Smart Aleck Persin

Considering the wildfire that was set ablaze through our life in 2018 I was excited to start this new year off right. I’ve been back to exercising regularly for the last six weeks and I can feel a whole body and mind shift that I’m thoroughly enjoying. Binging on Netflix is reserved only for at night and weekend work, which means I’ll hardly be watching it at all anymore, and I’m ticking off my to-do list one by one. But if we truly want to start this year off on the right foot, it was time once and for all to address the left foot. Aleck’s ingrown toenail on his good foot (cue James Brown), the foot on the leg that isn’t currently still recovering from baseball stitching scars all over, was still a problem and six months later we were ready for this to be behind us as well (see last month’s post about it by clicking here).

After three podiatrist appointments, the doctor recommended he be taken care of by his surgical team in his clinic, but Northwestern doesn’t “operate” on children so our hand was forced over to Lurie. Craig called there and after telling the story a few times was passed onto the clinic where they made an appointment with a doctor for after his last day of school before winter break. They assured him over the phone that they’d be able to take care of an ingrown toenail there, no problem. Meanwhile, I was still hoping that the teeny piece of cotton from a Q-tip trick was going to work, I had done that while we were at Shirley Ryan, but Aleck’s toe never calmed down enough for me to get near it. Craig was convinced that there was a tiny piece of a nail stuck in and under the skin and that the nail had to be cut back and the piece removed. Aleck was swooped from school, they drove downtown and met with a lovely doctor who informed them that they could not get this taken care of during clinic and instead this would have to take place in the operating room and gave us January 8th as our date.

On January 7th Lurie called to inform us that the appointment was at 3:30pm and that Aleck was to only have clear liquids all day since they would be putting him under general anesthesia. Wait, what?!? It’s a toenail, this is not major surgery, trust us, we know, we’ve done that already. We aren’t doing that anymore unless we have to. And what in the world are we going to do with a starving child all day long who’s finally back at school after break? OK, fine, they called us back and changed the appointment to 12:45pm. But still, only clear liquids, he was going under. Now Aleck has been under plenty of times but there is ALWAYS a risk when you are knocked out like that. And as parents we have to sit there not only worrying about the stupid toe but also that nothing went wrong with the anesthesia, that his brain isn’t going to be damaged, that an accident isn’t going to happen. It’s adding a very big risk for such a small procedure. I told Craig to cancel the appointment, we will take him to the ER together after school. As his parents we will force their hand to give him something to relax him while they begin the numbing shots needed in order to then cut back the toenail. We are not starting the year with anesthesia. Plus, when he wakes up from that he feels awful, it sucks so much more time and we’d have to keep him home from school the next day, all for a toenail.

When we discussed the toe with his surgeon a week ago she agreed that there was no need to turn this into major surgery, but she has no pull with Lurie on this one. She explained to us that they’ve developed a policy of trying to put the child in as little distress as possible, the goal being as few tears and screams elicited from the patient. But they are forgetting the parents in this equation because we’ve sat through anesthesia with Aleck six times already and each time is like your heart is being suspended in mid-air by dental floss and it hurts to breathe the entire time. Not to mention all the worry leading up to it and then the repercussions of coming off of it afterward. I’m sorry but I think a few tears while some calming medicine is kicking in is a whole lot better than putting my seven-year-old at an even greater risk that could have way worse lifetime effects than being anxious when going into the ER.

So onward we marched in at 3:15 pm on Tuesday, our agenda in hand. Every single person who walked into our room heard us loud and clear because we were almost shouting. The resident starts asking us when he last ate and Craig jumped out of his chair. I had to remind my hubs that “resident” means “student” so be calm and patient, this 20something does not have the final say. They secured Versed in a nasal spray and I think that made Aleck scream the most. We held him down, the nurse sprayed, and he was then calm and complaining about the taste. This was actually another battle since they prefer to give it as an IV. I hear my mouth say, “so you want to stick a needle into his vein instead of having him deal with the momentary discomfort of an oral or nasal medication? Not happening.” Shall we weigh that one? I’ve had bad IVs, anyone else? Your hand can swell up like a balloon and turn purple, it’s awesome. Plus, Aleck is a really tough stick because he’s got such low muscle tone in his arms. It would take them almost as many times to get the needle in the vein as it took them shots to numb his toe, how does that make any sense? By the way, before taking your child away for general anesthesia they give them Versed anyway! I mean, how much can we pump into his 40lb belly for this toenail? Talk about overkill.

And just so you know, it takes twelve shots to numb the toe, the same twelve shots the podiatrist at Shirley Ryan was going to try to give Aleck without any Versed or anything to calm him down, and looked at me deadpan asking me if I could keep him calm during those twelve shots. What was she thinking? I can hold him down, I’m not against doing that. And until the Versed really kicked in I was holding him down and coaching him through it while his screams went from Jamie Lee Curtis to a mild-mannered “ouch.” Craig had Aleck’s favorite show cued up on his Ipad and he was as cool as a cucumber while we watched the doctor pull out large chunks of the nail that had been wedged under his poor skin.

When it was all done we had a bit of a debriefing with the doc, telling her the story of getting to this point and asking why the hospital was insisting on turning this small ten-minute procedure into major surgery. She explained that they prep everyone like that so that if something happens and they do need to put the child under everyone is ready, they don’t need to wait until the stomach has cleared out of its food. And that probably if we had shown up at our appointment earlier in the day we would have had a discussion with the pain team and done Versed or something like it instead of general anesthesia. But there’s a “probably” in that sentence that we weren’t comfortable with and as much as I understand preparing for the worst, that puts everyone in even more distress than addressing the worse when it comes up. Shit happens, I get it, even under toenail sized circumstances, but I’m not putting my family through the wringer for a possible WCS if I don’t have to. Tears are one measure of how much distress a child is in, but anxiety lasts longer, it tears at your insides completely since it has no outlet, and takes a tougher tole on everyone.

After it was all done Aleck commented on how the doc was so nice and how she did a great job and it really wasn’t bad at all. Then he asked us what we were doing for dinner. We picked up Potbelly’s in the lobby, ate dinner in the car on the way home, and he was in bed by 7:45pm. The next morning he got out of bed without any complaining, we sent him to school with his wheelchair just in case, and at 2:55 he walked in the back door proudly announcing to me that he didn’t use his chair at all that day. And that night he was back in bed with the lights out by 7:45pm.