“My son might die!”
Unconvinced, I left Jeri in charge and started research on my own. I reviewed his lab work and saw his sodium levels were quite low, and the urine-specific gravity was also very low. He had gained four pounds of water weight. It seemed like the Syndrome of Inappropriate Antidiuretic Hormone Secretion or “SIADH” that I had learned about, and I recalled it was quite dangerous. It could cause the brain to swell, and it always caused the edema I was concerned about. “System Inappropriate Anti-Diuretic Hormone” secretion had many causes, and it made the body swell. I started looking for causes. Nothing I read seemed to apply to my son until I stumbled on a paragraph that reported it was seen in ventilated patients when the air pressure was set too high.
Trey’s PEEP (Positive End Expiratory Pressure) was set at the maximum recommended level since they were re-inflating his left lung. It had been going on all day, and both lungs were clear. I found his nurse and told her of my concerns. She refused to call the doctor again, and we felt helpless. The next morning, as doctor-rounds approached, I stood bedside and waited. When the doctor arrived, he was in a hurry. He had lots of patients to see. I blurted out my rehearsed research findings and requested that the PEEP be turned down. Third-year students (rightfully) have little credibility in the ICU. I was thanked and reassured, but they made no changes.
I was a father first, so I rechecked my medical facts and waited. The doctor would come back. The nurse was sympathetic but not convinced. When he came back later that morning, I was waiting. We had more time now.
“Sir, respectfully, my son has had his right mainstem bronchus intubated, which collapsed his left lung. The on-call doctor last night canceled the medication that had his heart rate over 220 after I requested him to. His PEEP is set high, and that may cause SIADH. I know this is unusual, but his lungs have clear breath sounds bilaterally, and I would appreciate it if you would turn down the PEEP pressure. He’s swollen all over, and his urine is inappropriately diluted. Please?” I pleaded.
The pediatrician listened but was not convinced. I was a medical student and had limited credibility, but was also a parent, and I might be right. He nodded and reached for the chart to write the order to reduce the PEEP. He did not seem convinced or happy.
“Thank you, sir,” I mumbled. “We will be here all day, monitoring him.”
During that day, my mother and younger brother arrived by plane from Virginia to help at home. I had called them in a helpless panic, and they came without hesitation. By 11 PM, I was tired and needed to go home to check on our daughter. I kissed Jeri, who was “on guard,” and went down to our ancient Chrysler Town & Country station wagon. It was dark out, but the car was distinctive. All four tires were different. We had bought them, one at a time, by getting discarded tires and patching them for $2. Sitting quietly in the driver’s seat, I searched for the keys in my pocket and tried to find the ignition. My hands were shaking, and my breathing came in choked sobs. I could not start the car, so I sat there, wanting to let it all out. I needed to cry but was not sure how. The pain in my chest needed release. One tear and one sob found a voice. I took a few deep breaths, found the keyhole, and started the car. The radio blared. I drove slowly home and called my mom.
“My son might die!” I sobbed.
My mother and brother arrived by plane in the morning. My brother decided on his own that he could help too and interrupted his own life to do so. He and Mom provided comfort and care for our younger daughter and us while we stayed at the hospital and prayed. This tale ends happily, with our son released from the ICU after four days. It was the beginning of Christmas vacation for our children’s school and me. We would be a family again and help him heal together. His swelling resolved, his voice returned, and he ate ice cream. Doctors had saved his life with immediate action. With Christmas a week away, I would be with family during the daytime again. Brother Bill and Mom returned home. Their generous help had proven invaluable.
Over thirty years have passed and my son has two young children of his own now. His son is named Robert Adams IV. My brother’s selfless gift of himself at a time of crisis is still cherished, and will never be forgotten.
From that day forward, I walked into the house, removed my germ-covered white coat, threw it in the washer, and washed my hands. The stethoscope was cleaned at work with alcohol swabs between patients. No kiss hello was permitted until the washer top closed. The next month, a ten-year-old arrived in the emergency room with the same neck abscess as my son had. An experienced physician had identified it immediately. Alas, before the needed surgery could happen, his abscess eroded an adjacent vessel. He became septic and died.
This experience profoundly moved me as a father with a critically sick child. My son and namesake had come as close to death as he could and survive. The emotions of fear and helplessness stay with me in my memory always. It made me a better physician when dealing with the inevitable losses my patients would experience in the years to come. Family helped us to survive a situation so grave that words do not do it justice. For that, we will always feel blessed and grateful. Thanks again, Bill.
This story is from my new book Swords and Saints A Doctor’s Journey.
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