Mind Games & Silence
Silence.
Alone, I’m surrounded by strobes of memories—the baby monitor wresting us from sleep … muffled choking sounds … my wife holding our pale, stridorous 2-year-old … desperate attempts to clear his airway … the studied detachment of the 911 operator … paramedics … my wife running from the house without a jacket … the fading ululations of the ambulance … silence.
I’m left in the bathroom, heart jack-hammering, holding a bloodied towel. Just 20 minutes earlier, I was cloaked in deep sleep. Now I’m shrouded with dread and cold sweat, my wife and son gone—leaving me to tend to our sleeping three-month-old daughter. The night ultimately ends well—perhaps comically, even—but not before being defined by three common cognitive errors.
History of Present Illness
It was a Monday night, and, after putting our kids down, my wife and I retired early to get a good night’s rest. An hour later, we awoke to gasping sounds from the monitor. My son, Grey, who was fine before bedtime, was panting and wheezing, unable to secure a full breath.
I immediately recalled that the night prior he had gagged on a dissolvable “gummy bear” vitamin. As he projected the appearance of someone who had aspirated something, we commenced manual sweeps of his mouth—feeling something in its deepest recesses. Gummy bear? Uvula? After numerous retching attempts to dislodge it, we moved on to Heimlich maneuvers. Nothing.
Just then, the paramedics showed up and took over, hearing this history of present illness.
Momentum Shift
An hour later, having secured a sitter for our sleeping infant, I showed up at the ED. Interestingly, the gummy-bear premise, nothing more than a harried utterance, had gathered the momentum of a boulder rolling downhill. The paramedics had relayed the possibility that our son might have aspirated a vitamin to the ED doctor, who relayed this certainty to the ear, nose, and throat doctor, who was actively scheduling operating-room time to bronchoscopically remove the offending foreign body.
It was all a bit like that childhood game of Telephone, in which the original message gets incrementally distorted with each telling, such that what starts as “Johnny told me he likes Lisa” turns into “Johnny crushed Lisa.”
My inner physician, elbowing the nervous parent aside, asked about the evidence for an aspiration. “The X-ray was negative, as was the exam, but the history suggests aspiration,” the ENT told me.
“What history?” I asked.
“That he has a history of ‘tonguing’ vitamins,” he said.
“Tonguing vitamins?” I responded, incredulously feeling the need to defend my child’s pill-swallowing honor. “Where did that story come from? We aren’t even sure we gave him a vitamin tonight.”
Nonetheless, the ENT was confident that “kids aspirate things all the time.”
Skeptical, I continued the debate. “But what if we hadn’t given that history? Would you still think of aspiration in this case?”
“Probably not, but then you did give us that history,” he replied. “So we need to bronch him.”
Culprit Revealed
Meanwhile, Grey was looking better with supplemental oxygen and a nebulizer’s worth of racemic epinephrine. His stridor took on more of a “barking seal” nature, and 30 minutes later, he developed a fever characteristic of croup. After a dose of steroids and another whiff of racemic epi, he was himself again, laughing the laugh of a wounded seal at the pulse oximeter, which backlit his big toe red. Comedy-club-level laughter replaced the look of death in the matter of an hour, as I was reminded of the resiliency of children. If only Mom and Dad could capture a bit of that.
