attending physician vs family D1

It started 2 weeks ago when Xian had started to experience cough. It was mild initially and later the cough become bursting in nature. No fever was noted and he had noted with no sign of life influenza. I had given him some cough syrup and the cough was better later on. The cough was still non-productive but had been disturbing in the night.

D-5 days before the incident, Xian’s cough character had changed – episode become longer and the sound quality was different from before. I had started him on Augmentin syrup and after the completion of the 3 days course, the cough was stationary and I stopped the antibiotic. On D-1 days, he was noted with low grade fever. I had gone for my night shift and felt very uneasy about his fever. His spirit was ok but yet the cough did not improve.

When I arrived home, I did an auscultation again and found that Xian condition had worsen; there were bilateral basal crepitation with mild wheezing. He was also tachycardia which made me more uncomfortable. I had started him on azithromycin, antipyretics and and some cough syrup before I gone to sleep. I hoped that when I woke up with the fever subsiding, his heart rate would become better…and I was wrong.

After 4 hours of sleep, I woke up and found that Xian’s fever had subsided. He was still tachycardic. I hesitated for a few minutes and decided to take him to the hospital. Tachycardic was not a good sign. Baring in mind that he would be admitted, I grabbed all my gadget and took him to the hospital.

ED was crowded and I seen him myself. The initial vital sign was unsatisfactory, tachycardic, hypoxic(SpO2 93% on room air). The CXR was better than I excepted, some infiltration over rt lower lobe instead of a very large patch. Another struggle….but there is no alternative, to risky to do home care therapy as I don’t have an oximeter in the house. I signed the admission form and praised the great one that there was still a single room available. Single room had been hot cake and very difficult to get one nowadays.

I started him on rocephine and azithromycin as he was an ICU candidate; not much choice for me.

Although with all of the “I am in very bad condition” findings, Xian was still comfortable which worried me. This is the sign of "I could deteriorated fast anytime" without any sign of warning...

The most difficult part was inserting the branula; Xian is definitely a super needle phobia compare to my needle phobia. It took 4 persons to perform the task, he is now 168cm and 63kg instead of the kiddo few years back.

In less than a hour, I had managed to take him into the room. SpO2 had increase to 95% after inhalation but yet he was still tachycardic.

I was unable to sleep that night due to anxiety; I was there as an attending physician, nursing aide and also a family. Xian’s life was in my hand and at the mercy of the great one….

I had questioned myself many times if I made the right decision...should I referred him to a better setting and under care by a pediatrician or should I use another regimen of antibiotic. Questions which I was unable to answer...