Friday night E.R. lights

Friday started innocently enough.  The newly be-Hooptied Big Blue was finally ready to ride (after a bit of a debacle involving the internal hub and a missing o-ring), and we towed Lightning to the park for a morning ride.

The previous week, we’d made some progress in riding Lightning after I added some homemade streamers to the ends of the handlebars and made a game out of riding the circle path around the playground.  His interest was strong the first two days but already starting to fade.

Later in the day, after not napping, we hooked Green Bike to Midnight (finally picked a name for my 3-month-old bike) and headed out for a multi-modal trip to meet up with my family, who were visiting from Iowa for the weekend.

Two mile bike ride and 10 minutes on the MetroLink later (I rotated the Burley Piccolo almost 180 degrees to fit on the train), we were at the hotel where my family was staying.  Easy peasy!

An outdoor pool is a nice amenity for summer StL visits, and we changed into our suits and headed to the pool (I was wishing I’d worn mine under my clothes so I could just jump in after the hot bike ride!).

Things went south from there.  I was just about ready to join G and my mom in the pool (after getting all sun-screened and letting it have some time to sink in), when G came out for a little break.  I don’t remember what he was heading for, but he was running on the pool deck.  I was a few steps behind and literally starting to say, “Don’t run next to the pool,” when we experienced the consequence of said action.

He slipped and landed really awkwardly, kind of a side split, but with knees bent instead of straight.  Given the position, I was assuming he’d pulled or strained something in the groin.  He was in quite a bit of pain, and ice and time didn’t seem to alleviate it.  We got him back to the hotel room, and he held his leg very awkwardly.  There was some swelling, but no bruising, and after consulting with a nurse on the after-hours exchange line, we headed to the E.R. at Children’s Hospital.  By that point, I was pretty convinced that something was wrong — I’ve never seen him that upset/inconsolable.

They started pain meds, and took him for some x-rays.  Soon enough, we heard the news: spiral fracture to his right femur (the long bone in the upper leg).  Our treatment options were either spica casting (basically a huge cast, from his waist down past his knee on the right leg, and possibly including some of the upper left leg) or titanium elastic nailing (TEN) of the femur, a surgical procedure which would involve no cast and allow him to start bearing weight as soon as he was ready.  Either way, it would be done under full anesthesia, and we would be waiting until morning.

They put his leg in a very temporary cast for the night.  The manipulation this required was pretty tortuous, even with morphine in his system, as he was crying and screaming, “No, please no, please don’t do that!”  — agonizing for him and for me and my mom.

Matthew stayed with him at the hospital overnight, and I headed home to do a bit more research on our treatment options before attempting to get a bit of sleep.  The TEN procedure seemed like a no-brainer in most ways, both for G and his caregivers, and it was what the pediatric orthopedic surgeon recommended (“What I would do for my kid”).  There wasn’t a ton of information either way.  We were concerned about the risk of surgical site infection with the TEN procedure (not an issue with the spica casting, since it doesn’t involve surgery), but in the end, we went with that option.

Saturday morning a bit before nine, he was wheeled into surgery.  Sometime after ten, the surgeon found us in the waiting room and said we would be able to see him in a bit, and the procedure had gone as planned.

The green is not a cast, just a stretchy bandage covering the incisions from the surgery.  After some time monitoring him, a visit from a physical therapist, a trip to the pharmacy for oxycodone, and much crying about the transfer, we headed home on Saturday night, a little over twenty four hours after arriving at the E.R.

We had great care overall, and were fortunate to be at a state-of-the-art children’s hospital.  I do feel the hospital staff could have done a bit better job preparing us for what to expect once we got home, i.e., how much pain he would be in, wound/dressing care, etc.  I also wonder if some kind of splint or brace would have been useful, but that was never mentioned or offered.

The past few days have been challenging for all of us — a temporary return to the days of having a needy young infant: lots of inconsolable crying, sleep-deprived parents, multiple night-time wakings (even if he’s sleeping, we need to make up to give him more pain meds).  Those were not my best days, and I’m trying to stay positive this time around.

Despite the fact that, bone structure-wise, he theoretically could be bearing weight on the leg now, he is clearly far, far from being ready for that.  I think the way they presented the procedure was a bit misleading in that aspect.

He is clearly still in a lot of pain, compounded by his anxiety about the pain.  I almost think he has some kind of PTSD from all of the pain of the initial trauma, plus the limb being manipulated in the E.R., and then just being in so much pain for so long (he was on pain meds all night on Friday night, but nothing but the morphine seemed to help much, and they were hesitant to give that).  Now, anytime we go to move him, he freaks out, crying and screaming before we even touch him.  Afterward, he often admits that it didn’t actually hurt (although sometimes, despite our best efforts, it does).  I’m not sure how to help him past the psychological issues.

We’re not pushing movement right now, other than wiggling toes and flexing the ankle, but we do have to move him sometimes (e.g., to sit on the toilet — we have a thing for him to pee in; we could use a diaper for bowel movements, but we would likely have to move him just as much, if not more, to clean him afterward, so potty it is!), at which point he usually screams bloody murder and tries to push us away.

We confirmed that the seemingly odd/awkward position he favors, with the leg angled outward, is not a problem, and they gave us another script for more oxycodone (they were really stingy the first time around); as much as we would like to wean him from the hard stuff, acetaminophen and ibuprofen just don’t seem to be cutting it yet.

After consulting with the hospital staff, we decided that the coordination required for a walker, much less crutches, was probably too complicated at this age.  The expectation is that he’ll start bearing weight on the leg as he’s ready, first crawling, then pulling himself up and walking with assistance, and finally walking unaided, so, basically learning to walk all over again, but a faster progression (theoretically — we’ll see with this naturally cautious, and now anxiety-ridden, child — he may just decide it’s safer to crawl everywhere for the rest of his life).