Tag Archives: hospital

10 things to remember if your child breaks a bone and you are nowhere near a hospital

How’s that for a light-hearted title? I bet you’re well cued that this is going to be one of those laugh-out-loud posts.

Or maybe not.

Most of you probably won’t be in the position of having your child break a bone and being thirty hours and an international flight away from good medical care, but if you’re a parent thinking this topic through can’t hurt. Presumably, for example, some of you go camping. So today I’m going to share some of the lessons we learned or put into practice last week when Dominic broke his femur. Some of these things we learned the hard way as events unfolded, some we already knew and came in very, very handy.

 1. This doesn’t strictly count because it’s prevention, but we all know that prevention is infinitely better than any cure, so … Sit down with guests when they arrive and specifically warn them about any hazards in your house. Staircases and swimming pools are always significant hazards (visit this website to review other common hazards). Briefing guests will not prevent all accidents, but it can’t hurt.

2. After an accident happens, do not assume that the people involved are able to relay a complete and accurate account of events. Accidents happen fast – those involved may not be aware of everything that unfolded in that instant. They will also be shaken themselves and may be in shock. Assume that your child is seriously injured (and handle them accordingly) until you are reasonably certain that nothing is broken and that they did not hit their head.

3. If in doubt, get it X-rayed. We were fortunate that the X-ray machine here in Luang Prabang was working last week and the technician was in work. When local doctors examined Dominic’s leg it was the only time all morning that he didn’t scream when it was moved. The doctor seemed very confident that it wasn’t broken but we had it X-rayed just to be sure.

4. Use your friends. This is not time to be shy about calling in favors from your medically trained friends. Get on your phone or get on skype and call a doctor. Even if you think you have things under control, you are also very stressed and outside observers may be able to provide helpful input on something you’ve missed. (In our case our friend, Asha, a pediatrician, got on skype with me at 10pm her time, walked me through appropriate pain relief and provided advice on how to make Dominic as comfortable as possible during the night).

The pharmacy near our house

5. Have a variety of infant pain medication on hand. We already had children’s paracetamol in the house but nothing else, and it is not advisable to administer more than four doses of paracetamol in 24 hours. Apparently, when treating breaks and fractures, one good strategy is to alternate doses of infant paracetamol with doses of infant nurofen. Luckily, when Mike got on his bike at 6:30pm and made an emergency dash to some of the local pharmacies, one of those stores had infant nurofen in stock.

6. Have a medication dummy/pacifier in your first aid kit: We don’t have one of these (yet) but I’ve since learned of their existence. It works by loading the medication into a reservoir that then flows through the dummy teat. Apparently they can sometimes work better than syringes when it comes to getting babies to swallow medicine they don’t like the taste of (orange-flavored infant nurofen, for example).

7. Breastfeed upon demand. Breastfeeding apparently reduces distress and lessens pain, and so does proximity to mum (or dad, if dad is the child’s primary caregiver) so stay close by.

8. Splint the limb to hold it stable and reduce your child’s pain. Our insurance company’s doctor told us over the phone how to splint the leg. We used packing box cardboard and a gauze bandage. Cardboard turned out to be a good choice because it didn’t have to be removed for the X-rays in Thailand. I taped the cardboard edges with gauze tape so they wouldn’t scratch him, but another thing I wish I had thought to do was slip a soft pair of my cotton socks over the cardboard to make it marginally more comfortable against Dominic’s skin.

9. Move your child as little as possible. This one is common sense – anyone who has broken a bone knows how much it hurts when that limb moves – but make sure you think creatively about how you can minimize movement. We were assuming we’d put Dominic in his travel cot as usual during the night until Asha pointed out that we could just leave him on the change table mat to sleep for the night rather than trying to maneuver him into that small space. And to that end…

10. Sleep your child somewhere where you can get to them to comfort and/or breastfeed without having to move them. The change-table mat on the floor by my side of the bed worked for us – I was able to feed Dominic by kneeling over him.

Finally, a bonus number 11: If you take up yoga while you’re pregnant, don’t quit after you give birth. You never know when you’re going to find yourself on an airplane having to breastfeed a baby who is strapped into a carseat.

Any tips to add? Leave them below to help out others who will read this post.

Feeling much better in hospital in Thailand

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Conversations in hospitals

As you can probably imagine, Mike and I have talked about many things since Dominic’s accident. Much of what we’ve been mulling over is serious, hard stuff and nowhere near funny. These two snippets, however, I can share. They’re as close as we came to laughing this week.

In the doctor’s office, staring at Dominic’s X-rays on the computer screen while three specialists debated out in the hallway about whether Dominic needed surgery:

“I think I should quit the fruits of the spirit project,” I said.

“What?” Mike said.

“Think about it,” I said. “It took me more than a month after Dominic’s birth to untangle how I felt about the fact that maternal love hadn’t swamped me upon delivery. Then the month of joy was full of days that felt decidedly joyless. During the month of peace a friend dies and one of my worst fears fulfilled – now the month is ending with my baby in a cast. If I wanted to speak Christianese, I might say that I was under spiritual attack. Now, I sort of have to do the month of patience given what’s in front of us during Dominic’s recovery, but after that I think I should quit.”

Mike laughed.

“I wouldn’t laugh,” I said. “You know what comes after the month of patience? The month of kindness, then the month of faithfulness. I would want me to quit if I were you.”

Day three in the hospital. I’ve only left the room once each day, briefly, to go downstairs to the lobby and procure a caramel macchiato and a cream cheese muffin. Mike is trying to do some work and I’m on the bed pretending a toy bear is looking for honey in Dominic’s ear. When that stops working in about 23 seconds I will move on to fake sneezing, because that’s always good for a smile at the moment.

“Remember last time we were here?” I said.

“Yeah,” Mike said.

“I mean, I know you had an IV stuck in the back of your hand and all,” I said. “But once we knew the staph was under control it was sort of fun, wasn’t it? We ate French fries and ice cream sundaes. We got to hang together all week and work, then cuddle up in the evenings in the hospital bed and watch movies on the big screen TV.”

“And go for walks in the evening down to the nursery to look at all the babies,” Mike said. “And now we have one of our own.”

We both looked at our baby. He looked frustrated and needy.

“Last time was sort of like a little holiday, wasn’t it?” I said.

“Yeah,” Mike said. “It sort of was.”

Yes, folks. We were reminiscing about previous medical evacuations … wistfully. It was that sort of week.

We’re back in Laos now. Dominic seems to be doing OK. Not well, but OK. He still needs pain medication every couple of hours, which is a bit problematic because he’s decided he hates the taste of the infant nurofen (not that I blame him, it’s sickly sweet and orange-flavoured).

“You think I’m going to take that nurofen nicely? Think again.

Every time we try to dose him with nurofen it’s a trial that starts with locked lips and glaring and inevitably progresses to screaming and sticky orange goo all over his face and clothes. The strawberry-flavored panadol, however, he gulps down like a starving piglet and doesn’t let a single drop escape. This week has so ruined his taste buds for broccoli and carrots.

Now the countdown begins. We take Dominic back to Bangkok for more X-rays and (hopefully) the removal of his cast three weeks from yesterday. My parents will be in town then, so on that day we were hoping to land in Bangkok at 9:30, clear immigration and customs, get to the hospital, get X-rays, see the orthopedic specialists and get the cast off, see a pediatrician and get 6 month vaccinations (sorry little guy, you’re just having the worst run at the moment), and make it back to the airport by noon at the very latest so that we can fly back to Laos at 1:30 that afternoon rather than overnighting in Thailand.

After seeing the lines at Bangkok airport immigration yesterday I think our chances of all that unfolding on schedule are … (insert appropriate idiom here). I’m tempted to go with “a snowball’s chance in hell”, but Mike thinks we can do it. Anyone want to place a bet?

Finally, here’s how today’s introduction to rice cereal went:

“Oooh, what’s that? Maybe it’s strawberry-flavored Panadol!

“Yuck! Rice cereal tastes worse than nurofen!”

“Why are you torturing me like this? What did I ever do to you?”

“How many times do I have to say no?”

“Much better. You got any panadol around, though? Cuz I’m sorta hungry, you know.”

Dominic’s leg: The ugly, the bad, and the good.

We’re here at Bumrungrad hospital in Bangkok. I tried to organize this into some sort of coherent update by good, bad and ugly categories, but I not feeling coherent enough myself yet to pull that off. So, in no particular order and with no particular artistry, here’s what’s going on.

Good: Mike and I are overwhelmed by the amount of love and support people are directing our way from around the world. We are so touched and feel so loved. Dominic, of course, has no idea that so many people are thinking of him and praying for him, but we sure do.  Thank you. Thank you. Thank you.

Bad: Despite our insurer’s best efforts, it took us more than 30 hours to get Dominic to Bangkok after the break. During that time we splinted his leg using cardboard and gauze (Mike’s dad did most of that, actually) and kept him as still as possible. We slept him on the change-table mat on the floor and I fed him by kneeling over him. I also managed to feed him on the plane without taking him out of the car seat (which I think I should get some sort of acrobatics award for, and maybe an honorable mention for sacrificing dignity). During these last 48 hours there have been several times when I really wished I had not slacked off on yoga after Dominic’s birth.

Good: This is our second medevac with our medical insurance company, International SOS, and they continue to impress (and when I say “impress” I mean: I would like to kiss every single employee of that company plus anyone who sits on the board).

They made probably a dozen phone calls to Laos to keep us updated on their efforts and a doctor walked us through how to splint the leg ourselves. They flew a doctor up to Laos to escort us back to Bangkok on the flight. We were met at the gate and whisked through the diplomatic channel at immigration and customs and then met at the curb of the airport by an ambulance and two nurses.

Bad: In the ambulance the nurses and the doctor who’d travelled with us were in frequent communication with the team waiting for us at the hospital. They told me they didn’t want me to feed him after 4pm because they’d scheduled him for surgery at 8pm, and then they put the sirens on the ambulance in an effort to get us to the hospital faster so that I could feed before the deadline.

Running the ambulance sirens because the baby needed to kin nom (drink milk) would have been funny … except that it wasn’t. Also, the sirens were a nice try, but they didn’t make much of a difference in the middle of Bangkok traffic jams. We sat on the freeway within sight of the hospital for more than 30 minutes (which, if things have been dire, would have been mind-blowingly agonizing).

Good: Bumrungrad is the nicest hospital I’ve ever had the (dis)pleasure of spending time in. The place looks more like a nice hotel than a hospital and the staff seem phenomenally efficient. With one exception (see the next “ugly” point) I’ve never had a moment’s doubt that we are receiving top of the line medical care here.

Good: Dominic had been X-rayed and seen by two specialists within an hour of walking into the hospital. During the first consult they told us that they would take Dominic to surgery, set the leg under a general anesthetic, and put him in a spica cast (a both-leg rib-height body cast). Then they changed their mind. They could set the leg without surgery, they told us. This initially seemed like good news, but…

Ugly: They didn’t mention anything about a game plan for pain relief. When I strongly requested they make such a game plan the nurse went away and came back with … oral paracetamol – the same thing I’d been giving him for the previous 36 hours. I argued that they should at the very least give him paracetamol and codeine, but the doctors told me that they only ever use paracetamol or a general anesthetic – nothing in between – and they had no experience with giving codeine to infants so they just wanted to “do it natural.” As if there is anything “natural” about breaking the end off your femur. I was so angry. Mike had to be the one to take Dominic in to get the leg set. I couldn’t face it.

Ugly: The break is bad and complicated – all the way through the femur, right above the knee and in the growth plate area. For those of you who haven’t had a crash course in orthopedics lately, that’s bad news when it happens to a baby at this stage because there’s a chance that it’ll disrupt normal growth patterns. Dominic will have to be monitored annually by X-ray for the next few years (1 yr, 2 yr), then every two years (4,6,8) and then annually again up through the teens.

Good: The break was set by 6:30pm (less than 2.5 hours after our arrival at the hospital). And in the end they did not have to put Dominic in a spica cast, just a hip to toe cast, and that will probably only have to stay on for three weeks. X-rays today reveal that the set helped realign – even my untrained eyes can see the difference and the doctors seem pleased. They also told us that the specialist team met again and they think the chance of us having ongoing problems has dropped slightly. They’re not sure, but they think the break occurred just above (by 1 cm or less) the growth plate. If that’s the case, the long-term prognosis is better.

Good: Dominic slept quite well last night, all things considered, and has been relatively content today with only a couple of crying jags. We’ve even had some smiles. It is a huge relief to see him in less pain.

Good: Despite how harrowing the last two days have been, we remain acutely grateful that we have the resources and the networks that allow us to receive such excellent medical attention. These have been some of the worst days of my life, I cannot really fathom how much harder they would have been without the resources that are available to us.

So that’s some of the good the bad and the ugly from this end. To finish, here’s the “lovely”. The insurance company had flowers and a teddy bear delivered to the hospital. Dominic was a fan … of the ferns, anyway.

Love and thanks from Bangkok,

Lisa, Mike & Dominic

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