On the evening of Wednesday, March 30, 2011, 10-year-old Maya came down with a slight fever. The day had been like any other typical day. She had gone to school and completed her gymnastics practice without any difficulties. However, the following day she didn’t go to school, hoping that with rest she would be able to participate in her class marionette show that evening. Maya had a starring role for which she had been practicing for months and did not want to miss it. By that afternoon, her fever reached 102 degrees, but it came back down to a normal level with some medicine. Everyone was counting on Maya to be in the show, and she did not want to let them down so her parents let her go. She did fine during the show and even attended the ice cream party afterwards, all the while seeming like her normal self. However, that night, after she went to sleep her fever spiked to 104 degrees.
In the morning, her mother called her pediatrician and made an appointment. The doctor checked Maya for strep, for which she tested negative and felt that it was probably just a virus. She prescribed an antibiotic, just in case, and said to bring her home and give her lots of fluids. She said to try to keep the fever down with medicine and tepid baths. In retrospect, her mother wishes she had been more forceful about her concerns at this point. What the doctor didn’t realized was just how bad Maya was already feeling. Her mother had to carry her into the office because she was feeling too weak to walk. She threw up once in the office and again after they left, inside the elevator.
After her mother brought Maya home on that Friday afternoon, her fever ran between 101 and 104 degrees. She only threw up one more time, but by the middle of the night began to experience diarrhea. During all of this time, Maya was sleeping a lot, yet when she was awake she was coherent and would drink water. On early Saturday morning (around 2:00 a.m.), it appeared that her fever had broken and her mother thought things would start turning around for the better. However, despite her lower fever, she didn’t seem any better and in fact, seemed worse. Her mother would later come to learn that this may have been the point when her little body was beginning to give up and she was going into septic shock. Instead of feeling warm to the touch, now her hands and feet were feeling cold.
Maya seemed more lethargic and her whole body was red. Her parents called the pediatrician early Saturday morning (around 7:00 a.m.), who continued to say that they could treat her at home with fluids and over-the-counter medicine. Her mother accepted this for about 20 minutes and then called back again and said they were taking her to the emergency room. Maya has asthma and now she was saying that she was having a hard time breathing. All of a sudden she seemed to be decompensating rapidly. Her mother knew she was much worse than she had realized; when she picked her up off the couch to bring her to the ER, Maya had lost control of her bowels and didn’t even know it.
Her mother drove her to the hospital and walked right in without stopping at triage and insisted that she be seen right away. Luckily, the doctor in the ER immediately recognized that something was terribly wrong. The ER nurses were unable to start an IV due to her severe dehydration and needed to call in a nurse from the pediatric ICU for assistance. It took many, many sticks, but they were eventually able to start an IV to draw blood and give her fluids. The blood tests confirmed the doctor’s hunch…everything was off. She had “thrown” her sugars (prompting worries that maybe she was diabetic), her electrolytes were off, and every other test was off the charts. Her heart was beating rapidly and for the first time, she seemed to be a little confused about what was going on. Still, the doctor tried to reassure her parents that perhaps she was severely dehydrated and with fluids and antibiotics she would stabilize.
Maya was transferred to the Pediatric ICU for close observation, where more tests were done. Despite all the fluid going in, she didn’t seem to get much better. Her mother learned that the fluid was going into what is called “the third space,” which means her body wasn’t processing it. A young doctor that was on shift in the PICU until 7:00 p.m. that night continued to monitor her closely, but did not change the course of her treatment. At shift change an older doctor with many years’ experience came on board. Thankfully, he recognized the precarious state that Maya was in. He kept insisting that she looked “shocky” and without us knowing began to prepare for what was to come. This included making sure there was a crash cart nearby.
Around midnight, Maya crashed during a catheterization procedure. Her blood pressure dropped and she was no longer able to breathe on her own. Because the doctor was prepared, he immediately put her on a ventilator to assist her breathing and started medication to keep her blood pressure up. A line was also quickly put into her jugular vein to better administer the myriad of IV medications she now required. Tests revealed hypotension, hypocalcemia, renal insufficiency and thrombocytopenia. A platelet transfusion was done due to the possibility of severe bleeding. She was diagnosed with “toxic shock” another name for sepsis and was now fighting for her life. But, thanks to her strong spirit and the excellent care she received, she pulled through.
Maya remained in a medically induced coma and on the ventilator for three days while her condition gradually improved. What her mother remembers most about this time was that she was initially in a state of denial about how critical Maya’s situation was. She did not want to believe that there was a chance that Maya would not come off the respirator. Now she knows that more than one-third of patients who require ventilation do not make it. Had she known that at the time, her fear would have been unbearable. After coming off life support, Maya stayed in the PICU for two more days then remained on the regular hospital ward for a total of 10 days while she continued to receive breathing treatments and IV antibiotics. Maya was finally discharged from the hospital to go home on April 12, 2011.
Tests came back revealing that Maya had been dealing with the H1N1 influenza virus. Maya’s mother knows that a flu vaccine could have prevented the horrible ordeal; her greatest regret is that she did not get Maya vaccinated that year. Her mother had gotten all her children vaccinated in the past, but was not consistent year after year, particularly as they had gotten older. The flu vaccine had been offered but she had put it off not realizing the potential danger she was putting her children in. Now she knows just how dangerous the flu can be and that it can take a life with lightning speed.
Maya’s mother wants people to know that influenza can be a serious threat to your health and can escalate into a life threatening illness in a matter of days. The best treatment is prevention….get your flu vaccine.
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