Evan's story, Chapter 13, Call 911!

Call 911!

Yea, though I walk through the valley of the shadow of death,
I will fear no evil:
 for thou art with me: thy rod and staff they comfort me.

Psalms 23-4

   Evan was eight years old when it happened. He had not been feeling well for the past three days. Cindy was planning on taking him to the doctor that day. I was at work at Diablo Canyon, John and April were at school, David was on his mission, and Rachel and Katie were getting ready to leave for middle school. Evan was in the bathroom when he became pale and slumped over. Cindy feared that he was choking. She immediately laid him on the floor and checked that his airway was cleared. When he bit her, it became clear what was really happening. Evan was having a Grand Mal seizure. That is, he lost consciousness and was having violent muscle contractions.

   Rachel saw this happening and screamed, “Katie, call 911!”

   Soon, the ambulance sirens pierced the air. Rachel had never felt so glad in hearing a siren. She knew her little brother needed help. The girls were scared, but decided to put on a brave face.

   Minutes later, the paramedics rushed into the house, passing Katie and Rachel on their way to school. The paramedics placed Evan on a gurney, put an oxygen mask on him, and quickly wheeled him to the ambulance.

   Cindy asked, “Can we take him to French Hospital?”

   Arroyo Grande Hospital is closer, but French Hospital had a pediatric ward. Evan had been there before. More importantly, Dr. Bravo’s office was nearby.

   “Sure,” they replied, “We can take him there.” So off they sped, sirens blaring, with a crew of baffled paramedics, a distraught mother, and a medically fragile little eight year old boy racked with seizures.

   When they arrived at the Emergency Room, they asked Cindy, “Does he have a medical history?”

   “He has a kidney disease. We just changed his medication. His potassium level may be too low.”

   With considerable difficulty, a blood sample was drawn and immediately analyzed. The potassium level was somewhat low, but well within the normal range. The doctors were baffled. As doctors, they knew Grand Mal seizures are caused by abnormal electrical activity throughout the brain. But they didn’t know why it was happening to Evan.

   Meanwhile, I was in a training class at work when my pager went off. “Nobody ever pages me,” I said aloud. My heart jumped when I saw that the call back number was my home phone. Cindy never pages me. I immediately left the class and called home, but there was no answer. I went to my supervisor, Roger Jett. “I’m afraid something is wrong with Evan,” I said. Then my pager went off again. It was from my previous co-worker, Tim Kessinger. He had added 911 as part of the call back number. At Diablo Canyon, we only do that if the call is very urgent. Tim informed me that Cindy called him with an urgent message; Evan had been rushed to French Hospital.

   I was thirty minutes away. Normally, I enjoy driving outbound on the Diablo Canyon access road. But now, I wasn’t paying any attention to the grand scenery. I was trying to drive carefully while dreading the worst. I didn’t know whether Evan would be alive or not when I arrived. I would be told later, by the ER doctors, something even more dreadful; they didn’t know either.

   I rushed into the ER and identified myself.

   “How are you doing?” one doctor greeted me. I immediately felt that was the dumbest thing he could possibly have asked me.

   I frantically replied, “You tell me. Where’s Evan?”

   “We’re doing a CT scan on Evan. Your wife is with him. We don’t know what’s wrong with him yet.”

   I was a little relieved he was still alive, but I was extremely worried.

   A few minutes after I arrived, Dr. Bravo entered the Emergency Room.

   As four worried doctors listened closely, Dr. Bravo started asking questions.

   He asked, “Did you check his potassium level?”

   “Yes, it was 4.2” Dr. Bravo was alarmed by that result. In eight years, Evan’s potassium level had always been either on the high side of normal or just above normal. 4.2 is on the low side of normal.

   “Did you have a hard time drawing a blood sample?”

   “Yes,” one doctor admitted. Under these conditions, fluid from under the skin may have been drawn into the needle. When the sample is analyzed, the potassium level would indicate higher than actual.

   Dr. Bravo said, “The sample may have been contaminated. We need to get another blood sample, now. I think his potassium level is actually too low.”

   By that time, an intravenous tube had been established. This allowed the doctors to immediately draw a clean sample. The results were both revealing and sobering. Evan’s potassium level was, in fact, dangerously low. Now that they knew what was wrong, they knew what to do to save his life.

   Later that day, I was sitting next to Evan in the pediatric ward. Evan was very quiet and very tired. He soon fell asleep.

   A nurse said to me, “You look very tired.”

   I said, “Physically, I’m not tired at all.” What I didn’t say, but she surmised, was “I am an emotional wreck.”

   She drew the curtains around the bed. “Here, I’ll give you some privacy. You can cry if you want to.”

   I appreciated her concern. I really did. I liked most of the doctors, nurses, and other trained professionals that have cared for Evan through the years. But I hate hospitals. I hated the fact that my youngest son was here in the hospital instead of in school, where any eight year old boy should be. Yes, I know, a hospital bed is better than a coffin.

   As we thought back on the previous week, we realized the coffin was actually very close. We had just been to UCLA for a follow-up exam with a kidney specialist. One of the medicines Evan was taking was having a long term side effect.  The medical term for the side effect is “Nephrocalcinosis.”  The English translation is “The kidneys are turning to stone.” It was time to try another medication. She told us she would call our local pharmacist with the new prescription. When she called in the new prescription to our local pharmacist, he balked. He felt that, for Evan, the dose she wanted to try was too high. He convinced her to lower the prescribed dose. As it turned out, the pharmacist was more correct than he thought. If we had given Evan the original prescribed dose, we would have lost him.

   Taking Evan to the hospital nearest Dr. Bravo was a smart move. Any set of Emergency Room doctors at any of the hospitals would have encountered the same problem with drawing and analyzing his blood. It was Dr. Bravo who recognized the problem and provided the proper course of action.

   We credit Dr. Bravo and our pharmacist for Evan’s survival. The specialist at UCLA felt terrible. But I don’t blame her. She was trying her best to meet the needs of a patient with a very rare and complicated kidney disease. I also give her credit for listening to another medical professional.

After writing this Blog post, Katie expressed surprise that Evan was still in danger by the time she left for school, because he was conscious and breathing.  I found this discussion of Evan's problem on the net. 


Hypokalemia
From Wikipedia, the free encyclopedia
Hypokalemia is a potentially fatal condition in which the body fails to retain sufficient potassium to maintain health. The condition is also known as potassium deficiency. The prefix hypo- means low (contrast with hyper-, meaning high). The middle kal refers to kalium, which is Latin for potassium. The end portion of the word, -emia, means "in the blood" (note, however, that hypokalemia is usually indicative of a systemic potassium deficit).

Signs and symptoms
There may be no symptoms at all, but severe hypokalemia may cause:

• Muscle weakness and myalgia (Why Evan wasn't looking well prior to the incident)
• Increased risk of hyponatremia with resultant confusion and seizures (We found out the hard way)
• Disturbed heart rhythm (ranging from ectopy to arrhythmias) Serious arrhythmias (This is a polite way of saying sudden death because the heart stops working correctly.)
• EKG changes associated with hypokalemia
• Flattened (notched) T waves
• U waves
• ST depression
• Prolonged QT interval