CHAPTER 8- MEETING THE PEDIATRITICAN
Apart from nebulizer treatments every four hours and nurse checks Ryan had a relatively peaceful night. Sandy couldn't say quite the same thing considering every change of Ryan's breathe caused him to start. In the end though Ryan had done well and had made it once more to a new day.
As the sound of a meal cart interrupted the quiet of the morning Ryan's eyes fluttered opened. Seeing Sandy watching him he smiled shyly and whispered "Hi".
"Hi yourself. Looks like you awoke just in time for a gourmet meal."
"Yeah right- gourmet. Think I might prefer Kristen's food over theirs."
"Blasphemy Ryan." Sandy countered with a mock face of terror.
Ryan chuckled at the expression which caused him to also break into a short coughing fit. Sandy had moved to stand beside him when he started coughing and had gently rubbed his back during the process. When Ryan had finished he grabbed the juice cup from the breakfast try and handed it to Ryan.
"Thanks." Ryan said after a few sips.
"Alright well let's not put off the inevitable. Open up that mystery container let's see what they've prepared for you."
Deciding to play along with the act Ryan slowly moved his hand towards the covered tray and acted like he was going to open it. He drew out the process barely moving the lid up as if afraid something might jump out at him from under it.
"Come on son that's no way to handle the fear. You have to treat it like a Band-Aid. Just rip it off."
With a grin Ryan listened to Sandy and suddenly tore it off with a flourish. Apparently with a little too much zeal as the lid suddenly flew out of his hand and went flying towards the side of the room nearly taking out his IV pole. Both boys found themselves laughing and blushing at the whole episode.
The tow laughing men were unaware of the fact that the whole thing was being witnessed. The food delivery person had forgotten to slide the door closed after delivering the meal allowing a doctor to approach the room unnoticed.
"Well gentleman it seems some people are feeling a bit better if they can attempt to assasinateThe doctor who was observing spoke up with a voice laced with humor.
At his speaking two sets of eyes immediately connected with his. The youngest pair seemed full of guilt while the older pair seemed to be twinkling with joy and mischief.
"No worries son." The doctor spoke up in order to ease any fear the youngest might have. "I am quite aware of the facilities poor excuse for cuisine."
"Good to see you Doctor Peters. I'm surprised this is the first we've seen of you." Sandy spoke up indicating he recognized the new doctor.
"Yes well I have been in touch with the hospital, but while he was still in ICU I decided to put off coming in until it was a little closer to planning follow up care for discharge." The doctor responded.
"Ryan, this is Doctor Peters. He's been Seth's pediatrician since we moved here. He's one of the best." Sandy remarked bringing Ryan up to speed with his new quest.
"Well I don't normally toot my own horn, but I certainly won't turn down a positive endorsement now will I. It is my pleasure to meet you Ryan your parents boast of you often though I do wish we could have met on better terms an in more appealing surroundings."
"Yeah – me too." Ryan said softly. He liked the demeanor of this doctor. He was an older gentleman probably in his sixties. He had a hint of a British accent though it was hard to hear probably worn away by many years living in the States. His face was welcoming and his eyes spoke of kindness. He looked nothing like the doctors Ryan was used to in the free clinics of Chino. Those doctors always seemed so distant like they had been worn down by too much violence and too many hours.
"Do you mind if I listen to your lungs? I'm caught up with your charts, but I feel it's always best to do a personal exam."
Ryan demonstrated his approval by sitting up with Sandy's assistance as he still felt quite weak.
"Alright take a deep breath in. As deep as you can."
Ryan complied and was soon coughing from the effort. He was able to calm himself relatively quickly though. The doctor repeated the process a few times moving the stethoscope around sometimes asking for deep breaths and sometimes asking Ryan to breathe normally. When he was done he stepped back and swung his stethoscope back around his neck.
"Well I'm hearing bilateral wheezing- meaning both of your lungs are still constricted. However, the fact that I can actually hear you wheezing now is a marked improvement form the absence of breath sounds that were noted when you first came in. I am glad that your cough is the dry asthmatic cough we would expect and not a wet one indicating you haven't picked up any secondary infections. Your blood work indicated this also. Your pulse ox is a little between today climbing back into the mid-nineties. We will try you on room air instead of the nasal cannula today and see if you can maintain those numbers. If you can than we will talk about discharging you tomorrow. You'll be on restrictions when you go home though. Because of the severity of your attack plan on missing one more week of school. They should be able to arrange to bring you work at home so you don't get too far behind. What we will probably do is have you come into my office next Friday for a follow up before sending you back to school. In that visit I can write school releases and double check meds. Now I saw what the ICU doctor mentioned in terms of starting you on preventative medications, but I want to check with you first about what you may have taken in the past. So you know what meds you used to be on?
"Truthfully, no. I was pretty little and we didn't have insurance so we weren't often real consistent with meds. I know I had an inhaler for a while –a blue one. I think they had me taking pills sometimes too but I don't know what. If I was supposed to be on anything else I never was. Mom wasn't too keen on spending money for daily prescriptions. She was more of the mindset you only need meds when your ill not all the time."
"If I ever get my hands on that lady…" Sandy grumbled under his breath.
"It's okay Sandy. It's in the past and mom wasn't all bad." Ryan interjected feeling like he should make some effort to defend his mom though in truth he kind of agreed with Sandy. He was just a kid and even he knew to treat people better.
"It's not okay Ryan, but we'll talk about that later for now let's hear what the Doc wants to do for you." Sandy replied. He intended to have a heart to heart soon with his son to assure him he was deserving of love and care and that it wasn't right that he'd had to wait this long for it. Sandy could not erase Ryan's past but he could sure as hell make sure the boy got all the love and care in the world now.
"Thank you Ryan for clearing your past up a bit. It is actually about what I expected considering very few kids are aware of the names of their medications and you were quite young at the time. Dr. Jackson had mentioned he wanted you on a rescue inhaler and a preventative medication called Advair. I agree with these choices and I am going to start you on them today and show you how to use them. Before I do this can you tell me if allergies are something you have trouble with?"
"Sometimes. Usually in the spring when things start to bloom. I am prone to Sinus infections."
"Alright we'll keep an eye on that then and I may end up starting you on one other medication called Singulair. It works well to relieve allergy symptoms and is also helpful in preventing asthma flare ups."
"Okay." Ryan said.
Doctor Peter's took two things out of his pocket and set them on the tray table in front of Ryan. One was a small red inhaler and the other was a purple disked shape object. The doctor picked up the purple disk first.
"This is an Advair inhaler. You will use this twice a day. One puff in the morning and one at night. What you do is you twist it and hold the open hole to your mouth and breathe in as deep as you can. Then you hold your breath for a minute and breathe out. This allows all the medicine to get into your longs. This medicine consists of a steroid that helps to reduce inflammation over time and strengths your lungs against future attacks. Why don't you try it right now?"
Ryan took the inhaler and did as the doctor demonstrated. When he was done he set it down on the table. He had a bad aftertaste in his mouth and his expression must have given it away.
"I know it leaves a bad taste. It is actually important that you rinse after using it or brush your teeth as the residue isn't really good for them." Doctor Peters informed him as he handed him a glass of water and an empty cup.
Ryan took both cups and rinsed and spit a few times until the aftertaste was not noticeable.
"Now this inhaler is your rescue inhaler." Doctor Peters said indicating the second device. "This is what you use when you notice a persistent tightness in your chest or you begin wheezing or having that annoying dry cough. You shake it before using it than bring it to your mouth and push down as you breathe deeply in. You hold your breath for a minute and then breathe out. Wait a minute and then repeat. Since you haven't just had a nebulizer treatment I am going to let you do this now also so you can feel the effects."
Once again Ryan performed the tasks as they were described. The feeling of the inhaler was familiar to him. He could feel a little bit of relief from it in his breathing fairly quickly. Not as much as the nebulizer which gave him more medication, but enough to be noticeable.
"Now the rescue inhaler can be used 2 puffs every 2 hours as needed. In an severe attack you can use it again after ten minutes, however; if after the second use you still feel no relief or you feel worse you need to get to a doctor or call for help. Likewise if you end up using your inhaler more than four times in one day I would like you to make an appointment with me to get checked out. If you do this hopefully we can prevent any more serious attacks and get your breathing back under control."
"I understand." Ryan said.
"Me too thanks for explaining. I may have you show Kristen too." Sandy said.
"Yes that would be good. It is important others now how to use Ryan's meds in case he ever has trouble administering them himself."
"Alright Ryan there is one last item I want to show you. Have you ever seen one of these?" Doctor Peters asked as he pulled out a contraption that looked like a cardboard tube attached to a plastic device with numbers on it starting at 0 and going to 800.
"Umm I think so but I'm not really sure?"
"That's fine. Let me explain it. This is called a peak flow. It is a tool that helps us measure how much air your lungs are able to move. What you do is take a deep breathe in as deep as you can and then blow it out as hard and as fast as you can into this tube. When you do this it will move the meter up to one of these numbers indicating your peak flow result. Now since your about 5'8'' your average should be between 450 and 550. Considering you just had an attack it will probably be much lower. What I am going to have you do for the next few weeks is use this in the morning and at night and record your results so we can see what numbers you fall into. Over time this helps establish a pattern and can help warn you on days when your lung function is diminished indicating you may need to change your meds or visit me. Do you understand?"
"I think so. Can I try it?"
"Yep. Here you go."
Ryan took the peak flow and breathed in as deep has he could and blew out. He was disappointed to see the meter didn't even pass 200.
"Try again Ryan. I am not surprised its low you have to remember it was only two days ago you stopped breathing completely. It takes time to get your lungs back in shape."
Ryan tried again getting it a little higher though it still hovered right around 200.
"Alright again don't worry. I am going to leave this with you and you can practice with it. The more you practice the more you work out your lungs and it will help. Just don't overdo it. Remember your still healing."
"Okay." Ryan said eying the contraption the whole time. Sandy had a feeling the meter was going to be getting a work out today. Ryan didn't do anything half way.
"Well unless you boys have any questions I think I will let you get back to your meal."
"I can't think of any, what about you Ryan?"
"No". Ryan said with a shake of his head.
"Okay then get some rest and I'll see you in the morning to discuss discharge."
"Bye." Both boys said in unison.
Once the Doctor left Sandy looked back to Ryan and his peak flow.
"Let me see that thing I want to see how well I can do. After all you know I am in great shape. I bet I master it with a perfect 800." Sandy remarked his chest puffed out to add to the bragging.
"Sure old man see what you can do." Ryan affirmed handing over the dreaded piece of equipment.
Sandy took a deep breath in and blew out. He got a 500.
"Now that can't be right let me try again." This time he got 510.
"Great job superman." Ryan teased. "Let me show you how it's done." Ryan took the meter back and tried- still only achieving 200.
"I say it's broken." Sandy teased back.
"Yeah that must be it." Ryan confirmed with a smile. For the next few minutes the boys continued to play around with the new torture device/assistive tool.
"Alright that's enough." Ryan finally said with a smile and a few wheezed breathes from the exertion. "I think I am going to rest again."
"What about breakfast it's still here?" Sandy joked.
"Yeah and it is still unappealing. I think Kristen said she was bringing bagels later. I'll wait for shift change with you two."
"Fine be that way." Sandy pouted.
"I will." Ryan said as he laid back.
Sandy grinned at his son. "Get some rest kiddo. You did well. I love you." Sandy said as Ryan closed his eyes.
At the words 'I love you' Ryan's eyes jumped back open in surprise. Upon meeting Sandy's own eyes that shimmered with assurance Ryan relaxed.
"Thanks" he whispered as he fell into alight doze.