The worst headache…

I was driving to work, later than usual due to some clinginess on J’s part. I was heading north on I-95, listening to the non-stop coverage of the Sandy Hook Elementary school shooting last week, when my phone rang. The display on my car showed a number I didn’t recognize. I hit the “Answer” button.

“This is the school nurse at [local] elementary school, and S is here with me saying he has a bad headache and he’s crying. He says he got hit by a door at karate class last night.”

“How strange,” I said. “He didn’t mention it, and he didn’t complain of a headache, either last night or this morning. May I talk with him?”

She put him on the phone. He was, indeed, crying.

So, of course, I turned the car around, and headed back the way I’d come, assuring her that I would be there as soon as I could get there.

It wasn’t easy to turn around. I had passed every exit that I knew would allow me back on the southbound lanes, and I took the first exit, which I’d never taken before. While doing so, I tried to reach Dad, whose workplace is closer to school than mine, but I failed to reach him at both work and cell numbers. I left a somewhat frantic voicemail message, and finally got back on I-95 heading south.

My next call was to the pediatrician’s office, to ask whether I should bring him there (and, would I need an appointment to do so?), or take him to the nearest ED. I got through to the nurse, who was very reassuring, and suggested that I call her when I am with S, and we could decide then, with more direct information than I had at the point.

The phone rang, and it was Dad, calling back. I explained the situation, interrupted once by a cellphone disconnection. Once I’d communicated the whole story to him, he asked, “OK, so should I go get him?” But, by this time, I had covered a lot of ground, and I figured, with his walk to the parking garage and possible traffic, I was now closer. So, I told him I’d keep him posted, and kept on going.

I finally got to the school, and S was lying on a cot holding an ice pack to his forehead. And crying. Which made me nervous, since S is such a tough kid. He never seems to flinch with physical pain or discomfort.

“What happened?” I asked him. He explained that he got to karate class last night with our carpool buddies, and went into the boy’s room to change. He was coming out when someone pushed the bathroom door open hard, and the corner of the door hit S squarely on the forehead. He didn’t tell anyone, and went to class, and the pain went away. He said it was hurting. A little bit when he woke up, but went away. Then, during Art class, he suddenly had severe pain, and finally told the teacher.

I ran through my list of warning ROS (review of systems) questions that we use in medicine to distinguish a life-threatening problem from non-life-threatening:

  • did you fall down or pass out?
  • vision changes?
  • ringing in your ears?
  • dizziness?
  • weakness in arms? Legs?
  • nausea or vomiting?
  • anything else?

He answered no to everything, but his expression was so anxious, and he continued to cry, so I decided – I was taking him to the ED, in case there was any indication for a CT scan to rule out a bleed! I don’t know if that’s how every physician-parent thinks, but that’s what went through my head. So we headed over to our nearest hospital.

Sadi was full of objections.

“I don’t want a shot!”

“I doubt they’ll need to give you a shot” (although I was thinking if they did need to do a CT scan to rule-out an intracranial bleed, they might need to inject intravenous contrast dye).

Ignoring my reply, he asked “Would they have to give me a shot in my brain?”

“Definitely not!” That was an easy one. “They might need to take a special kind of picture of your brain, but it doesn’t hurt, and they don’t have to open up your head. It’s kind of an X-ray.”

“Oh, I want an X-ray! Will I be able to see my brain?” He was excited at the prospect.

“Let’s just see what the doctor thinks.”

We got there, and checked in. I had my clinical eye on him the whole time, and I noted no signs of any neurological problem, and he was getting more and more chipper.

It was a slow morning, and we were the only one in the waiting area. So, we were taken back pretty quickly. Vitals – normal. And the doctor came in. A nice guy with skin close to the color of S & J and an accent that strongly suggested that he was from Ethiopia. S refused to tell his own story, so I did, from what he had told me on the way. While I was telling the story, S interrupted to clarify certain points, which amused the doctor, and reassured me. Then, Dr G did a thorough neurological examination (I had told him I’m a doctor, so he knew I knew what he was doing). S was now in his silly mode, and wasn’t totally cooperative, but we coaxed him through. And then, Dr G threw out a sentence in Amharic. S replied with a silly grin, and shrugged his shoulders, and finally said “Hop-hop!” The word for watermelon. Dr G was nonplussed. I explained that we had tried to preserve his Amharic, but he had resisted, which prompted S to trot out his pat explanation/protest “It’s my parents fault! They brought me to America, and taught me English, and that’s why I can’t speak Amharic anymore!”

It’s an interesting he’s put on the story. We are exploring tutoring or classes to try and recover Amharic for S, and give J a base t all, since he only has minimal exposure from our nannies.

Anyway, Dr G and I agreed that S seemed fine. I was reassured. While the checkout papers were being printed out, Dr G asked if we were familiar with Amanuel, an adopted Ethiopian kid living in Australia. No, I wasn’t. But, here he is…

We got our aftercare information sheet on headache, and left the hospital. I took S home, and we made grilled cheese sandwiches before going to the NIH to drop S off with his dad, so I could go to my clinic in Baltimore. His “headache” was merely a bruise from getting hit in the forehead by the corner of a door, hard. Did I overreact? Maybe. Am I glad of the outcome – most definitely! I had a lovely couple of hours with my more remote kid…and I’m happy for it. He showed some vulnerability, and maybe that will lead to a way closer in. He’ll always be more isolated, and more alone.

And I know that feeling…all too well.

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