I don’t like this at all

Yesterday my daughter (the one in my picture, but older now) started sneezing—a lot. Allergy season in this part of the country is brutal. We keep a box of kleenex on every flat surface in the house. But this morning she started coughing, and had a low-grade fever, so we knew she was sick, not just allergic. My wife stayed home with her while I represented us at our family’s Passover Seder. When I got home, she was still coughing—a lot. I grabbed a stethoscope and listened to her chest. It wasn’t perfectly clear, but she was coughing and crying so it was hard to hear (also, I’m not a pediatrician). I stepped back for a minute and looked at her. She was miserable. She was using her neck and chest muscles to help her breathe, and her stomach was moving in and out in what’s called a paradoxical pattern. She was clearly not doing well. We grabbed a few things and jumped in the car, heading for my hospital.

When we got there, she was really struggling. Thankfully, lots of people I knew were working, and we got plugged in pretty fast. After a breathing treatment, she was a little more cheerful, but still breathing about 40 times per minute.

Any parent knows what it’s like to see your child ill. When I look at her as a patient, I can see how sick she really is, but I try to keep a calm demeanor for her and for my wife—inside I’m screaming, tearing at my clothing, shaking. Her oxygen saturation is in the high 80s to low 90s, but she’s improved since we came in. My wife sends me home to get some rest (like hell!), and the plan is for me to pick them both up in the morning when I come in to round—assuming the little one is well enough.

I feel horrible leaving them there without me, but one of my residents is taking care of them and I know he’ll call me if anything is going on. Still, it’s laughable to think I can just come home and sleep.

It turns out she has respiratory syncytial virus (RSV), a nasty little respiratory virus that makes little ones miserable. Unfortunately, there is no vaccine for this one. We’re stuck with chance, and I don’t like chance very much tonight. In fact, I don’t like anything very much tonight except my daughter and her big, brown eyes that shine when she laughs, which is most of the time. When she coughs so hard that she can’t speak, I want to vomit.

But instead, I’m sitting at home next to the phone, typing, and hoping and waiting.


So, as soon as I settled in at home, I got called back to the hospital. She’s doing a little better, but not well enough to go home. More later.

More under the fold—>

She’s finally sleeping, giving me a moment to reflect. My wife, having realized that sending me home wasn’t the best idea, called me back to the hospital at about 3:00 a.m. My sweetie was still breathing hard, and I climbed in bed with her to hold her oxygen to her face (and of course to cuddle her). I could feel her heart pounding at 130-160 beats per minute. Her respiratory rate was in the 30s-40s, and her oxygen sats were in the high 80s to 90s. Needless to say, neither of us slept.

It helps to know people. The resident on-call is one of my trainees. He kept a very close eye on us. The ER doc, while not recognizing my face, knew my voice immediately—we probably speak to each other at least three times a week. We’re in a private room, but not because I’m on staff here—RSV is quite contagious. We’re getting the best care available in the world, but as my Dad always says, ” a hospital is no place for sick people.” At 6 a.m., after my little girl finally fell asleep, housekeeping came in and started loudly changing the garbage. I told her to get out and come back later, but she said she would finish quickly. That was the last time until now that my baby slept, and if she pulls that again I can’t be held responsible for what I do.

I sent my wife home for a shower and a nap. I grabbed some clean scrubs out of the machine.

Sleeping seems to make a difference for my little patient. Her respiratory rate and heart rate are slightly lower. Mine, though…

Anyway, for some reason, live-blogging this helps me, and perhaps something useful will come out of reading this. More to come.


First, she’s doing much better. Her breathing has improved dramatically. I mentioned earlier that housekeeping woke us up. After that, we put up a “do not disturb” sign. And who do you think had the arrogance to ignore the sign? It doesn’t apply to nurses or doctors, but otherwise, it’s pretty clear—but not to the random hospital clergy member. A guy of unknown denomination walked right in, and despite my immediate, “thank you, you can go now”, he kept at it.

Collar: “I just wanted to…”

PalMD:: “Please go.”

Collar:”…there is a Passover service at…”

PalMD:“We’re tired. I asked you to leave. Please go.”

Collar:”Well, I just want to tell you…”

PalMD:“I don’t know how much clearer I can be…leave now.”

Collar:”OK, well, I’ll pray for your daughter.”

PalMD:“Fine, as long as you go.”


33 responses to “I don’t like this at all”

  1. jillbryant

    I am so sorry your little girl is sick. Very tough on a parent. I hope she has a very speedy recovery.

  2. Good luck, I hope it all turns out ok.

  3. Yes, good luck and a swift recovery for your daughter.

  4. Hey Doc, your education and experience gave your daughter the opportunity for you to catch this quickly but was simultaneously dangerous in that you were much more scared than any non-medical parent. The Pharmboy family wishes the Pal family all the best for a rapid and unremarkable recovery.

    Love the picture of you with her as a baby in your newly-unmasked sidebar. I now understand how our daughters will always remain these little babies to us Dads.

  5. jnovitz

    getting RSV is pretty much part of the process of being a child, i think around over 98% of children show antibodies to it by the age of 2. Hospitalisations are extremely rare.

    being of a rather conservative bent I wouldnt automatically be in favor of a vaccine for RSV as opposed to developing a treatment for hospitalised cases. Coincidently some years ago I worked on a research project looking at inhibitors for RSV cell entry, although our compound worked it wasnt suitable for further development.

    I take the point of your previous post about chickenpox (which could also have been seen as a part of growing up). But I do see risks in over intervention in terms of vaccination down the road. A classic example would be Crohn’s disease where some scientists think our ultra safe food supply is leading to a lack of challenge of intestinal parasites and auto-immune reaction. Similiar theories are put forward about asthma. It might be possible that overcoming viral infections that are 99.999% non-lethal does confer benefits later on in life.

    My conservative bent often tends to be suspicious of too much medical intervention.

    Best of wishes for your daughter’s speedy recovery. Although following on so closely on your last post about hb vaccine I do see a possibility that this particular case of RSV hospitilisation could be more in realm of instructive parable – although doubtless given from the best and purest of intentions. It is a bit of the feature of the internet what someone called post-modern journalism “It SOUNDS true. It COULD be true. It REVEALS a truth without having to be true. ”

    Anyway, again, best wishes for a speedy recovery.

  6. I’m very sorry you daughter is ill. Best wishes for a speedy recovery. I remember from my pediatrics rotation that RSV seemed to be one of the more common reasons that kids ended up in the hospital. It generally goes away with supportive care, but so miserable for the kids.

    I know this advice is next to impossible to take, but do try to take care of yourself and get some rest. Your family and patients need you to be at your best and you can’t help anyone if you neglect your own health.

  7. Best wishes for the recovery of your daughter.

  8. jnovitz, you’re a fucking idiot—-fuck off, and please don’t come back for a while.

  9. The most stressful events in my life have been when my little one has been sick. He had croup twice when he was an infant, and I thought I would tear my eyes out. It was the most horrible thing to witness, and I finally *really* understood the desire to feel pain rather than have a loved one feel it.

    My best wishes for a speedy and uneventful recovery for your daughter. And try to rest while you can.

  10. Blind Watchmaker

    Actually, there is a vaccine for RSV. It is incredibly expensive and really only indicated for premature babies with lung disease. It is given in the fall to those infants at most risk of dying from RSV.

    Hope that she feels better soon. Keep those hands clean.

  11. Denice Walter

    I!m so sorry to hear about your daughter!s illness.I hope she is well soon and all of you are feeling better.

  12. I really know how you feel–The Girl had pneumonia when she was 2. Of course, I didn’t have the added terror-inducing knowledge you do. I knew pneumonia was bad, but just not HOW bad. I didn’t know all the things that COULD happen. I’m really sorry she’s sick and my thoughts are with you and her and her mom.

  13. Dear Pal,

    Sorry to read of your daughter’s illness. The fear and dread that strikes the parent of an ill child is indeed terrible. I’m thinking of you.

    I hope that she makes a speedy and complete recovery.

  14. I’m truly sorry to read you and your family are going through this. There is something about a family member having difficulty in breathing that amplifies distress for everyone.

    Best wishes to you, those whom you love and those who love you.

  15. I’m sorry to hear of your daughter’s illness; it’s so scary to watch your child go through this. I wish her a full and quick recovery.

  16. Pal,

    Best wishes for your daughter to be home and well as soon as possible.

  17. Hospitalization for RSV was the beginning of a very long and painful process for my eldest child. I honestly and sincerely hope you child has a quick and complete recovery with no long term lasting problems.

  18. I really feel for you. The parent-of-a-patient side of the fence is a terrifying and difficult place to be, but it sounds like you’re doing what your daughter needs really well.

  19. Pal, sorry your daughter is sick. It’s especially hard when a loved one looks at you wanting you to fix it and there is nothing you can do. It is the most helpless feeling you will ever have. As hard as it is, you will be a better doctor and a better person because of it. That’s no consolation, but it’s true.

    Blindwatchmaker, perhaps you should forward the information about that RSV vaccine to the CDC. They don’t seem to know about it. http://www.cdc.gov/ncidod/dvrd/revb/respiratory/rsvfeat.htm

  20. Matthew L.

    I hope your daughter gets better soon. I can only imagine what it must be like to be stuck watching your child be ill in the hospital.

  21. I truly hope your daughter gets well soon. How old is she?

  22. PalMD,

    My family is thinking happy thoughts real hard for you and your family. <grin>

    My son had RSV when he was about 6 months… one of the worst times as a parent is feeling helpless when your child is ill. If there were a vaccine…

    Best of luck and keep us all posted!

  23. Awww 🙁

    *hug for the baby*

    Thank you for this post– I use syncytia every day in the lab. Theyre more of a lab side effect than a medical problem with HIV-1, and I didnt know ‘respiratory syncytial virus’ existed.

  24. Elf Eye

    To Pal-as-Dad,

    Best wishes from Elf Eye-as-Mom. My daughter has gone through her share of illnesses, starting with a bout of severe diarrhea in Lima, Peru (not a good place for an infant to be experiencing diarrhea). But she is eighteen now, and healthy. May your daughter’s experience, too, end well. Given that she has attentive, well-informed parents and access to excellent health care, that will no doubt be the case. You stay well, too, and your wife also. All the best to all three of you.

  25. Yeah, ERV, as a fellow basic scientist it wasn’t until we had a kid that I learned RSV wasn’t only for Rous sarcoma virus.

  26. I’m not a usual reader, but came across this today and wanted to share my support for you as well. When my little ones were wee things I remember there was almost nothing scarier than the sicknesses where they couldn’t breathe well, and nothing lonelier than a pediatric hospital room in the middle of the night. 🙁 I’m glad she’s starting to do better.

  27. Peter,

    Hope your girl is all better by now.

    Mine is 30 and has a baby of her own, but they’re always our babies.

  28. jnovitz

    “I remember from my pediatrics rotation that RSV seemed to be one of the more common reasons that kids ended up in the hospital.”

    Incidently is it common to test for RSV in the states? In the hospital I worked (not as a clinicial) a diagnostic test for RSV was never done (I understand that kits are available but the test was not offered by our virology department). Primarily because there was little clinical benefit from knowing the exact causative agent. An infection of the respiratory tract was treated the same way regardless of if it was RSV or some other virus.

    Hence, although many but not all respiratory tract infections of children was caused by RSV, such an exact diagnosis was never made, for the simple reason it was never tested for. So I often had to explain to clinicians what my research had actually been about and the significance of the virus.

    Is RSV testing routine for paedaetric admissions in the US?

  29. csrster

    No doubt about it, the worst part about having kids is when they’re ill – even everyday snots-coughs-and-fevers are miserable enough. My thoughts are with you.

  30. As you well know I ain’t gots no chil’rens so I get to NOT have these overwhelmingly powerless feelings associated with a sick chilren.
    But I also will never know the sheer joys that “…her big, brown eyes that shine when she laughs, which is most of the time…” brings.
    Unfortunately, “time takes time”, and though you know that she will be better in a few days…getting (you [and Mom]) though those days will be rough.
    You’ve taken good care of the kiddo, take care of Mom and you.
    Hugs a’nat.

  31. Pal, sounds like a rough time for you and your family. Best wishes for the lot of you; serious illness is never easy, especially when kids are involved.

  32. So sorry to hear about your little ones illness, I hope she is doing much better now! *hugs* for you both.

  33. Spica

    Hi PalMD

    I’m really sorry to hear your little girl has been ill – that RSV is a nasty, nasty thing for a child to catch. I hope she continues to improve and that she returns home quickly. All the best to you and yours.

    Spica (from RW).

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