We made it together!

“Can you look at my throat?” requested my seventeen-year-old neighbor, who was standing in her grandmother’s front yard next to ours.

“Sure, Elizabeth. Let me look,” I responded with enthusiasm. The grass was fragrant and green, and the sun gleamed warmly on us. She was tall, blond, and cute as a button. I relished the opportunity to show off my skills.

“Open wide,” I said and analyzed the back of her throat, which was coated with numerous thick, white plaques. The surrounding tissue appeared red but not swollen.

“Ouch. It looks like strep throat. You need to see your doctor. It needs antibiotics,” I continued sympathetically.

It would not be my first or last erroneous diagnosis. She stopped by the next day to let me know that her doctor had made the diagnosis of mononucleosis, “the kissing disease,” and she did not need antibiotics since a virus caused it. Oops.

I have not missed that classic presentation of “mono” since then. It is remarkably different in appearance than strep throat. I had simply never seen it before. I did not know what I did not know.

Later in that same month, my son reported home from elementary school with a sore throat. It was a Friday. My wife called and said Trey needed a doctor. As students, we did not have health insurance, but there was an area pediatrician that gave us free care when needed. I called their office and got an appointment. The diagnosis was strep throat, a common school illness. They gave him a liquid antibiotic and sent him home with a reassurance that he would not be infectious to others after one day on the medicine.

That night he still had a fever, and his tender, enlarged lymph nodes could be felt in the front of his neck. We gave him the medicine four times a day, exactly as prescribed. He could not eat because he felt horrible all over, and it hurt to swallow. Popsicles were better tolerated. He was not getting better, and swallowing the medicine was becoming difficult. Did my dirty germ-covered white coat bring germs home? I wondered. Of course, it did.

Sunday morning began as an actual rare day off for me, and Trey was having more trouble swallowing the liquid medicine. His neck appeared more swollen. We were both concerned.

“We should take him back to the doctor today, and let them take another look,” I pronounced.

We drove three blocks to the doctor’s office. It was Sunday, and they only had morning hours. There was another doctor there, alone, to see the walk-ins.

“Sir, my son was seen two days ago, and today he can’t swallow the medicine and has a fever. His neck is more swollen,” I said concerned. Jeri watched.

He glanced at the chart and said, “He has strep throat. This is not uncommon. You need to keep giving him the antibiotics,” he stated with conviction. He was busy, and he moved to the next patient.

We were getting free care, and this prompt dismissal intimidated me.

Sunday was a tough day and night for us. We could not get him to swallow the medicine, and his neck and throat were so swollen that, by the evening, his tongue stuck out of his mouth so he could breathe. His breathing was labored. He could not lie down because of secretions, making him cough with pain. I wanted to go to the emergency room, but I feared that doing this would be viewed negatively by the doctors we had already seen.

We waited until morning and took turns sitting up with our son. He had to lean forward to breathe, and drool covered his shirt front. Swallowing was impossible.

I was off to school early, and Jeri agreed to go to the pediatric office again at 7 AM and wait to hope someone came in early. The doctor arrived at 7:15. He recognized Jeri and our car. It was the only other car in the parking lot, so he walked over curiously. Our son was in the back seat, and the back door was open.

“Hello, Mrs. Adams, how is your son doing today?” he asked warmly, approaching the car with a friendly smile. He shook her hand and peeked in the car at the young form leaning forward in the back seat.

His face froze.

“Oh, shit!” he gasped. The child he saw was a pediatrician’s worst nightmare. He knew immediately that Trey’s condition was serious and life-threatening. He had a retropharyngeal abscess that any experienced physician would recognize as a surgical emergency. The pus pockets expanding in his neck needed to be drained, or the infectious pus could erode into a vessel, causing total body sepsis and death. Children hardly ever survived if it happened.

“Mrs. Adams, please do not take your son out of the car. I will have him seen at the ENT surgeon’s office right away. His condition is dangerous, and he needs surgery,” he announced with fear in his voice.

He pulled out his cell phone and called the office of Doctor May, the Chief of ENT surgery. His secretary answered, confirmed he was in, and told him to have Trey come directly to his office. What she did not say was Doctor May was already in the first surgery of the day. It was 7:30.

Jeri did as she was told. It was a short four blocks to the Wake Forest School of Medicine, and she knew where to park. Doctor May’s office was easy to find. For the last two years, she had wandered these hallowed halls with me.

The Chief of ENT Surgery had a brightly lit corner office on the second floor. The secretary expected her and informed her Doctor May would be up as soon as he finished the surgery that he was currently doing. She smiled reassuringly but looked concerned when she saw Trey. It was 8:00. Jeri beeped me on my call beeper, which displayed her location. I was needed and made a quick exit from the ward where I was working. I ran to the office.

At 9:30, Doctor May walked into the room wearing green surgical scrubs. He was smiling and had his hand out to me.

“Hello, I am Doctor May,” he intoned pleasantly and glanced over at our child sitting in a wheelchair, leaning forward, and drooling into a small towel.

“Oh, shit!” he said as he let his hand drop. He went into emergency mode and scared us both with a series of quick instructions.

“Bob, you know where the CT scanner is. I want you to take your son there now. They’ll do a CT of his neck. Bring the films with you to the operating room admission area. They’ll be expecting you, and we will go into surgery to drain an abscess in his neck,” he directed.

To his secretary, he said in a commanding, staccato voice, “Ellen, call the OR and tell them we’re coming right now. Tell the anesthesia staff that shift change is on hold. Have them ready when we arrive. Call the CT scan staff and tell them to get anyone on the table off of it, and we are on the way with an emergency. Bob, you and your wife, go now,” he finished.

We left for the CT scanner in a hurry, with wide eyes, and I heard him say determinedly to his secretary, “Ellen, when you talk to these people, remind them that they all owe me favors, and I am calling all those favors in, right now!” He sounded very concerned. It did not calm us.

As we approached the CT scanner on the first floor, the double doors were being held open by a doctor and a technician who were looking with curiosity at what might be coming. They ushered us to an empty scanner bed.

“Does your son need sedation, or can he hold very still for a few minutes?” whispered the doctor.

Trey heard the question and stuttered a wet reply that he would hold still. We lifted him onto the cold, hard, movable table and placed a rolled towel under his neck to help him breathe. The scan took one minute.

A few minutes later, the radiologist came into the room with the wet 2-by-3-foot films. He held them up to the overhead lights.

“Oh, shit!” he mumbled and gave them to me.

“Get going, and good luck,” he said as he handed me the bare films. Off we went to the surgery suite down the hall. My hands were shaking.

Again, the doors were held open, and the staff was waiting. We were waved to a table where the anesthesiologist stood with a needle in his hand. It connected to an IV bag, and as soon as it was in and running, Doctor May appeared in clean scrubs.

“We will be in the operating room for about forty-five minutes. I’ll come to talk to you both after we’re done. You can wait in the waiting area,” he directed calmly. He turned and rushed away to follow the bed, now rolling rapidly away.

Two and a half hours later, he came into the waiting area. His scrubs were soaked with sweat to his belly button level. He looked tired.

He sat down with us. “Your son had an abscess that had dissected deep into the tissues of his neck. Tracts of pus were going everywhere. It was the worst I’ve ever seen, and the surgery was difficult. But I think we got it all.”

“Due to the swelling and difficult surgery, we will leave him intubated and neuromuscular blocked. He’ll be in the pediatric ICU for a few days,” he finished.

Trey’s bed burst through the door on the way to the ICU upstairs. He had a large breathing tube in his mouth and other tubes everywhere. I was petrified, and Jeri was mute. We thanked him and rushed away with my wide-eyed wife to follow our son. I was just a frightened father now.

The next few days would change me forever.

This story is real and is a chapter in my new book Swords And Saints A Doctor’s Journey My son lived thanks to the instant and critical skills of many.