Shortly after 3:00 I was sitting and listening to Chloe’s precise clinical description.
Mysti had been fine, ‘in her usual state of rambunctious health’ despite a runny nose and a low grade temperature of 99.8 to 100.6 that she had not felt warranted treatment because she was eating and drinking and playing normally, and sleeping despite a very mild cough when she lay down. Mid morning, she had noticed a change. Mysti had become fussy, wanted to be held. Her cough was now ‘chesty and junky’ and increasingly disruptive. She had barely touched her lunch. Her temperature at 1:00 had been 102.8 and only came down to 102 with ibuprofen. Her respiratory rate was about 24 but without retractions or grunting. At that point she had called.
I sat listening to this description of an ill child while I watched her daughter playing happily on the floor of the exam room.
“When did she get her last ibuprofen?” I asked, thinking about the fact that the nurse had recorded a temperature of 98.4, a pulse of 82, and a respiratory rate of 14.
“A little more than 2 hours ago” was the answer.
“Hmmmm. You know, she looks pretty good right now. And I haven’t heard her cough since I came in.”
Chloe paused, and I could see a small tremor pass through her. She looked down at her daughter. She leaned forward and her eyes got narrow, little slits.
Then, softly, more to herself than to me:
“Oh shit. I brought the wrong one.” And she looked back at me, a look of true panic on her face. “I DO know my kids. Really. I don’t understand how I could I have brought the wrong one.”
That was easy to answer. “You’re a mother of four, including twins. And you work full time as a nurse. When was the last time something was easy? Call home and have your husband bring Mysti in.”
It got more complicated then. She called home to find that Karl was upset and was about to call to report that Amber was suddenly sick, too, and to get two prescriptions for whatever Mysti needed. It took several calls, but we worked it out that Mom would bring well Amber back home, get sick Mysti and grandma and return to the office, while Karl brought well Amber and the other two kids to grandpa at the grandparents house on his way to work. Chloe would be here for the visit, and grandma would take sick Mysti back home after the visit while Chloe went to her inservice.
An hour later I was seeing the real Mysti, who had a temp of 103, a respiratory rate of 22, an oxygen saturation of 99%, a right otitis, and crackles consistent with pneumonia in her lower left lung, which we treated with azithromycin and ibuprofen.