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This chapter is a bit shorter, but it’s a lead in for everything coming.
I hope you like it,
Sharon felt much better as she walked back into the ER waiting room. She and Rick had talked for some time about how they felt and how to proceed from here. When she approached Peter and Becky, she leaned down and kissed Peter on the cheek and said “Thank you.”
“Everyone needs a few minutes. I want you to take them at least twice a day. Trust me, it’ll make this a lot easier to handle.” Peter told her with a smile.
“Sound advice.” Gary said as he walked up behind Sharon. “I’d like to go sit down and talk about Billy for a few minutes.” he told them.
“What’s wrong?” Sharon immediately asked with concern.
“Oh, nothing. I think I may have a way to help eliminate the effects that he’s showing every time he becomes terrified though.” Gary said reassuringly.
“I’m all for that!” Rick said with relief.
“Let’s go sit down for a bit then.” Gary said as he led them toward the treatment area. Rick walked with Sharon, and Peter carried Becky with April beside him. A moment later they sat down in what looked like a lounge. Peter was glad for the couch he was sitting on because it made it more comfortable for Becky as she slept. “Alright, this young fella here,” Gary said pointing to Peter, “is a bit green to have prescribed a medication that I want to give Billy. It’s an old one that’s been around for a long time, but has some benefits that I think will help.” he explained.
Peter smiled. He remembered going through his internship with Gary many years ago. Gary had been a pharmacy technician before he entered med school, so he had some background with the older meds that Peter didn’t. “What med?” he asked curiously.
“Toradol.” Gary answered.
Peter thought about this. That particular drug had a laundry list of side effects that could complicate Billy’s situation. He needed to know more about how Gary wanted to use it. “How did you want to administer it?” he asked.
Gary was glad that Peter didn’t just dismiss the drug out of hand. A lot of physicians had stopped using it because of the side effects involved. The benefit here was that Billy didn’t have a serious disease. He had some serious swelling, and some unique neurological symptoms, but nothing like the diseases that this drug was normally given to treat. “I want to give a milligram per Kilogram once a day for four days by IV.” he answered.
“What do you expect to see with this drug?” Peter requested.
“In my opinion, Billy is in a unique position to benefit from this drug without danger of the severe side effects that are normally associated with it. He doesn’t have kidney or heart disease, his liver is fine, and he doesn’t have any problem clotting. The folks that normally take this med have at least one of those problems. Toradol would help reduce the swelling in his brain. It will most probably prevent the complications he had the last time he got extremely upset. Not only that, I expect that it’ll improve some of his physical difficulties as well.”
When Peter looked at Sharon, he saw she was confused. “Most folks that take Toradol have severe arthritis, or other autoimmune diseases. Billy doesn’t have that problem. It’s one hell of an aspirin to Billy and would reduce any inflammation he has at the surgery site.” he explained.
“What are the risks?” Rick asked.
“There is a chance that he will have a severe allergic reaction. There’s also a possibility it could give him an ulcer of the stomach or the intestine. That usually comes with longer usage of the medicine, but can happen in rare cases with only two doses. The last one that we would need to watch for would be bleeding. It could cause him to bruise and bleed, having trouble with clotting. These are the side effects I’m concerned about. There are others that are uncomfortable, but not dangerous, like upset stomach, that sort of thing.” Gary told them.
Peter thought a second and added “There is also a chance that he would improve dramatically in a day, and then slowly return over a period of weeks back to where he is now, there’s no way to know.”
“Improve in what way?” Sharon asked. She wasn’t sure she liked the sound of that. The way things happened, Billy quickly became comfortable with being a baby, and had no problem with it. If things suddenly got a lot better, how would he adjust and then what would happen if they slowly got worse, until he was a toddler again?
“There’s no way to predict exactly what will improve.” Gary answered. “He may get better physically and be able to walk and talk as a nine year old should, but emotionally remain a little child. Or just the opposite might happen. There’s no way to know until we try.” he explained.
“Things might get better all the way around, or only a component will get better. There is also the chance that nothing will get better.” Peter added. “The only way to know is to see how he reacts to the medication. The main goal here is to reduce the potential for him to end up comatose and on a ventilator if he gets really upset again. There is no guarantee that he’ll recover from that if it happens again.” he told them.
“Jesus.” Rick whispered as Sharon reached out and grabbed his hand in fear. It had never occurred to Rick that Billy may not come out of the coma. After all, he had before. This thought made him consider the treatment differently. He wasn’t really fond of the risk of side effects when Gary had gone over them, but considering that it may prevent Billy from ending up permanently unconscious on a ventilator, it was worth the risk.
“I think this had potential. If we can get him through a period of time without further insult to the area he was operated on, then we won’t need to worry about it any more. That has to be the goal here. Any hopes that he’ll improve in function dramatically need to be secondary. If he does, then fine. If he doesn’t, but we don’t have to worry about him ending up in a coma, then I’m fine with that.” Peter explained.
“I agree with that.” Gary offered. “Even if he gains and then loses function, if this medication can get him through to where the coma is not a threat anymore, then I’ll be satisfied with the outcome.”
“When would you give him the first dose?” Sharon asked.
“In the next hour.” he told her. “I had Peter’s office send electronic copies of all of his MRI’s so I could compare them to where he’s at now. There has been some improvement since the initial surgery, but there’s actually more swelling now than what he had the last time he was in the hospital. I believe some of it is due to the reduction in steroids.”
Sharon looked to Peter. He told her “It’s probably the best chance he has of preventing another incident.”
When she looked to Rick, he said “I don’t see a better way.”
April was surprised when Sharon looked to her. “It may make things difficult for him for a little while if some things suddenly improve and others stay the same, but I think the benefit is worth the risk. We’ll help him get through whatever comes up.” she said with a warm smile.
Sharon had to agree. Peter and April had gone to great lengths to help him and Becky get through. “Alright, do it.” she said with a sigh. “God knows what that little boy is going to go through.” she thought.
“I’m going to keep him sedated until the morning so things aren’t so difficult for him. That way, he’ll be benefiting from the reduction in inflammation before he gets upset if things are unpleasant.” Gary told them.
“That makes sense.” Peter explained. “The question now is, how are we going to handle this with Becky. Are you going to take her back to the hotel?” he asked Rick.
“I hadn’t thought about it.” Rick answered honestly. “I can though, unless you’re telling me that he may have some serious problems. If that’s the case, I need to be here.”
Gary looked at Peter and asked “Has she got a fever? She looks awfully flushed.”
“Hmmm…” Peter said after he caught on. “She could be having a reaction to the sedative. It might be a good idea to admit her and keep an eye on her overnight.”
“You two are so bad…” Sharon said with a grateful smile.
“I’ll admit her to the regular floor. If Billy’s going to have a reaction, it’ll most likely be tonight.” Gary told them. “He’ll be headed to the PICU in just a few minutes then. Any other questions?”
No one had anything else, so Gary said “Alright, take Becky down to Admitting and I’ll send word. Sharon, you’ll want to come with me.”
“If you don’t mind, I’ll come with you.” Peter told Sharon.
“And I’ll go with Rick. It’ll be easier on Becky when she wakes up in a hospital bed.” April told them.
“Good idea.” Peter offered smiling.
“Thank you.” Sharon told her with a pat to her arm.
“Yes, I really appreciate it April.” Rick said.
“She trusts me so it’ll help.” April explained with a blush.
Rick took Becky from Peter and made his way out toward Admitting with April beside him. Sharon and Peter went with Gary. A moment later they were walking next to a portable crib as they wheeled a sleeping Billy toward the elevator. Sharon was thankful that he was sleeping as the doors closed and they made their way up.
Once Billy was wheeled into his room, the PICU nurse came and introduced herself as Rachael. She gave Sharon several forms to fill out and asked a long list of questions about his medical history. Once all of that was out of the way, Gary came into the room with a syringe.
“Well, we may as well get started.” he told Peter and Sharon.
Sharon stood at the crib side as Gary gave the injection. All three of them watched Billy for a while for any signs of trouble. When it looked like he wasn’t having an allergic reaction, Gary said “I’m going to go chart some things on him. Peter, let them know if anything comes up. I’ll be back in a few minutes to check on him.”
“Alright.” Peter replied as he slid a chair over for Sharon to sit in and took a seat himself in another chair.
Sharon sat down and took Billy’s hand in hers. She knew it was going to be a long night.
April sat with Rick as the triage nurse took Becky's vitals. "Did she have a rash?" the nurse asked. April answered quickly "No, but her temp increased quickly. She feels like it's starting to come back to normal though. Dr. Roach wanted to observe her overnight." "Is she developmentally delayed?" the nurse asked as she eyed the pacifier in Becky's mouth and then glanced at her wet diaper. "She underwent a severely traumatic event that left her terrified. Her psychologist advised us to encourage toddler behavior until she was home for a month or so." April explained. She hoped Rick was alright with her answering all the questions. "And you're her father?" the nurse asked Rick. "Yes." he answered as he pulled Becky's arm back in toward her chest after her blood pressure was taken. "And you're her mother?" "No. I'm her Aunt." April lied. After a laundry list of questions and several forms, the nurse put a hospital bracelet on Becky's wrist and called for a wheelchair. They were soon on their way up to the floor with Rick sitting in the chair holding Becky in his lap. Twenty minutes later, Becky was snuggled in bed, a dry diaper on her bottom, her Minnie Mouse hugged close. She would nurse intermittently on her pacifier as Rick watched her. When Carrie the nurse came in, she asked a slew of questions, including whether Becky drank from a bottle and did she feed herself. "Yes she takes a bottle and we feed her at this point. I have bottles here, we'll just need milk and juice." April answered. "Alright, then I'll order her a tray for dinner. I don't think she'll be awake for lunch as it's eleven thirty now." the nurse told her. "I'll bring some PediaSure for her bottle in case she wakes up hungry." "Thank you." April replied with a smile. She was glad they weren't giving her and Rick a hard time about Becky. "It will be so much better if they just go along with what Craig recommended." she thought. "I think I'll lay down with her if you don't mind." Rick told April. "There's no telling how long I'll be up later." "That's a good idea." she responded. Rick pulled the covers back and laid down next to Becky. He pulled her close to him, making sure she still had Minnie in her arms. He closed his eyes as he began gently patting her diaper. With any luck, she would be alright with being in the hospital and Billy would do just fine. These were the thoughts making their way through his mind as he drifted off to sleep.