In the hustle and bustle of today’s short-staffed health care system good old bedside manner can often go the wayside. However, since becoming a mother five years ago I have developed a new sense of empathy and have made a conscious effort to listen to my patients and give them the full attention I expect when I play the role of the health-care recipient. How I could have slipped in my own home, I still have difficulty accepting.
My oldest daughter, Isabela can be best described as an exuberant, articulate, assertive, and very dramatic. She prefers to announce that she is “parched,” instead of thirsty, “starving,” instead of hungry, and often enjoys pretending to swoon in an effort to avoid eating her vegetables.
Early one morning this past August I considered her limping to be a new addition to her arsenal of early acting skills and even gave a chuckle when she announced that she was “limping like a little old lady.” I placed my skinny daughter in her car seat, turned on her playlist of high-pitched children music and we were on our way on an hour drive to drop off my mother at a work-related retreat in the Adirondacks.
My mother and I noticed Isabela was more quiet than usual and began to ask her if she was feeling well, to which she responded that she was hot. I turned up the air conditioning and asked her if she would like to stop for ice cream. Upon her exuberant response I dismissed the idea that she wasn’t acting like herself and continued through the hilly terrain.
When we made it to the lake to drop off my mother Isabela refused to get out and see the lake and started to fall asleep so I continued driving to an ice cream stand we had passed a few miles away. I opened Isabela’s door and began caressing my daughter’s forehead in an effort to wake her gently and noticed she was perspiring. When I began to unhook her from her car seat she asked if we had arrived and looked at me through glassy eyes. It was then that I knew something was wrong. She was not herself.
“Isabela, are you not getting enough cold air in the back seat? Do you feel “the wind” back here?” I asked, worried that perhaps the air conditioning had stopped working and she was overheated.
“I’m cold mama. I don’t want ice cream. I want juice.” With that she climbed down from her seat and out of our minivan. The minute she tried to stand up on the pavement she collapsed. I was able to prevent her from falling to the ground but it was clear that she could not bear any weight. She looked at me and said; “I don’t feel good. We better call Dr. Shumee so he can look at me hip. It hurts a lot.” My heart broke and I pulled a juice box and some chewable Tylenol from my purse before strapping her in.
My nursing skills finally kicked in and I realized that Isabela had a fever and began to brainstorm possible medical scenarios as we drove toward an urgent care center that I knew had an x-ray machine and felt enraged at myself for taking my four year old on the long road trip. Several different scenarios tumbled through my panic-stricken head during the car ride while Isabela slept: a stress fracture we hadn’t noticed that had become infected, bacterial meningitis, her recent growth spurt had made her bones weak, some terrifying childhood cancer, her sinus infection was back on top of having a stress fracture, some strange flu!?
As I carried Isabela in to the waiting room she seemed to perk up a little and I noticed that she did not feel as hot as before so I began to calm down and reconsider that perhaps we would just be looking at getting an x-ray.
The doctor at the urgent care center was serious yet kind and patient. I was surprised when he did not chuckle or grin when Isabela told him she was limping like a little old lady and I noticed his eyes change when he saw her limp and almost fall when she attempted a pirouette. He scooped her up and put her on the table and began assessing her hip and leg.
“This joint feels hot. Come on over and feel mom.” He was right, it felt like the outside of coffee cup although it didn’t look very swollen and it was not red. “Has she been sick recently? Had a fever?” He asked over his glasses.
“Yes, first she had a cold, and then she had a sinus infection about three weeks ago. I believe she had a fever this morning and I gave her Tylenol about one hour ago,” I responded.
“Ok, then. I think your daughter has a synovitis. With any luck it is the “transient” kind and will go away in a few days on it’s own but we need to make sure that it is not more serious. I ‘ll call over to the pediatric emergency room at the medical center and let them know you are on your way.”
Things began to move quickly at that point and although I am sure that the doctor explained his diagnosis thoroughly I only focused in on the words “inflammation of the hip joint and “further testing to rule out sepsis and choose an effective treatment.”
Like any trip to the emergency room with a small child, the experience was long, tear-filled, and an exhausting test of our parenting skills within the realm of creativity and patience for keeping Isabela from trying to escape or being compliant with the “testing.” Everything looked scary to her and when the nurse came in with her IV tray the crying turned in to sobbing and it took a very long time to calm her down and her trust in the staff was broken.
The “further testing,” consisted of an x-ray of the hip, blood testing, repeated temperature monitoring, and several physical assessments by pediatric and orthopedic pediatric residents. When the blood testing came back negative I felt relieved and began to make plans for dinner in my head because I understood it as a sign that Isabela had the “transient synovitis,” as opposed to the “bacterial synovitis” and that the inflammation would go away by itself in a few days with some Ibuprofren. I was very surprised when an orthopedic surgeon entered our room and pulled up a stool.
“Well, the blood tests came back negative which is good. But there could still be some concern as to the collection of fluid in the space around her joint. Unfortunately the only way to test this collection of fluid for bacteria is to take a sample. If that is something you don’t want to do today, we could hold-off and see if she remains fever free and how she responds to an anti-inflammatory. But she will need follow-up everyday for the next few days.”
My husband looked at me with panic and confusion and I spelled out the words: “B-I-G-N-E-E-D-L-E in H-I-P.” My daughter looked at me and frowned, she hates it when we spell and the surgeon looked at me and nodded.
We opted not to have the “blah blah” procedure in the hospital that day and took our daughter home where I vowed to be her personal nurse round-the-clock and give constant updates of her monitoring to the orthopedic group and her pediatrician. The week after she was discharged was filled with repeat re-assessments and check-ups and thankfully her fever never returned and there was no need to proceed with the testing. It only took one or two days for the feeling of heat radiating from her hip to go away but it took 12 days for the limping to dissipate completely.
Our experience with Isabela had a happy ending and has served as an educational experience in itself but also left me to wonder about the other synovitis and propelled me to share this information to other parents that may one day encounter symptoms that are similar.
