“Peter Nguyen” was admitted to the Pediatric floor for an unspecified difficulty walking. He arrived on a Monday and he left on a Monday.
Peter is a skinny little boy. He’s 9yo, but has the height of a 7yo. He’s partially verbal due to his autism, parroting words that he hears when you ask him questions, but follows commands quite well. His father stayed with him for almost the entire week, sitting by the bedside with short-cropped salt-and-pepper hair that leaned towards the salt. He would stand to greet us, the pediatric team, whenever we entered the room. He stood uncomfortably, without complaint, with his cane for support.
For the first few days on the service, Peter presented a bit of a mystery. He had trouble walking for a day or two before admission. He walked slower than his normal rambunctious nature and with an odd gait, unusual to him. He also had a mild fever and other systemic signs of an infection. Upon physical exam, the overnight residents noticed that he slid off the bed in order to stand up, that he didn’t utilize his hip musculature in the normal way to sit up.
The admitting physician believed him to be a classic case of a psoas abscess. Peter, however, could not verbalize exactly what hurt him. A CT scan on admission revealed no lesions suspicious for an abscess, or a collection of pus.
So, we waited and watched him throughout the week. The treating team controlled his occasional fevers with tylenol. They consulted infectious disease, to cover their blind spots and to get another set of eyes on the confusing case. No antibiotics were started, because no one knew for what to treat him.
Towards the middle of the week, we began to talk about discharge. His gait, while not wholly improved, seemed to be on the upswing. Additionally, his father noted that he really wanted to return home. We said that if he showed no more fevers for the remainder of the day and his gait continued to improve, then perhaps he could be discharged to physical therapy on an outpatient basis. For a mystery issue with his hip.
He did, of course, spike another fever and his gait declined. The attendings kept scratching their heads and ordered a sedated MRI for the next morning: MRIs are quite sensitive but require the patient to remain still for upwards of 45min, difficult for a young boy without chemical assistance.
When I returned to the pediatric floor the next day, I found both good and bad news awaiting me.
First, the good news. The MRI had picked up bilateral abscesses in the adductor muscles of the hip, as well as an abscess in the psoas muscle. This explained his symptoms and justified the admitting physician’s gut feeling. We still don’t know why the CT did not pick it up, but at least we have an answer and plan for treatment. Interventional Radiology would put the young man under anesthesia and drain the collections of pus to both reduce his symptoms and to culture the organisms causing him harm, to best tailor the antibiotic therapy.
Now, the bad news. Overnight, the father had returned home to find the house robbed. We didn’t know the extent of the robbery, but that a significant amount of valuables were taken. For the first time, the father was not present in the morning when we rounded. His brother took his place at the vigil.
The news hit all of us hard. Peter had a charm about him. For me, perhaps I assumed a connection because of our shared yellow blood: him Vietnamese and myself Korean, we were far closer than the mostly white treating team. I hoped sometimes that he liked me because he saw someone that looked like his family. He had a cheerful demeanor even when he was in discomfort.
Additionally, his father was a stalwart companion throughout the entire admission. Many of the residents gave him the informal ‘Father of the Year’ award for his involvement in care. To the point that when Peter was wheeled down to the sedated MRI, the nurses and residents ensured a wheelchair for the father so that he would not need to hobble his way with a cane down to the procedure.
I rotated off the service on Friday morning, after the IR procedure to drain the abscesses. It had gone well, with cultures brewing and empiric antibiotics preventing further fevers. I remember waving to them both, assuming that this was goodbye.
He arrived on a Monday and left on a Monday.
The following Monday, after I rotated out of inpatient peds and onto outpatient pediatrics, I saw Peter sitting on a bench outside of the outpatient hospital pharmacy. A feedback session with clerkship directors brought me to campus, and I bumped into Peter and his father on my way out.
Peter had his legs kicked out in front of him and he wiggled from cheek to cheek. A big plastic bag filled with other plastic bags, a stuffed backpack, and a plush monkey shared the bench with the father and son. The father searched through his pockets, but I didn’t realize that until after I had greeted Peter with an enthusiastic wave.
It seems that they were discharged from the hospital just moments before, and I was glad to have caught them before leaving. Their story left an impression on me. The path for them after leaving the hospital was just as fraught as the one leading them here, to discharge.
While he searched through his possessions, I offered some condolences for the burglary. He sighed and told me how they took just about everything, since the robbers had the luxury of time. He told me about the Christmas presents that were taken. He mentioned the lost red envelopes that have accumulated a good bit of wealth over the years for Peter.
It stung to hear and likely hurt more for him, knowing that whoever stole from them shared their culture and their neighborhood. Otherwise, how would they know that this family had been out of their house? And how would they know the value of a red envelope?
I grabbed their backpack and plastic bag while the father put his cane to the floor and Peter hopped off the bench. His shoes lit up with red LEDs from the impact and he continued to hop, keeping them lit. We made our way out the lobby and to the lot of cars nearby.
I walked behind the father and next to Peter. The father would alternate between asking Peter to slow down and if he was excited to go home. I’m sure he was looking at this walk as a small transition between events, rather than an end to something. I knew this little dude and and his family would have a lot of work ahead of them, but I hoped he wouldn’t be returning to the hospital soon.
We made our way to a silver sedan, with two sets of safety seats in the back. I placed the backpack and bag on the passenger side, while the father buckled Peter into his throne. The father thanked me, probably quite ready to get on the road and settle Peter back into the house.
I shook his hand and mumbled something about anything I could do to help. I turned to Peter, who had been looking at me, and waved a goodbye. Instead of returning it, he stuck out his little hand for a shake and gave me a good squeeze when I met him.
I can’t remember if he smiled at me, but I know I was smiling something goofy when I walked my way back to the hospital.
Emotionally, I feel great. I feel like the winter doldrums and recession is over. Warmth is slowly returning to the landscape and I have all sorts of plans for the coming spring and summer. I feel more myself with everyt passing week.
Spiritually, I know I have work to do and I know that I am working. I keep my practices going and restart old ones. Chop wood and carry water.
Physically, I feel good. I am stiff, that is secondary to lots of movement the past few days without much mobility or stretching. I need to prioritize that. Lots of moving has felt great. A short run and play session outside yesterday felt so good.
Relationally, I have been doing alright. I would like to keep myself connected to loved ones, but I never feel like I have enough time. I did, however, watch a scary movie with the house and Bansi. And I am preparing for a week of missing my spouse, as Mackenzi begins nights this week. Life is good.
Emotional – 4/5
Spiritual – 4/5
Relational – 4/5
Total – 16/20
3wk running total – 48/60
Long Form Sundays
- On responsibility and engagement (or halfway through Women’s Health/Pediatrics)
- On making the rounds
- On shifting priorities