First time parents stick out in the emergency room. Not in a particularly good or bad way; it’s just that you can see, in the lines of their faces and the set of their shoulders, that they are unsure about it all, the monitors and the beeping and the rushing nurses trying to accomplish a million tasks simultaneously. As a childless pediatric intern, I resonate with first time parents because I feel unsure about it all too.
My third day in the emergency room, I met the Garcias. Isabella Garcia was an adorable 3 year old girl whose parents were extremely worried. She was coming in with a week of mild fevers, a rash on her hands and feet, and a sore throat. They had been to their pediatrician who diagnosed a viral infection known as hand, foot, and mouth disease due to the characteristic ulcers which appears on the hands, feet, and in the mouth (doctors aren’t very creative.) Isabella’s pediatrician wrote a prescription for ibuprofen and told her parents to make sure Isabella drank plenty of fluids. However, although her parents tried to help her drink, they had come to the ED because, as they said, “she won’t drink anything!” By their report, it had been 3 days since Isabella had had anything to drink. At all.
This is a pretty worrying history. Dehydration can be really serious in children, and hand, foot, and mouth disease has been known to cause a sore throat so painful that patients will drool excessively to avoid swallowing their own saliva. So as I entered the room, I was already thinking about admission for IV fluids in what I expected to be a very dehydrated kid.
The only thing was, Isabella’s vital signs were stable, and when I walked in, she was sitting up on the bed happily playing with a princess doll. Her mouth was moist, her skin was the appropriate texture, and the skin under her fingers went from white to red quickly after applying pressure to the nail, all signs of good hydration status. Although she still had some of the rash on her hands and feet, it looked like it was resolving, and there weren’t any signs of it in her throat. She looked, well, mostly okay! But still, her parents were frantic and insisted that she could not drink.
I really did not want to admit her to the hospital for IV hydration. The hospital, as many of you know, sucks intensely. But I respected her parents’ concern. They were worried in a way that only first time parents deeply in love with their child can be worried, something I actually find kind of wonderful. In fact, it’s one of the reasons I went into pediatrics – parents, even when they’re pushing back, are most often pushing because they love their children. What could be more beautiful than that?
Still. Hospitalization? Not so much.
The other reason (okay, maybe the real reason) I picked pediatrics is because there are always toys, stickers, bubbles and other fun things around. I found the sticker box, collected a few of my favorites, and returned to Isabella’s room.
I offered her a juice box, and she shook her head no. I showed her a sticker of a green cat adorned with sparkles, and she eyed it hopefully. I offered her the juice box again, with a clear intention to bargain as needed. She edged towards me, put her mouth on the straw, and took an experimental sip. I nodded encouragingly and waggled the sticker at her, at which she looked me full in the face and chugged half the juice box.
Thus began an extremely enjoyable half hour where I would proffer a juice box, Isabella would drink it, and then I would give her a choice of stickers. She would then take her sticker hoard and count it into her father’s hands; as she wandered off to the other side of the room, I would collect them back and offer them again in exchange for yet another juice box. Her parents, initially drawn with concern and ready to battle on their daughter’s behalf, relaxed more and more with each sip, until finally we were all giggling as Isabella once again carefully counted the same stickers into her father’s waiting hands.
My final note read, “Patient drinking well in ED. Parents and patient discharged home with plan in place for hydration.”
I just didn’t mention that the plan was bribery with sparkly kitty stickers.