When Your Newborn Goes to the Emergency Room

 
​A week ago I spent the night in the hospital with Ryley. And I think it has taken about a week to breathe fully again. I cannot overstate how profoundly my view of the parents I take care of at work has changed (when I go back at the end of my maternity leave). I think differently of them all, but particularly the parents of our severely or chronically ill children. What I went through was a mere blip compared to what they experience for months, years, and sometimes decades. I do not know how they function, let alone handle these situations with the grace and even humor I have seen. I was impressed with them before. Now I am awed.
 
It started suddenly, as illnesses with very small children usually do. I had just returned from visiting my best friend and her new baby and put Ryley down for a nap in her room. She was her usual smiley self and went down without much fuss. However she woke up about ten minutes later. I went to try and put her back down, and as I was holding her and rocking/walking around her nursery she coughed and let out a huge stream of vomit that went all over her front, all over my shirt and shorts, and the floor. I paused but wasn’t too alarmed, more puzzled. Thankfully my baby is not a spit-upper. She spits up maybe 2-3 times a week, max. And when she does it is usually a very small volume. This was a huge volume, but she had gotten a bottle from my husband while I was away, so I assumed she had simply eaten too much when faced with a bottle versus the usual boob.
 
And then she puked again, also with a large volume and force. I called my husband down from his office to ask about how she took her last bottle, and as he was holding her she vomited again. At this point I was worried but still wasn’t overly alarmed. I assumed she had again either eaten too much.

My husband went to take a shower while I took the baby out to our sunroom. I sat down with her in the rocker and at this point noticed the change in her. She was very still and quiet, and there was no wiggle or squirm to her as I held her in my arms. I reminded myself that she had only napped for ten minutes and this along with the puking just meant she was overly tired. As my husband came out to check on us a few minutes later, she vomited again, again all over me, the chair, and the floor.
 
I gave her to him and went to change my shirt and get a cloth diaper to clean up the baby. When I got back I could immediately see the worry on my husband’s face. He sat in the chair with the baby, and again she was totally calm and still. I’ve been a pediatric nurse long enough to know that with infants, quiet is what stops you dead in your tracks. We like crying. Crying and fighting and squirming means energy and lungs full of oxygen. Quiet and listlessness is far more concerning.
 
With mounting anxiety, I decided to call our pediatrician’s office to get their opinion, described the situation to the receptionist, and was told a nurse would call back. Somewhere in this Ryley vomited again, only this time there was green and yellow bile in her puke. Once again I know enough as a pediatric RN to know this was not in any way normal for an 11 week old. I also know the assorted laundry list of terrifying reasons why an infant might vomit bile. However I was even more concerned about her demeanor. I took her in my arms and there was no other word for it, she was puny.
 
Puny is the word we use at work to describe a kid who just looks sick, not just normal childhood illness sick, but sick in a way that makes you page the doctor to come to the bedside. Her eyes were glassy, her skin was pale, and she was totally limp. She was also lethargic. Her eyes fluttered open and closed. Now my baby is not the type of baby to fall asleep at the drop of a hat. Usually it takes a lot of rocking and swaying to get her to sleep and she fights it. Seeing her this drowsy was not a way I had ever seen her before.
 
The anxiety at this point turned into terror. My husband, who is a physician, was also very alarmed and we decided not to wait for the pediatrician’s office to call back. We left the house in such a hurry I’m shocked we remembered to close the door or put the dog in the crate. As we were walking out the door she puked more bile and we had to stop for a while on our stairs to turn her upside down and prevent her from choking.
 
I sat with her in the back and we briefly discussed Kid Med (doc in the box for kids), but as she grew more and more lethargic (asleep and not opening her eyes even with stimulation) my husband drove past the exit and instead headed to the nearest pediatric ED at St. Mary’s.
 
The weirdest part in all of this is that despite the fact that a huge part of me felt suffocated with fear and worry, I also experienced a preternatural calm. It was the same feeling that I experienced during labor when the baby showed fetal distress and all the people rushed in the room. I cannot really explain it other than in these moments, I just know she is going to be okay because I do not believe in a world with any other outcome. And trust me, I know how faulty the logic is in this kind of thinking, because I take care of very sick kids whose parents probably felt the exact same way. Maybe it’s denial or adrenaline. But for whatever reason, I’m grateful to find that in these moments instead of falling apart, I go into almost an out of body composure. I think as parents it must be an instinct to not lose it when something is wrong with your baby, because they need you to be together in that moment.

We got to the ED and I was thrilled to see the waiting room was completely empty. We were quickly ushered back to the exam room and met by an RN and a only a few minutes later the doctor. We put the baby on the stretcher, and she lay there completely still. She was in and out of awakeness at this point with all of the activity around her, and again it was her calm and stillness that scared me the most. Instead she simply lay there limply while her BP and other vitals were taken and while the doctor examined her. Also during the exam she vomited more bile. I think it was at this point the doctor became alarmed, because she immediately ordered a slew of tests including chest and abdominal x-rays, an ultrasound, blood and urine cultures, a ton of labs, and a fluid bolus. She also said she wanted the baby on the continuous monitor.
 
The next couple of hours were spent in and out of the exam room with a rotating assortment of people. The nurses took urine, drew blood and started an IV (I felt so bad for them, knowing that as a peds nurse the most stress inducing situation is starting an IV on a kid whose parents are in healthcare, particularly if one is a nurse who starts IVs; however they were awesome and got the blood on the first try and the IV on the second, I typically take care of bigger kids and if I have to do a stick on an 11 week old I usually ask someone else to do it, because they have TINY impossible baby veins). We went with the baby to X-ray where we had to contort her in a variety of poses to get the imaging they wanted (we were able to go with her to all of her tests and were given lead aprons so that we could be there the whole time, thank you St. Mary’s for showing such commitment to family centered care!)
 
Through all of this Ryley was an utter champ (largely I think because she was so sick and dehydrated and didn’t have any fight in her). She also discovered the magic of Sweet Ease (hospitals dip pacifiers in this mixture of sugar and water and give it to babies to keep them calm during procedures or tests) and I’m pretty sure formed some sort of worrying Sweet Ease drug habit. At one point the doctor came in and told us she was worried about intussusception based off the x-ray (a condition that occurs in babies where suddenly one part of the intestine sort of telescopes into another part, it sounds really scary but can actually usually be fixed with a barium enema). However she was also worried about other causes of obstruction that would require emergency surgery so she wanted to do a fluoroscopy (another type of imaging using contrast dye to see how it moves through the GI system and identifies any possible obstruction). Yet again despite this very alarming news that my baby might require emergency GI surgery, I felt that weird calm (I swear I didn’t sneak any hospital xanax).

I can’t explain it other than again as parent I felt almost that I could simply will Ryley to be fine. I couldn’t fully process my fear or worry, because I would not allow any outcome other than her being okay. I know that is foolish and basically denial, but it kept me together through all of this so I’m grateful for it even if it was just denial.
 
Somewhere in all of this my wonderful parents had arrived (I called them to help with our dog because the doctor told us regardless of the cause, we would be spending the night because of how acutely sick the baby got and because of her age). I also desperately needed my breast pump because it was 8pm, I hadn’t fed the baby since early in the afternoon, wasn’t allowed to feed her until we knew what was going on, and didn’t want my breasts to leak all over me (I was covered in puke and diarrhea so I’m not quite sure why I cared about my shirt being covered in breastmilk, but I guess I drew the line somewhere). They stayed with us while all of the tests were going on and even went out and got us chik-fil-a.
She was still a little on the puny side, but once Ryley got a bolus of fluids she started to look a lot less terrifying. Her color came back and she wasn’t so lethargic and limp. She also started to have massive amounts of diarrhea which despite coating my pants (I was given lovely paper scrubs to wear until my parents brought me clothes) was incredibly reassuring because it lessened the likelihood of a serious obstruction and pointed more toward a GI bug.
 
The last thing we did in the ED was take Ryley for the fluoroscopy study. The sweet techs there went over the procedure in detail, because I think they were worried we would be horrified. They basically have to tape the baby like a mummy to the table, because the table itself rotates and flips during the test (in order to get the contrast liquid to flow through the baby’s GI system while the radiologist watches). At this point she was getting a little feistiness back but she was appeased with Sweet Ease despite having to be a human equivalent to a rotisserie chicken on a spit during the test (seriously why don’t they SELL this stuff at every baby supply store, we would stockpile it). With the radiologist in the room we were able to get instant confirmation that things were moving the way they were supposed to and there was no intussusception or obstruction.

Back in the ED exam room the doctor told us the good news but did say she still wanted us to be admitted for the night so Ryley could receive more IV fluids and they could monitor her.
 
We were taken up to the floor by our ED nurse and met our night nurse. I was enamored with her immediately for two reasons 1) She brought me a giant plastic hospital jug of water and told me I had to drink it because I was breastfeeding 2) she let me finally feed the baby (we had given her 2oz of pedialyte in the ED that she tolerated fine). After a brief visit from the pediatrician on the floor, we were more or less done for the night except for check ins from the nurse. Our wonderful nurse had brought us a cot as well as a chair that sort of functioned as a rocker. I briefly tried to put the baby in the little hospital crib before realizing that of all the nights to try and get her to sleep through the night in a crib, this sure as hell wasn’t going to be it.
 
Instead I brought her (and her IV pole) to the sleeper chair and lay down with her on top of me while I was half propped up with pillows. My back is still angry at me for staying in this position for the entire night, but the important part is the baby slept. I mostly stayed awake, too wired by everything that had happened and too in tune to Ryley’s every little twitch and sigh. I was also scared that our nurse, despite being so wonderful, would yell at me if she came in and I was sleeping with the baby (oh how I wish I could take back every time I’ve judged a parent for sleeping with their baby in the sleeper chair or even the times I’ve walked in to see the parent in the crib with the baby, I now realize how little I knew). I watched the sun rise out the hospital window and held my baby close as she slept.
 
The morning was relatively painless despite a lot of baby diapers full of diarrhea. We hung out for a while waiting for the doctor to round. I gulped down a Starbucks venti latte like it was manna from heaven. If I could have started an IV on myself and filled it with coffee I would have. When the doctor stopped by she mentioned that she wanted us to wait for the baby’s blood cultures to come back (which wouldn’t have been until the evening), but after talking to us and learning about both of our healthcare backgrounds, she said she would be okay with us going home since she trusted we knew when to call if anything worrisome happened.
 
We got home around lunchtime and I briefly considered making a sandwich. That lasted for about five seconds until I decided on a new plan. I handed my husband the baby while I showered, took the baby back, and then got in bed with the baby. Both of us then proceeded to take perhaps the most glorious nap in my entire life. I cannot overstate how beautiful it felt to be back in my bed with my baby beside me, safe and sound and not in the hospital anymore. If I could have stayed in bed with her for the next week I would have.
 
Later that night we got a call from the doctor telling us that her stool tested positive for campylobacter, a type of bacteria normally responsible for food poisoning. It can be passed person from person, or as we suspect in this case, from pets to their owners. Considering the fact that our dogs routinely lick the baby on her mouth and often routinely eat poop and sniff each other’s butts, I think we might know the source of the baby getting sick.
 
If I haven’t said it enough in the last couple of months, DAMN IT GEORGE.
 
After a couple of days of diarrhea followed by a couple of days of constipation, baby is doing great and back to her normal feisty self. As for me, my perspective on a few things shifted.
 
1. Before this I was getting really stressed out about the sleep situation. Whenever Ryley had bouts of short naps I felt it was the end of the world. I felt like a bad mom for not having her sleep in her crib all night long. It was a constant source of anxiety. Let’s just say after this little ordeal I have never cared about sleep less. Of course I want my daughter to sleep, but I could give less of a crap right now if it’s in the crib or my arms or in the sling. I also don’t really like the idea of her sleeping all night in her nursery away from us right now, because of course the paranoia factor has ramped up considerably.
 
2. I knew babies get sick fast. I’ve seen babies get sick fast. And yet I was still mentally unprepared for just how fast a 10 week old gets sick. It is terrifying.
 
3. I was really concerned about using “organic” “non-toxic” cleaning supplies before this. I was all into the Honest Company and Simple Truth like probably all first time moms easily persuaded by advertising. The day after we got home I bleached the crap out of my house. If I could have SOAKED my entire house in bleach I would have.
 
4. The dogs will never again be allowed to kiss the baby on the face. And we will be sending them the hospital bill. 
 
5. I’ve spent a lot of time making jokes about parents who bring their kids to the ED too quickly. And yes, that does happen. But I also have a newfound understanding of what it means to know in your gut something is truly wrong with your baby and also know in your gut that your baby needs help immediately.
 
Thankfully everything turned out fine, the worst-case scenario did not happen, and we were in the hospital less than 24 hours. On the scale of scary things that can happen to your kids, this ranks very low. It was however still the scariest thing that has ever happened to me in my life. And I hope it is the first and last time we spend any time in a hospital.
 
To all the parents who deal with sick kids on a daily basis for months or years, you are super heroes. I look forward to going back to work only so that I can do everything possible to be that calm, reassuring nurse who helps make your experience even just a tiny bit less frightening. 

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