GoMom

In this case, when Lillie came down with a fever last Monday afternoon, I didn't think much about it. She's twelve, and the youngest kid in a big blended family. I've seen a lot of fevers over the years. But late that evening, when she wilted on the couch and I noticed some steam rising from the top of her most amazing and beautiful head, I stopped working and walked over to touch her. "Oh my god, you're on fire," I said. The thermometer seemed to agree, at 104. We do fevers at our house, the kind where you touch the forehead and say, yep, you're a little hot. And we do fevers, the kind where you say, oh, you are hot!, and we go to the trouble to hunt down the thermometer to confirm a temp of 101 or 102 or something, and then we fish out the Advil.

But 104 . . . we don't really do those kinds of fevers. So I figured I'd better haul her in to the urgent care. Where, of course, the strep culture came back negative and the doctor predictably wanted to wait and see about the 48-hour culture. Sure, fine. I mean, I totally get the whole antibiotic thing, the whole over-use and resistant bacteria thing. When my kids were little and got earaches, we did garlic oil and ear candling instead of the amoxicillin the doctors always wanted to give them. They've had about ten prescriptions in their combined lifetimes. I'm more wary of misusing antibiotics than most of the docs we've seen at our various HMOs.

So anyway, it came as no surprise that we left urgent care on Monday night empty-handed and with the advice to gargle and wait for the final culture results. Which, as we learned on Wednesday, were negative. Now, this came as a surprise, because Lillie was by then much worse, not better. Fever still hanging steady at 104 between doses of fever reducers. And throat swelling practically shut with huge, red, inflamed tonsils.

Back to the doctor on Thursday morning, this time the regular clinic, not urgent care. Another strep test (negative). A mono test (negative). White blood cell count (normal). A peek at the tonsils . . ."Wow! You've got something awful going on in there. That must hurt." Ummmm, yes. That must hurt.

But still, no prescription. Why? Because we need to culture for staph and various other bacteria. We need to figure out what this is, because an antibiotic can make a viral infection worse. We should have the new culture results back by the weekend, maybe even Friday.

Fast-forward 24 hours to Friday, and now we have a kid who can barely swallow water. I am worried that soon she will not be able to breathe. I call the clinic to ask if they will please, please order a prescription to our local drug store. I am told that the doc--or actually, nurse practitioner--that we saw the day before will call me back. But she does not. So I call again, and again. I am told each time that the NP will call me right back. I would like to go up to the corner drug and pick up a prescription without hauling this miserable, feverish kid back to a clinic for the third time. But it is not to be; I get no call back.

So, I load her in the car and go back to the urgent care and see yet another new doctor. But this time, we've hit the jackpot. After a review of what's been tested for so far, and a brief inventory of her symptoms, he takes a look in down her throat (which I myself have been inspecting with a flashlight throughout the day to make sure there's still space for breathing). "What antibiotic is she taking now?" he asked. 

"None, that's why we're here, her cultures have been negative. No one's been willing to write a prescription."

He practically fell over in his quiet, authoritative, measured East African way. Then he calmly explained how he would be ordering an immediate shot of a strong antibiotic and a steroid shot, too, to bring down the swelling. And a 10-day oral antibiotic prescription. And some Vicadan for the pain (which Lillie never took, but it makes a good story). Then he asked if we wanted another strep test (a third?) and Lillie and I both cringed, and he laughed, and said fine, it didn't matter anyway. He'd be writing the same prescription no matter what the culture said. And by the way, he told me, if she's not getting better in the next day or two, bring her right back in and I'll check her into the emergency room. Hallelujah, no more salt water gargle from this guy.

Within two hours of the antibiotic and steroid shots, Lillie was feeling dramatically better. I mean, night and day kind of better. Of course, it took about three more days for her to really get back up off the couch, but at least she could read instead of just sleep. And the fever never returned after that first antibiotic shot. Her throat, five days later, is still clearing. Her sense of taste returned today. She's almost back to normal weight (she lost five pounds in six days). 

I appreciate the increased prudence around antibiotics, but at the same time, this was a frightening experience and I do think that the delay was longer than it should have been. Are others experienceing a noticable shift  in  philosophy with doctors and antibiotics?