Getting Started

So it's my first post here. We'll see if this ends up being something I want to keep going or not. I hope that this will be a place to talk about the ups and downs of being a doctor, of being a mom, and of having a kid with chronic illnesses.

I became a doctor in May 2003 when I graduated from the University of Tennessee. I spent 3 years in Lexington, KY during my residency. I moved to Lebanon in 2006 and changed jobs within the city in 2007. Two weeks later Jack was diagnosed with cancer. Cancer? In a doctor's kid! Well, of course. It seems all the weird things happen to doctor's kids.

Oh, did I mention Jack also has food allergies on crack? Eosinophilic gastroenteritis. He was diagnosed with that when he was six months old. Yep, six months. When he was just a few weeks old he had bloody poo so we assumed he was allergic to milk. Sure enough, decrease milk in my diet and the poo got better. But he was miserable. I have always chastised moms who say their babies won't sleep in their bassinet. Well, my kid would not. He screamed within minutes every single time I would lay him down. Shear misery! He was 4 months old when he got his first soy formula. He had vomiting and diarrhea. I told Jeff it was fine, just a bug. A week later it happened again. For a few hours he had vomiting and diarrhea. A few hours wouldn't have usually been a big deal. But when Jeff brought him to the hospital for me to see him it was profuse, intractable vomiting and copious amounts of jelly-like stools. It did stop after about four hours, but he was dehydrated by that point. By the morning he was back to himself, got some IV fluids, and went home from his first hospital stay. For Thanksgiving he got some barley cereal. He became unresponsive with some head lag. This lasted about two hours then was over. At almost six months he did the vomiting thing with green peas. Finally, after getting a couple of bottles of hypoallergenic formula he again reacted. At this point I figure it cannot just be allergies, there is something wrong with the GI tract itself. I hoped he had malrotation or something easily fixed. He got an upper GI the next morning which showed very slow gastric emptying into the small intestine, 20 minutes for the first drops to trickle. The biopsies from the following scopes showed the eosinophilc gastroenteritis. Jack had large ulcerations from his esophagus to his rectum. After much angst I stopped breastfeeding. I had eliminated everything but wheat from my diet and still he had these ulcers. It wasn't enough. I really wanted to drink the new formula myself and keep nursing. If I thought I could actually have stuck to it I probably would have done it. There were days I wished I did. But, I let that part of motherhood go. We began making bottles of Neocate, then Elecare, with no end in site. Finally, I put my mommy instinct in and refused to let Jack have issues with texture. I started feeding him single-ingredient foods at 10 months rather than waiting until after he was a year as suggested. He tolerated the apples fine so onward we went.

During the whole process he got tested and was found to be allergic to milk, soy, egg, peanut, coconut, wheat, oat, and barley. He also got tested for immune deficiency. He was found to have low NK function. It was better after it was repeated. Did it matter? I'm not really sure.

September 18, 2007 I took Jack to the nurse practitioner just to have his ears checked. He's had fever of 104 for three days. No signs of infection so a CBC was ordered. That was the shock of my life. WBC were 1400 or so, I cannot remember exactly any more. Hemoglobin was 7. Platelets were normal. He was neutropenic. My first words were "Is that Jack?" Tina said yes. I said "stick him again" and "get a central stick." I just knew that it was a clotted specimen or something. But I followed that with "those are leukemia labs." It was something I wouldn't believe. I figured it was a viral thing. That's what I would have told a patient, I think. I'm not really sure because when it's your own you don't think of how you would react otherwise. I do know, though, why you don't take care of your own kid. Stacy had more clarity than I did and called Heme/Onc. When she looked at me and said "She says 'Don't you think he needs to be admitted?'" I then realized how bad things really were. Neutropenic fever could mean extreme bacterial infection. Two cell lines affected could mean bone marrow failure or leukemia. Was I really willing to wait two days to see if it got better? Thank goodness I did not.

By Thursday his fevers were gone. He was acting better and better every hour. If we'd have been at home I would have thought we were done with the virus. But we were far from done. His counts were very slow to come up so he got a bone marrow biopsy. I had mentioned the night before to the nursing staff that I found it strange that the same parvovirus B19 that I got when I was pregnant could be the culprit for Jack's bone marrow suppression and reason for our admission. Well, it was sometime the next day that I realized that things were changing. I found myself walking down to the chapel at one point. As we waited for the results the longer wait time was telling. Finally, when Jack's IV came out I refused to let them put it back in because I knew we would be leaving after the results came in. A resident came in to convince us to get the IV. I don't think she knew I was a doctor because she told me they were waiting for the "flow." I was silent. I knew what that meant. Jack indeed had some form of cancer. When Doctor Kuttesch came in to talk with us he brought the cancer nurse. I knew what that meant, too. I vaguely remember pieces of that conversation "we were looking to see if there was nothing or if there was something" meaning aplastic anemia or infiltration with something... "found something"... "pre-B cell..." I really am not sure if I heard the words "ALL, leukemia" but I know that's what came next. I was thinking "Thank, God." I know it's the most common and most curable form of childhood cancer. It was good to be in that category. It mean outpatient treatment, high cure rates. I do remember hearing "85%" and something about with you child it's either 100% or 0%.

Needless to say this has been a really weird experience. We've had some disagreements from time to time. We've had some differences in training. We've had opinions.

Through it all I've gone from myself, Dr. Wiggins, Stacy (peds NP with 2-3 yrs experience) to adding Leslie who has come and gone, losing Stacy, Dr. Wiggins retiring, getting a brand new PNP and a part-time FNP. That's months and months of training. I am so looking forward to Kristen coming and helping me out. At least with another doc I won't have to do any training, just computer training. It'll be different for her. I hope she's a quick study.

I've stressed and stretched my husband to the max. He's taken a semester off to care for Jack. Then went back part time. Now he's home with him full-time this summer again for another week. Then it's back to school for Jeff. Hopefully it'll be back to school for Jack as well or we'll have a lot of creative scheduling to initiate.