A and E on 12th

02:00 Thursday morning.  I was in a deep sleep when the bedroom door opened suddenly.  We always kept the landing light on at night and so she appeared as a silhouette against the bright light, until my eyes adjusted.  She had her hand on her throat and said, in a very husky voice, “I can’t breathe properly.”

I leapt out of bed, pulled a dress on and led her downstairs.  I gave her a drink of water and a Paracetamol Melt, and she seemed a bit better.   Whatever had caused the obstruction must have moved.  My husband and son were still in bed, so I told my husband that I was taking Evelyn to A and E.  She sat in the front seat so that I could see her at all times and I drove to A and E.  The roads were deserted and so we arrived by 2.15am.   I remember feeling a sense of relief when we arrived there because I had been frightened by her sudden inability to breathe and I was worried that it might happen again.

I parked a few yards from the entrance and we walked to the front desk.  I wish now that I had carried her, it might have made them take her condition more seriously.  But she was a relatively tall child who was a couple of months away from her eighth birthday.  She was going to be much taller than me in a few years’ time.

I explained that she had woken a few minutes earlier, struggling to breathe.  The woman at the reception desk asked Evelyn questions about her age and name, but she couldn’t really speak  because of her croaky voice. The woman commented that they had had a couple of cases already that night and said that it was croup. The waiting room was deserted.

As soon as the details and history were taken, the triage nurse opened a door and told us to come straight through. What I had not realised was that Evelyn’s temperature was over 40oC. I believe that she said 40.8, although she wrote 40.2.  I have seen her develop temperatures of over 40 before and I remember being extremely concerned, which is why I suspect that it was higher than 40.2.  Either way, this was a significant fever and, combined with the sudden severe breathing difficulty, was very worrying.

She led us from the examination room, through the main A and E department, into the children’s waiting room.  I had already given her a Paracetamol melt and so the nurse weighed her to establish what dose of ibuprofen could be given.  Soon afterwards, a second nurse came into the children’s area, and I remember the two of them having a discussion about whether the scales were working properly.  One of them went to get a portable set to confirm that the reading was correct.  I remember thinking how odd it was that in my own profession of engineering, we carefully calibrate all measuring equipment, yet when the equipment is important for life or death, it seems not to matter.  It was a good thing that it was such a quite night.

The children’s area was deserted, so Evelyn lay down across the seats.  I remember that I rolled up an item of clothing to give her a pillow and I can picture her lying there because I could see that it can’t have been very comfortable because the design of the chairs meant that there was a gap between each seat.  The second nurse took Evelyn’s measurements, including respiratory rate, oxygen saturations and heart rate.  She commented on the rapid heart rate and I asked if that was normal.  She said that it was normal with a high fever and therefore nothing to worry about.  At this time, the respiratory rate and oxygen saturations were within acceptable levels. Evelyn looked very pale and unwell.

At some point, I remember taking Evelyn to the toilet which was immediately next to where she lay on the chairs.  I must have taken a urine sample from her because I have seen that a sample was tested and showed no abnormalities.  The nurse brought a dose of Ibuprofen which I recall her saying was a 9ml dose because they had weighed her, as opposed to the 5ml that I would normally be able to give at home.

The doctor that came to examine Evelyn was a young woman.  She came into the children’s area and asked us to come into one of the examination rooms.  She was very pleasant and examined Evelyn once she had got her sat on the bed.  I gave the doctor a full account of exactly what had happened when Evelyn had burst into our room at 2am, struggling to breathe, and the history of developing a sore throat and very croaky voice the previous day.  I confirmed that all of her vaccinations were up to date and that her previous medical history was minor stuff including a couple of bouts of tonsillitis in the past few months.  She had been admitted to hospital once when she was a toddler because of a very high fever and she has suffered very high temperatures on other occasions.  After giving so much detail, the doctor asked me if I was also a doctor.  I said that I was not, and that I just wanted to make sure that she had all of the information that she needed.

After her examination of Evelyn, she concluded that this was croup.  She said that the treatment was a single dose of Dexamethazone.  We went back to the chairs in the waiting area.  After a short while, I started to feel very thirsty, not surprising as I had leapt out of bed at 2 am.  I had brought a drink for Evelyn and she suggested that I drank it, but I wanted to keep that for her. I told her that I was going to look around the corner to ask if there was somewhere to get some water.  I looked back at her as I got to the end of the waiting area and told her that I would be a few seconds and only just around the corner.  Immediately, I saw the the nurse was coming towards me.  She showed me that there was a water cooler a few feet from where I was, so I quickly filled a plastic cup.  Whilst I did so, the nurse told me that she was on her way to us anyway because she had the Dexamethazone.  She suggested that Evelyn would take it better from me so I took it straight to her and administered it.  I recall thinking that Evelyn would take it from anyone if told to do so because she knew that it would help her.  She was very sensible and mature, when I needed her to cooperate.

I am not sure when, but the nurse took a second lot of measurements and recorded that Evelyn’s temperature and heart rate were still very high, although coming down.  She offered Evelyn the opportunity to lie down in one of the side rooms because she did not look very comfortable, but Evelyn did not want to bother.  Gradually, her breathing and condition improved a little.  The nurse took the measurements again and commented that her temperature had come down, but was still not normal, and didn’t think that the doctor would let us go home yet

Soon afterwards, Evelyn said that she felt sick.  I had a very quick look around, but could not see a sick bowl.  I sat her on the chair next to the open toilet door and ran around to the main A and E area.  There were several members of staff sat around the desk.  Presumably there must have been some patients in side rooms, but it certainly appeared very quiet indeed.  I asked a nurse for a sick bowl and she said that there was “a blue cupboard in there”.  I knew that I might not have time for a polite conversation and I felt very distressed because Evelyn was alone.  I can’t remember exactly what I said but it was along the lines of “I need one quickly – she is going to be sick any minute”.  She got up and went into a treatment room and appeared straight away with a disposable bowl.  I sensed her irritation.  I ran back to Evelyn.

I sat next to Evelyn and held the bowl under her chin.  She then stood up, clearly wishing that she could get it over and done with, but could not vomit.  The doctor then came to see us.  She began telling me that Evelyn could go home because she had received the medication for croup and her temperature was coming down.  She said that I needed to be aware of the signs of cyanosis, the blue tinge around the mouth that is seen in people with low oxygen saturations in their blood. Whilst talking, she had to pause because Evelyn started to vomit into the bowl.  I can still picture her expression of empathy as she waited until Evelyn had stopped.  She asked Evelyn if she wanted to go home, to which she replied “yes”.  I said that was not surprised because she looked shattered.  I remember saying “doesn’t she need antibiotics?” The doctor said that croup was viral and so antibiotics would not help.  There was a word missing from this statement – usually viral. I foolishly imagined that she knew more about croup than me.  I now know that she didn’t.  I was thinking at the time that it was getting on for 5am and so the GP practice would be open in a few hours.  If I was unhappy about Evelyn’s condition then I could try them.  I also had a question in my mind “how do they know it is a virus when they always say that?”

I asked the doctor what I should do with the bowl of vomit.  She told me to leave it there and a nurse would remove it.  I was amazed, as I thought that even Florence Nightingale would not do that, but she insisted.  She walked away and I pressed the door release and went back to the car park.  I have always found it shocking that people in desperate situations have to look for a pay machine to get out of the car park in hospitals in the UK.  The A and E drop off was not clear, so I had gone into the main car park. Fortunately, I scraped together enough change to allow us to leave and we drove home, both of us exhausted.  I was not convinced by the treatment so far, but told myself that they had seen lots of cases of croup and I had seen none before that night, so I needed to trust what I had been told.Photo0570