Emergency! Emergency!

While most people were sleeping and resting up for a labor day full of relaxation, Susanne was headed into work. This was her one holiday that she had to work this year.

As Susanne arrived at work, she received a phone call from Scott. He was calling because Paxton was coughing up blood and Scott was concerned. He wanted to make sure that this was not something that had happened before since Paxton had a lot of idiosyncrasies. Susanne had definitely never seen this. Her first instinct was to panic, but she knew that would not benefit anyone. She put on her thinking cap and thought of a few things Scott could check out before they got worked up. She had Scott evaluate Paxton's mouth for any evidence of a cut or injury. She had him rub over his gums where he was cutting teeth to check for blood. Lastly, she had him check his NG tube and look for evidence of any ulcerations on the inside of his nose. He found nothing. According to Scott, it truly seemed to be coming from deeper down. At this point, they both thought that it would be a good idea to take Paxton to the Emergency Room. In the meantime, Scott called the pediatrician's office to speak with the doctor that was on-call to see if there was anything that he could do for Paxton until they arrived at the hospital.

This was definitely a situation where Susanne's background and knowledge didn't help calm her nerves any. She knew too much and that was scary. Her brain ran through all of the different possibilities as to what the problem might be. Hopefully, it would turn out okay. She started thinking about how ironic it was that the last patient that she saw at the clinic before she left for the ER was a dog that was coughing up blood the night before. Unfortunately, he came in on emergency in full blown congestive heart failure and didn't make it. It was times like this that she thought ignorance might very well have been bliss.

Scott, Poppy, and Paxton arrived at the hospital first. They were taken immediately back to an exam room. The nurse did her initial assessment and thought that he looked stable. Shortly thereafter, Susanne and Moppy got there. They made it just in time to meet the doctor that came in and evaluated Paxton. She thought that he looked good overall, considering the amount of blood he had coughed up. She was thankful that Scott had brought in the paper towels with the evidence on it so that she could try to quantitate the amount of blood present. This was Susanne's first glimpse at what came up. She was truly shocked at the sight of it. It sure seemed like a whole lot of blood to her. After the doctor completed the exam, the only concern she had was that his lungs sounded crackly. On a more positive note, his temperature was normal and his oxygen saturation levels were hovering in the mid-eighties, which was where they had been for the last couple of months.

The doctor requested three diagnostic tests, which would determine whether or not Paxton needed to be hospitalized. The first test was assessing the stomach fluid that they acquired through gastric lavage. They basically flushed multiple syringes of sterile saline down his NG tube into his stomach and then aspirated it back out to look for evidence of blood. Luckily, the stomach contents were clear. The doctor also ran a fecal occult blood test, which showed trace amounts of blood in his stool. Susanne made sure to inform her that this was a typical finding for Paxton. The last test was x-rays of his chest. The doctor knew that his heart would look abnormal, but she really wanted to evaluate his lungs. She was interested in ruling out full blown congestive heart failure, aspiration pneumonia, or a consolidated lung lobe. Thankfully, the lungs looked clear despite what she had heard with her stethoscope. The doctor thought about running some blood work to look for evidence of any clotting problems or anemia, but she decided against it. Since she could not find a cause for him coughing up blood and he otherwise looked good, she said that he could go home for close monitoring. They were informed that if the clinical symptoms returned, then he would definitely have to be admitted into the hospital for observation.

While they waited to be discharged, multiple residents came into Paxton's room to take a listen to his heart. The severity and nature of his heart murmur was a rare find, so everyone wanted to hear it. Paxton was such a great patient through it all. He served a greater purpose that day. He was used as a learning tool. Paxton was able to help expand the knowledge of the up and coming doctors on his congenital heart condition. The more people learned about Ebstein's Anomaly, the better chance of finding a more successful approach to stabilizing the condition. Go Team Paxton!

Susanne and Scott were so relieved that everything turned out okay. Susanne headed back to work to finish out her shift while everyone else went back home to monitor Paxton. Once everything settled down, Poppy loaded up the car and got on the road back to NC. He was going to be missed by all.

Susanne returned home later that evening to a sleeping baby. Paxton had done well the rest of the day with no other evidence of blood. The cause of the episode this morning still remained a mystery.