Noah's Hospital Stay, Part Two: Operation Appendectomy

It had already been quite a week by the time we were being told to bring Noah to the E.R. at 2:30a.m. Friday morning, January 29. Lucy had sustained a fever since Sunday, prompting me to finally make an appointment for her Wednesday. She was, of course, positive for strep throat. Awesome. Nothing else the matter with her--- no complaints of pain or anything... just that fever. Still, I'm glad we caught the strep and kept her home all week, so she could keep her germs to herself for the most part. 

But then late Wednesday night, Noah woke up moaning. He complained about his tummy, and I got to work preparing a puke bowl for him. He had a minor temperature--- no higher than 99-- but friends had reported that puking was one of the first signs of strep in their own kids, so I knew it was probably Noah's turn. He moaned next to me in bed for a while, not actually throwing anything up for nearly 20 minutes, but also not managing to make anything happen from the other end in the bathroom... But after that 20 minutes, he had a massive round of vomiting, and I figured, "well, that's that!" and Joe came to help clean him up, give him a drink, and get him settled back in bed with a clean puke bowl and a few towels. 

He woke to puke about three more times in the night, but he managed it well (thank heaven for older kids who can contain their own vomit. THANK HEAVEN.) By morning, Lucy had actually puked once, too, confirming my suspicion that this particular strain of strep was a puking kind. So I set both kids up on our couch with a sheet under them and towels over them, and puke bowls for each. I knew that my pediatrician was a stickler for seeing and swabbing each suspected kid, even when there was confirmed strep already in the house. So even though I was SO aggravated at having to go BACK to the doctor less than 24 hours after going for Lucy, I made the call so we could get Noah on the antibiotic and begin getting him well. He just looked so wimpy with his hunched over posture and moan-y sounds. His fever still held at a low 99. 

Lucy, meanwhile, was doing much better after her one rogue puke and a half-day's worth of the strep meds. And Quinn was his usual self among all the drama. I resentfully schlepped all three to the darn doctor, puke bowls in tow (doctor, PLEASE can't you just call in a scrip for me to pick up in a drive through, PLEASE??)... And sure enough, upon entering the lobby, hunchy-walking Noah bent over his bowl and retched out a huge bunch of liquid. While the receptionist tried to hound me for our 2016 insurance cards. Which had not been issue enough for the other receptionist LESS THAN 24 HOURS AGO to cause a hold-up, but apparently, today, with a puking kid behind me, was imperative. I confess, with a little bit of embarrassment, that I lost it. Literally moved my fists to my hair as I raised my voice to say, "THIS DIDN'T MATTER YESTERDAY! My son is BARFING, and my daughter is positive for strep and I'm having a hard time understanding why I even have to BE HERE RIGHT NOW when you guys could've just called in a prescription for my OBVIOUSLY SICK SON. Please don't hound me for my new cards right now! When I'm not DEALING WITH VOMIT AND DRIVING TO THE DOCTOR'S OFFICE every 12 hours, I PROMISE I will sift through the old mail pile and find the 2016 cards. PLEASE."

Needless to say, the other receptionists came to the rescue and patted the one gal on the back and murmured to her (probably, "Let the crazy lady through. We'll figure it out afterwards.") and told me it was okay and that we'd get it worked out and let's just show you to your room, okay? I calmed down enough to wipe away tears and blush and apologize profusely for losing it. The nurse was super helpful getting Noah and his full puke bowl to a bathroom to wash it out and wash his hands and face. And we headed to our assigned room to wait, me, three kids, two puke bowls, and a LOT of embarrassment and frustration. 

Doc came in, checked Noah, let me beg him to just swab Quinn too since we were all here and if Q already had strep, maybe I could avoid yet another office visit. While waiting for results from the test, Noah fell asleep on the examination table (!!)... Poor kid was clearly so yucky. After about 15 minutes, Noah's swab came back positive, and there we were. Prescription called in. Hallelujah. Quinn= negative. For now. So we trudged back out, Noah hunchy-walking and me hiding my face from the front desk as we exited. 

Upon getting home, I got everyone settled for Quiet Time, and made a little nest of blankets on the floor in my room for Noah and he was asleep within minutes. Everyone slept all afternoon and when Joe got home from work, everyone seemed a bit better. Noah had not puked since the doctor's office, and Lucy was downright perky. Noah got his first dose of amoxicillin at bedtime. He complained that his tummy still hurt, but it wasn't a puke-y type of pain, so I didn't know what else to tell him but to try to get some sleep. In spite of his long nap, he was able to sink back to sleep pretty easily, even with the hurting tummy.

Joe and I were jarred awake that night, at midnight, right as Thursday was rolling into Friday, by Noah moaning. I was so wiped out from bad sleep the night before that I sent Joe to take care of him. Joe offered him a puke bowl, tried to have him go to the bathroom... none of it helped. At one point Joe must've tested Noah's tummy by poking it, because even in my half-asleepness, I heard Noah yelp from his room, "Ow!" And even in my half-asleepness, the thought began to surface--- "What if this is appendix?" When Joe came back to bed, I asked if everything was okay, and Joe reported that he tried to make him as comfortable as possible and told him to try to sleep. I asked if he thought it was something else, and Joe said, Maybe? But that we should just wait and see. We drifted off.... but I was awoken less than an hour later by more moaning. Noah had clearly not been able to sleep. I went to see him and he was really miserable. I did my own poke test, to see what side the pain was on. Lower right. I then googled symptoms and began to line them all up. Pain in belly gradually moving to the lower-right side. Nausea and/or vomiting.  Low-grade fever, usually between 99-100. And Noah had been hunchy-walking the entire day. I went back to my room and woke Joe, asking him what Noah's temp had been an hour ago. 100. I told him I thought this might be appendix. He sleepily said he wondered, too. I asked if I should take him to the E.R. and he said he was hoping we could get through tonight and he would take him to the walk-in hour at the pediatrician's office first thing. I wanted to be conservative, too--- who want's to bring in a kiddo for suspected appendicitis, only to be sent home for gas? And Noah WAS already positive for strep. Maybe that was all this was. 

But just to be safe, I called our Nurse Hotline. She ran through symptoms with me, and at the end had me have Noah stand up and do the "jump test". "Ow! Ow!" was his response as he gingerly hopped twice. She said that was usually the last thing to confirm their suspicion, and that based on all of the info, she strongly recommended we bring him in right then. Joe had fully woken by now and come into the room while I was on the phone. I hung up and looked at him and said, "Okay. I guess we're headed in tonight!" A wave of trepidation crossed Noah's face, but we tried to reassure him that we just wanted to get his tummy checked. We told him a little about what appendicitis is, but omitted that it might get taken out. No sense in making him anxious before we were sure. Joe helped get Noah ready to go and carried him to the car while I got dressed and packed a handful of things-- books and the ipad, etc. 

By 2:30am Noah and I were at the Mercy Hospital E.R., getting him into a room to be checked. He was looked over by a really sweet E.R. physician and she was really kind and gentle with him as she requested blood and urine samples for testing and get him set up in a hospital gown. Noah also got some morphine and an I.V. and was able to doze a little between doctor visits. A little while later, a pediatrician on duty came to visit him. This doctor explained to us that while it was very likely this was, indeed, appendicitis, there is a not-well-known side effect that sometimes happens with strep throat where lymph nodes surrounding the intestine get inflamed and mimic the pain of an inflamed appendix. This thing, called "mesenteric lymphadenitis", is often the cause for misdiagnosing appendicitis, so they wanted to be really sure before they moved ahead with their diagnosis. She put in paperwork for Noah to be admitted into the pediatric ward officially and to be seen by the pediatric surgeon. He would, perhaps, give Noah a CT scan to an ultrasound to help finalize the diagnosis.  After almost 4 hours in the E.R., they rolled us up to his peds. room and Noah and I both settled into sleep for a little bit, since the surgeon didn't usually begin his rounds until at least 8:00am. It was almost 6:00am at this time. 

Between that brief sleep and the visit from the surgeon, we saw Noah's actual pediatrician (the one from his doctor visit the day before) when he came to check in and to sympathize with this turn of events. He did his own exam and confirmed that he was 93% sure it was the appendix. I'm sure he expected some kind of "why didn't you catch this yesterday?" from me and was ready to deflect it, but I sincerely don't fault his exam of Noah from the day before. Between that 1:00pm visit and the midnight moaning,  Noah's belly pain really had ramped up to where it was obvious to the touch, when it hadn't been at that level at the appointment. And, I mean, he DID have strep. So all the other symptoms lined up with that sickness as well. So I let the doc off easy, and he headed out, promising to check back in in a couple of hours. Meanwhile, Joe managed to gather some things for Noah and I and he made a run to the hospital to see us and drop off the items.  A wonderful gal from our church stayed with Lucy and Quinn so he could do this. 

At this point, I truly believed that if he did indeed need his appendix out, we were going to be here for maybe the full day and one overnight, at most. And then there was still that hope that maybe this was all due to strep and not his appendix at all. I kept working on keeping Noah's spirits up whenever he was awake. The morphine was helping his pain, so he was really not doing too terribly as we waited. By about 9:00am, we finally got the visit from the surgeon and from his nurse practitioner. The surgeon confirmed that he was 95% sure it was appendix, and with those odds, the best way to know for sure was to just get in and take it and know for sure. Noah didn't show any signs that his appendix had progressed to a rupture, so the doctor was confident this would be an easy visit for Noah, all things considered. The nurse practitioner stuck around to explain the details as to why this was more likely an appendix issue and not the aforementioned mesenteric lymphaditis-- something to do with white blood cells and some other stuff. But it made sense at the time and I was confident in their decision to get Noah on the surgery rotation as soon as possible. 

So then I was left alone to help my sweet 8-year-old kiddo process the news that this hospital visit would lead to an actual surgery and removal of one of his organs. He'd been clinging so hard to the hope that this wasn't actual appendicitis, and to see his hope dashed was so sad. His bitter disappointment was almost harder to see than the hint of fear starting to form in his eyes. I tried as hard as I could to validate his feelings, to tell him it was okay to be scared, to be sad... that I would be, too. That no matter how you look at it, this sucked. I reassured him that dad or I would be with him for as much of it as we could, and he would be okay. That this organ was not really super important, and that one day he might even like having the story to tell and the scars to show. I'm not sure my (too many) words were much help to him, honestly. I think what helped better was distraction-- being put in charge of the remote control, for example, a power I'm not sure he's ever really had. so iPad gaming helped, too. 

Lucky for us, a spot on the surgery schedule opened up pretty quickly, so by 10:30am, we were being wheeled to the pre-op area. Cue Noah's fears and anxiety again. But the pre-op stuff took AGES, so it was easy to see how his fear would wane and calm until the next person came in to give their speech and info. Then more fear, then more waiting, then more calm again. Eventually, he actually napped again, as he waited. At one point, when the actual surgeon came in to talk to us, he asked Noah if he wanted to pray together, and Noah said yes. What a neat guy to be comfortable making that offer a part of his daily work. It reassured Noah, I could tell. I added prayers of my own with him when we were alone again. Finally at noon, Noah was taken back to the operating room and I was shown the waiting area for family members. 

Noah's surgery only took about an hour, and the surgeon came to report to me while Noah headed to recovery. He said that everything had gone very well-- that Noah was doing great. However, upon opening Noah's tummy up, it was pretty clear right away that the appendix had indeed perforated, or ruptured. But the perforation was in an area, kind of pinched up or "walled off" against the colon that the leaking had been largely contained. He was confident that this was not going to be a serious concern, and that he was confident he'd been able to clean up most, if not all, of the mess. Anything he didn't get would be taken care of by the i.v. antibiotic Noah was going to be getting, and that for now, the main change in plans would be that Noah would likely be in the hospital for more than one night, just to get enough antibiotics pumped through him, and so that he could be observed for any complications from infection, etc. So much for that "in and out" idea I'd had in my head. Even if Noah recovered quickly, we'd likely be there through Sunday instead of going home early Saturday. Still--- it could've been much worse. One nurse told us that the worst cases are sometimes in the hospital for a month, healing from the burst appendix mess inside. 

I was able to see Noah in the recovery room by about 2:00pm, and we were back in his room by 2:30, and we both napped most of the afternoon, still trying to catch up on missed sleep from the night. Amazing folks from our ward helped us with dinners and offers of childcare throughout this adventure, and this sustained us as we tried to make sure Lucy and Quinn had some kind of routine while still managing to have a parent there for Noah 100% of the time. So after Joe served our first gifted dinner to the kiddos, he brought them to the hospital to see Noah and so Joe and I could switch places for the night. The little kids LOVED the hospital. The snack room, the toy room, the bed that moved up and down, the cartoon channels on the TV, Noah's cool balloons and things, multiple elevators... The whole place was like magic to them. Ha! I know Noah didn't see it the same way. 

What stunk for Noah was that his life got exponentially harder and more miserable after the surgery. His appendix pain was one thing... but the post-op recovery was a whole new beast, and it was a tough one to conquer. It was so hard to see him hurt like he did. He was happy upon waking from his surgery. A little goofy, even. But by the evening, he was pretty low, so even with his siblings and dad visiting, he didn't have much of a smile to muster, and was only marginally interested in treats/balloons/cards that Joe brought with him. 

At the end of it all, Noah ended up staying at the hospital Friday, Saturday, Sunday, and Monday night. Joe had been confident Noah would bounce back faster than that, but Noah was still so puny Sunday night that I am not at all surprised it took those extra days. His appetite was one of the last things to return. I think he was at his lowest on Sunday--- he had zero sense of humor and was snappish and short-tempered... SO not like him. But by Monday, he'd begun to show some signs of life again. It helped him to have visitors in those days following the surgery. He got a special visit from his second grade teacher Mrs. Clince, visits from his siblings multiple times, and visits from friend Hidde, Cooper and Luke, Jackson, and his home teachers, who helped give him a blessing. He also got to see my parents for a bit. My friends Jennie and Caroline came by with sustenance and sunshine. And Anne-Sophie, a friend from Joe's work, brought food and tea and gifts fro not only Noah, but for the little kiddos, too. So much love sent our way while we were helping Noah through this! 

During his stay, Noah got to dabble in  a bit of art therapy, music therapy, and he got to have a Wii rolled into his room so he could try his hand at a Pokemon game. He got to watch many movies, play lots of hours on the iPad.... and through all of that, really, what he wanted most was to just be home. Seeing him perk up at Lucy and Quinn visiting those last couple of times really drove home to me how much he wanted his normal life back. It was a relief to me to see his walk improve by Monday and to hear from Joe that his appetite was slowly coming back. 

Joe and I took turns sleeping over at the hospital,  and Monday night, Noah's last night, was Joe's shift. By then, we were all hoping that Noah would get sprung the next day, waiting impatiently for the surgeon to visit and give the go-ahead. Lucky for Noah, once the doc said he was good to go, it all happened really fast-- given the go-ahead at noon, Noah was shuffling slowly through our front door by 1:50pm. The relief on his face was tangible. He was alight at the sight of Fiona, and so genuinely happy to just be home. I immediately got him settled on the couch and within minutes he was fast asleep, the most peaceful he'd looked in days. 

 Since that crazy weekend, he's continued to heal and is doing wonderfully. I ditched the whole family the day after his return home and headed to Hawaii to visit my sister, a trip that had been on the calendar for months.... Terrible coincidence that this appendix thing had to happen right before, but people keep reminding me that at least it happened before I left and not while I was gone. Still, it was hard for me to leave my kiddo so soon after his ordeal. It was hard for him, too-- he was extra weepy and clingy in the days following the surgery, and I could hear the quiver in his voice whenever I talked to him throughout my trip. 

But while I was away, he managed to stop needing the pain medication, then to try two half-days at school, and eventually do full days again, one week after his return home. My parents and Joe's parents were both able to come help for parts of the week I was gone, and the kids all had so much love and care given to them while I was away. 

Today, you'd not even know Noah had been through this craziness, except, if you look closely, you might still see darker smudges under his eyes, and a skinniness that just needs a few more pounds to fluff him back to his usual self. And sometimes he reverts to a hint of that hunchy-walk.... Mostly, I hope, out of habit and caution, and not because he really is uncomfortable. He had his follow-up dr visit today and has been given a clean bill of health, so things are only going to look up from here. 

Thank you, all of you who lent support via your kind words, your prayers, your positive thoughts... And for you who sent love via food, childcare, visits, offers of any and all of the above.....Thank you for lifting up our whole family when life took us in an unexpected and difficult direction. We are so grateful. We are so blessed. All is well. All is well..... 

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(And thank you if you read this whole dagnab thing. I don't know how to make stories short. It's a problem. The end.)