I knew what it was as soon as my dry cough started. This time of year pediatricians see a lot of small children with laryngotracheobronchitis — LTB, otherwise known as croup. As a general rule-of-the-pediatrician, what we see is what we get. And I knew that was what I got!
Just like the little kids, my cough was worse at night, making it difficult to fall asleep. Then, this past Thursday night, it hit me suddenly and hard. I started coughing uncontrollably and the cough sounded different — brassy, almost like a seal barking. I was also making a loud noise with each breath which we call stridor. (The late, great Children’s Hospital of Pittsburgh emergency medicine doc, mentor, and all-around great guy, Ray Karasic, always made sure I described the telltale sound as “stridulous”, as in “that child sounds stridulous, not ‘stridorous.'”) I was stridulous. And it was very hard to breath. I tried to wait it out — 5 minutes, 15 then 30 minutes. Heeding a piece of advice I offer to panicky parents when their kids start that barking cough in the middle of the night, I walked outside into the cool night air. No luck. My respiratory rate was going up and I was starting to feel lightheaded; my fingers started to tingle. “Am I taking you to the hospital now or shall I call 911?” my wife asked me for the ninth or tenth time.
Enroute, I tried another tip I’ve offered parents rushing to the hospital: Open the car’s windows. Occasionally, the parent calls back. “We’re in the parking lot at the ER and he’s sleeping quietly in his car seat. What do we do?” they’ll ask. “Turn around and go back home,” I’ll reply.
Again, in my case, no luck. We walked into the lobby and I immediately felt guilty being there. I had arrived simultaneously with a woman in a wheelchair who had just broken her leg, an older woman with chest pain and shortness of breath, and a college student who looked like he had been in a fight. I tried to tell my story to the nurse: “Croup… I’m a pediatrician… caught it at work… can’t breathe…” I guess I belonged there after all.
Room 44. “I can’t breathe” were words unnecessary to describe the situation I was in. The noisy breathing, the retractions reflecting the extraordinary effort it was taking to get an adequate breath of air in, the panic on my face (and I’m sure the fear on my wife’s face) told the entire tale. A fast but thorough history of present illness, past medical history, allergies, and medications occurred simultaneously with vital signs. IV line in, x-rays ordered, medicines pushed, breathing treatments in my face — the professional and compassionate care I received was immediate and effective. Three hours later, loaded with steroids and provided an accurate diagnosis and plan for followup in the morning, I was discharged home. (The bed reserved for me in the ICU was canceled.)
As we discovered yesterday on The PediaBlog, croup is a common and highly contagious infectious disease that affects primarily children under the age of 5. Infants and toddlers often present with more severe symptoms, including a loud barking cough and signs of respiratory distress due to airway obstruction from inflammatory swelling of the larynx. Croup sends a lot of young children to the pediatrician’s office and to local emergency rooms, and a lot of parents into a state of anxiety from listening to the strange cough and watching their children struggle to breathe.
But older people get croup, too. A dry cough, sore throat, and hoarse voice are typical and mild symptoms that last several days and then go away without the need for any specific treatment. Sometimes croup can hit adults hard, like it did me.
I’m 56 years old, going on 15 months. Go figure.
Here is what I learned from this frightening encounter with a common childhood virus:
- Getting sick sucks. Getting sick badly enough to require attention from medical professionals is worse.
- Having health insurance, even if paying for it is a struggle and requires personal and family compromises in order to afford it, is far, far better than not having health insurance.
- It doesn’t cost the healthcare system anything to be kind and compassionate to healthcare consumers. Everyone I interacted with last Thursday night — from the valet attendant who parked our car, to the nurse who checked me in and walked me through the busy emergency department to Room 44, to the nurse who took my vital signs and got the show on the road, to the phlebotomist who started the IV (a master in the art of distraction, he talked to me and didn’t shut up until his work was done — I didn’t realize he missed the first stick until he got the second one in), to the respiratory therapists who administered my breathing treatments, to the escort who shuttled me to and from the radiology department, to the radiology technicians (the first who figured out a unique way to get the lateral chest view and the second who gently helped me into the CAT scan machine), to the physician assistants and emergency room doctor who figured it all out and put me back together — every single person I encountered was kind and attentive. Thanks to the combined efforts, professional skill, and teamwork from the emergency department staff at St. Clair Hospital, I had a positive outcome.
- I need to do a better job of washing my hands when I work in the office.