August- The Month of Infection
Written by Zach
It was August 1st that Linus all of a sudden started going through countless diapers and clearly wasn’t feeling great. His poop was gradually shifting to a higher and higher water concentration, until he was basically pooping just water. We contacted our team and knew that he needed some fluids before he became too dehydrated. So that Thursday afternoon, the day before my very first med school exam, we made our way to the Children’s hospital to get admitted once again.
After spending so long in the Seattle NICU, you’d think we’d know exactly what to expect from having Linus be admitted to the hospital again. But, true to his character, he surprised us. He didn’t have a fever (or any other discrete symptoms) and had every infectious test come back negative; nobody had a clear picture of what exactly caused him to get sick. So we spent about three days in the hospital pretty much to rehydrate Linus and be sure that his tummy troubles returned to normal.
About a week later, Linus developed a fever while at home. Since he’s a cancer patient undergoing chemotherapy, it’s important for us to immediately contact our team whenever he develops a fever to ensure that it doesn’t get out of control (as it may when immunosuppressed). We unsurprisingly were told to head to the ER for a quick workup, and were conservatively admitted once again to the hospital since Linus’ immune system was borderline and his breathing was not doing particularly well. This admission was largely uneventful thereafter, as his fever and symptoms resolved and we went home a couple days later.
Our third August hospitalization happened a week after the second, after Linus developed another fever. We had a visit with our cancer care team, who took some cultures of his blood to check for an infection and gave him some Tylenol, which significantly improved his symptoms and 104° fever. They sent us home when he started feeling better, but we got a call later that evening that the blood cultures confirmed bacteremia (bacterial infection in the blood), sending us once again to the ER. Antibiotics began immediately along with some IV medications. One medication gave us a scare with some seizure symptoms as a side effect, but fortunately they resolved promptly with nothing significant coming up with further testing.
Linus’ airway tends to struggle when he’s generally not feeling well, so his bacteremia exacerbated those symptoms pretty badly; this put us in the pediatric ICU upon admission. He generally stabilized the next day and we were moved up to the cancer care floor. That night, his respiratory symptoms worsened once again, instigating a rapid response team to evaluate Linus for another trip to the ICU. Somehow I slept through the chaos of this middle-of-the-night rapid response (pretty sure I had an exam the following day), but fortunately Anna is a superhuman and was able to stay sharp at 3:00am. One trip to the ICU, a bunch of antibiotics, and a handful of days later, Linus (thank God) stabilized enough to be sent home.
What likely precipitated all this was a central line infection - the long-term IV placed in Linus’ chest was a huge infection risk from the get-go, which we knew would be part of his cancer treatment. But fortunately, at this point Linus had become big enough to have a different kind of central line (a port that goes beneath the skin) surgically put in that would be far less infection-prone. We opted for this change and the surgery took place shortly thereafter, and have not looked back since. Needless to say, August was about as chaotic as we could have expected!