am, Miri was looking a little better.  Her breathing and heart rates were back down to near normal, and her oxygen saturation was at 100%.  We decided to try to wean her off the blown oxygen back to room air, at which point the attending doctor said we could be transferred from the ICU to the regular pediatric ward.  By 5pm we made the transfer, and Miri was looking pretty good.

I had booked a hotel room near the hospital for the night, and Omer arrived sometime in the afternoon to spell me so I could go take a nap.  After a four hour power nap I came back to take the night shift while Omer slept.  Since Miriam continued to improve, we scored a transfer back to SF Thursday afternoon.  Her lungs sounded better, but the coughing was sounding worse (at least to me!) and she consistently had coughing fits in the wee hours of the morning that required suctioning and  made me panic.  On Friday the results of Miri’s RSV swab came back – she was positive for RSV.  This made everyone breathe easier, since we had a diagnosis and knew the expected course of the virus.   By saturday morning, we were given the all clear by the doctors, but I opted to spend one more night in the hospital, hoping the worst of the coughing would be done by the time we left the next day (thankfully it was).  IMG_6253So we were released on Father’s Day (best present ever, according to Omer), and walked home from the hospital.  By Monday, a week after our first ER visit, Miri was back to almost-normal – very little congestion, just a bit of coughing.  Miri now holds the record for most days in the hospital for anyone in our family (as well as only recipient of an IV), and I’m hoping this is a record that we don’t ever break.