It was a cold winter’s day when I had decided to go to Connecticut. My baby had recently been discharged from the special care nursery and we were preparing for our first blizzard. My parents had offered some reprieve in the routine that we had of sleeping and breastfeeding as my son had begun taking to it quite nicely. I bundled him up in his white fleece suit and carried him to the car with care for our long trek. Though I had liked the closeness of our house in New Jersey, I had appreciated the promise of having family nearby temporarily.

 

It was a few days later when my routine came to a screeching halt. My baby who had at other times been a feeding machine, had been straining early one morning and began screaming uncontrollably. I was a new attending in pediatrics and tried to look for everything that I could, but he just wouldn’t stop crying. This was not a normal thing for him, and I massaged his belly which was firm to the touch. After a time, his cries became murmurs as he was still seemingly in pain but was cried out. He went to sleep and so did I.

 

I awoke to his screams a few hours later and began to panic. Something was wrong. I called my pediatrician’s office and received a call from one of my old attendings from my pediatric training program. Though we had not necessarily gotten along during my training, I trusted her judgement. I called in a panic stating that my baby had been straining during a bowel movement and had not stopped crying since. I wondered if he may be constipated but whatever it was, he was extremely uncomfortable.

 

I also informed her that since that time, my baby had not been able to take feeds. He would vomit them up entirely and I struggled to figure out the cause. Her tone essentially mocked my notions constipation and she gave me patronizing reassurance. “ It may just be a tourniquet” she said in passing and I checked his little fingers and toes to see if there had been any loose hair wrapped around tightly and found nothing.

 

After several hours more of my baby not feeding, I had reached my limit and called the pediatrician to let them know that I was taking him to the nearest hospital in the next town over. When we arrived, I was reminded of my previous life at the time since I was on maternity leave. The ER was a buzz and my tiny infant looked like he did not belong in a place like this.

 

I explained to the doctors what was going on with my infant, the fact that he had not eaten for 7 hours by that time. He appeared to be uncomfortable with belly distended. They did what they could, attempting to hook him up to intravenous fluids and failing since his veins were so small, finally sending him for an ultrasound of his stomach. I was reassured to find out that the results were normal.   Because my baby had been so tiny, the hospital had a neonatologist come down to examine my baby and hour after he returned from imaging.

 

It was here that they found an inguinal hernia on examination and thought that this could likely be the cause of my baby not eating as it was firm and indicated a possible incarceration, with his bowel essentially twisted into a knot, which was a surgical emergency. I listened intently as they explained that the surgery could not be done at the current hospital and that he would need to go to the university hospital 45 minutes up the road for further care.

 

My baby was dehydrated and before they could transport him, they had to give him fluids.  So, we waited for hours for the transport team to arrive. When they finally did, the two nurses stuck my baby 8 times to find access to his veins and were unsuccessful. My stomach dropped as I knew that there was only one certain option left. Interosseous access is a way to infuse liquids into the system quickly by way of the bone. In order to get access, nurses must drill into the bone and then can establish a line.

 

I knew that I had come to the limits of what I could take as a parent. I looked directly at my mother who was standing in the room with me and told her to stay there with my baby. I told her what they were going to do but could not hear him scream. I knew that I needed to be strong for him and that this would push me over the edge. I stood outside the doors to the ER and attempted to not hear his screams as they tried for access and were able to establish this on the second try.

 

When we arrived at the University hospital, it was early morning. The snow from the blizzard had fallen and made travel difficult and so it seemed, it had affected the routine of the hospital itself. The ambulance let out at the ER and I watched as the residents assessed my baby. My father had informed me in my haze that my baby was in pain, releasing low high-pitched moans. He had never gotten anything for pain, not even when they drilled into his legs with a large hollow needle.

 

I informed them of this in my haze and the resident reassured me that this would be taken care of. They examined the hernia and found that it was reducible now, no longer a surgical emergency they said, but that they would need an attending to make the final diagnosis. They stated that they would take us to a room in the ICU given my baby’s age and his symptoms.

 

As we rolled into the room and sat, I realized that we had been sent to the general pediatric floor instead. Whereas the intensive care unit offered the potential for more immediate care, for more critical patients, the general pediatric floor was very routine and getting services could take more than half the day as a child placed on the floor was deemed to be not as critical.  Two residents stopped into the room, both from urology, and explained that the weather had delayed the housekeeping staff. The attending was at home, it was too early in the morning, and reassured me that a general pediatric room should suffice given that it was clean.

 

I had reached my limit at that point and railed into them about the health of my baby. I told them in no uncertain terms that they had taken an oath to uphold the health and care of patients and were failing. I spoke strongly about my child’s symptoms, that something needed to be done and characterized that I would make their lives a living hell if they let my child sleep on the general pediatric floor that night. They walked out and spoke to the attending and my baby got a pediatric ICU room that night.

 

When we arrived at the ICU, my child’s venous access was removed, and the nurses attempted to look for cephalic ( in his head) venous access. They stated that they would try again in the morning.

 

I finally slept for a couple of hours after my baby was given Tylenol for his pain and could finally rest as well. I awoke to two surgical residents standing over my child and feeling his belly. They both had great concern. I walked over and they explained that his belly had remained rigid, that the past medical history of the straining, the hernia seen on examination, were possible indications of immediate surgery.

 

They set-up imaging and we were off almost immediately. They performed a barium swallow on my baby.  I looked on in horror as his intestines lit up. His intestines which should normally look like thick string instead looked to be the size of German sausage.  His belly was full to capacity. My blood truly ran cold as I considered the possibilities.

 

I had been a resident who had cared for a little boy on his 3^rd birthday. The story was that the night before his birthday, he had presented to a local hospital complaining of a stomachache, he had not wanted to eat or drink much and the local hospital staff had not wanted to cause him pain by poking him and trying to get him access to his veins. So they didn’t really do blood work and gave him pain medicine and observed him. In the early morning hours, the boy’s abdominal pain worsened and he came to my training hospital that morning around 7am.

 

I remember speaking to his family and looking at him holding his stuffed Elmo doll. I remember his mother stroking his hair. Right after me and my senior walked out of the room, nurses ran in and pressed the button and called a full code. My patient was crashing. We worked on this boy for what felt like hours and were able to tentatively stabilize him and move him to the ICU where he crashed again.

 

He was finally able to get up to surgery where they opened him to find necrotic (dead) bowel everywhere. It was so pervasive that my patient was closed up and subsequently died that day, on his birthday. That story had never left me. As I sat with my infant that day, I stroked his head and told him about all the dreams that I had for him. All the things that we had talked about when he was in my womb. I told him of the promise of the life that he would have. And how very, very much I loved him.

 

I composed myself as the medical student tried to make conversation with me. I told her that I only wanted to speak with the anesthesiology attending. See like my former patient, my son also didn’t have venous access anymore. Therefore, the medical team hadn’t been able to draw bloodwork on him and there was no way to know just how critical his condition was. I prayed.

 

The anesthesiologist came bounding in and was pleasant and calm with me. He told me that he had been a general surgeon in his native country of Turkey and that he would be able to get access to my son. I told him about my patient who had not fared well. I looked at him and told him to do everything in his power to save my son’s life. He nodded.

 

The general surgeon was the next to show up. He gave me reassurance at the time that my baby’s ailment was probably nothing but that they needed to look further. I let him know that I knew how serious the surgery was and told him about my patient. He was polite and reserved but reassured me that all would be well.

 

The anesthesiologist returned a short while later to let me know that venous access had been established and that surgery was underway. As I walked to the waiting room with a patient advocate, I collapsed. The weight of my baby’s impending health, his status was like a blow to the chest and I could not stop from sobbing. My partner at the time was at work hundreds of miles away. My parents had had to go home the previous morning and we’re on their way to the hospital in the cold and icy weather.

 

So, this just left me. I took my time crying and praying for all to go well. I reminded everything that he was the promise of dreams untold for me. That I was so grateful to have him in my life. And I waited.

My parents arrived in time for the surgeon to tell them that  The surgery was successful. I looked in as the surgeon explained to my parents that my baby had presented with symptoms that were indicative of 5 diagnoses, with 3 of them being deadly.

 

I followed in procession with my tiny 3-month-old preemie carted in on a regular hospital bed. He was bloated from the amount of fluids and his little eyes were lidded. Almost the entire pediatric staff stood in the room as the attending presented the case. Nurses lined the room standing at attention, while what seemed like all of the residents were in there as well surrounding the attendings. This was a teaching moment for all, and the department wanted everyone to hear the chain of events that had unfolded. 

 

They did this because my baby most certainly could have died that day.  I often wonder how if I had just stayed on the pediatric floor, my baby’s life could have been lost. Had I not fought for him every step of the way, he would have been a casualty. Had I been pacified by my former attending’s reassurance that my baby’s symptoms were normal, he would have been lost.  And the privilege of my education has not escaped me. Had I not been a doctor and had the medical knowledge of knowing what I knew at the time, all would have been lost.

 

If anything, this experience cemented my role as a mother. It solidified the ferocious love that I had for my baby and made me an even better pediatrician. Because of what happened, I have learned to be an advocate for my patients when they enter the hospital. I try to counsel my patients to always ask questions, to speak up if they disagree with something and to demand that every step be explained to them. Try as we might, medical professionals can slip into a bias that potentially leaves devastation in its wake. I am so grateful that it turned out well for my son, but also know that it could have easily gone the other way.