Diagnosis

(This is part one of what I expect to be a three part series.)

3:30 in the morning.

Max walks in and wakes us up, telling us that his tummy hurt and he was sick. He threw up in his bed. 

For the past week, he had been sick with what appeared to be hand foot and mouth disease. That day he had finally seemed to be over it and was eating again. Sarah gets up to go look and sure enough, he threw up all over his bed. I ask if I can help clean it up, but she says she has it. It is a top bunk against the wall. As unpleasant as it may be, it really is a one person job. Meanwhile, I am in bed comforting Max. Something isn't right.

I know he is sick, but something is wrong, really wrong and it takes me a moment to wake up enough to realize what that is. He smells like nail polish remover.

I'm an ER nurse. I know what that smell is and what it means, but...no way. Max isn't diabetic. No one related to us is diabetic. Can't be.

And yet I look down and see a groggy little boy breathing fast and deep. My hand against his chest can feel his heart pounding away like mad. Maybe he has a fever. I get (or more probably it was Sarah, I don't really remember) the thermometer and check. No fever.

What could it be? No, what else could it be.

After lying there for a minute thinking about dehydration and ketones and the danger of acidosis, I take Max into the living room and sit with him on the couch. How long until Walgreen's opens and I can get a glucose meter. Hell, we should have one of those around anyway. No way that he has diabetes, but I would sleep better knowing that for sure.

By this time, sleep is out of the question. Walgreen's doesn't open until 9am here. That is hours away. If he is diabetic and in DKA, I shouldn't wait. All in all it took nearly three hours for me to shed the denial, realize the situation, and get moving. I'm a little ashamed of that, but there is a special dread ER workers have about taking themselves or their families in to be seen in an ER. That takes something pretty big to overcome.

I told Sarah I was going to my ER to get his blood sugar checked and she got ready to wake Michael and get them dressed. I told her to stay home, don't wake Michael. I'll call if something is wrong. Hadn't quite shaken all of that denial off yet, really and there wasn't anything she could do there other than wait and worry. There would be plenty of time for that later.

We drove to my ER and checked his sugar. It was 469. DKA (Diabetic KetoAcidosis). My co worker whispered, “Shit. I'm so sorry” and I walked out front to check in to the ER.

I snuggled up against him on the bed while they started the IV and drew blood. I knew the script and let Max know what was coming. He was sick, but he understood. There wasn't much fight in him at the moment. They started the process for a transfer. The hospital where I work doesn't have pediatric services. Dr. Monick, the ER physician on duty that morning knew a pediatrician she recommended to us who just happened to be on call that morning.

I snuggled up in bed with Max trusting my co workers to do what I had seen them do so many times before. I let go of the burden on having to be on guard and just held Max. I started to grieve. I didn't know what was next, but I had a good idea. I have seen enough diabetic complications. I could see the bare outline of the struggle coming up and didn't want it. I grieved the loss of perfection in my little boy. I wanted so bad for all the best for him and now this. As a parent. I had an idealized version of my kids growing up. It never included diabetes.

Then I stopped, as much as I could anyway, because it wasn't about me. I wasn't the one who would deal with a lifetime of extra burden. This was about Max. And the best way for me to help him was to stop thinking about what was lost and start figuring out the best way to deal with the new reality that was in front of me.

I still had to call Sarah.

She sounded as confused as I was when I first realized what was happening. News of that magnitude takes a little while to process and she was coming in to all of this a little late. She made it to the hospital just in time to see us loaded up in an ambulance for the drive across town.

Next: Hospital stay.