I went through something terrifying on Tuesday. One of my nineteen-month-old twins was roused from his nap by my wife. He had been well earlier in the day, playing in the children's water park at Kelowna's City Park. But J was upset and said that our son, G, wasn't looking right. I was in the middle of a haircut at home and told her to stop freaking out. She remained concerned and upset, and my hairdresser offered to release me from my chair.
I went to look at G and was instantly struck by how wrong he looked. His cheeks and ears were flushed, especially on the left side. He was grunting and moaning, his breathing laboured, and his half-open eyes were gazing fixedly up and to his left. His back was arched, his head lolled back, his jaw clenched, and he wouldn't respond to anything. "J, I think he's having a seizure." She nodded, her face openly showing her fear in her knotted brow, downturned mouth, and imploring eyes. "Let's go!" I said.
I grabbed G and ran barefoot to the van. I barked at J to get the keys and my shoes. I strapped myself in and held him in my lap while she drove the two blocks to the emergency department. He remained flushed, which was good, that meant he was still getting oxygen, but he had brief apneic spells prompting me to consider mouth-to-mouth resuscitation. Fear gripped me as I gazed into those eyes, eyes that did not look back, eyes that gave no hint of the bubbly toddler they belonged to. I rocked him back and forth and begged him to return to consciousness. I lied to J about how he was doing so she'd keep her eyes on the road and get us to the hospital intact.
I raced into the emergency department, went to the triage desk and said, "This baby is having a seizure." I was directed immediately to a nurse and said again, "This baby is having a seizure." In retrospect, I still don't know why I referred to G that way, as "this baby." Was it more clinical? Did I intuitively distance myself to seem more objective in my assessment, and gain credibility? I don't know.
We were quickly escorted to a vacant trauma room where--nothing happened. For a seeming eternity, nobody seemed to make much effort to match our concern. G continued to look into the void, we continued to fret, and aside from some vitals, nothing was being done. No anticonvulsants were administered, no doctor assessed him, no tests were ordered. This was unbelievably distressing to J and I, but we are both too reserved to press for attention.
At last, after about five minutes, a colleague and friend of ours arrived to quickly assess G, looking him over and listening to a retelling of the events leading up to this episode. G is a healthy nineteen-month-old identical twin. His brother had a febrile seizure three months ago (witnessed by my wife, and also prompting a trip to ER). He has recently been well, except for a low-grade fever that day before his nap. I gave him some acetaminophen before I put him down to sleep. His brother had been gamely suffering through a mild head cold, snotty nose, disrupted sleep, nothing serious.
G received more acetaminophen and some ibuprofen. It took a few more long drawn out minutes for G to finally recover consciousness, before his eyes brightened and he gathered in his surroundings, before he was able to give voice to his own distress with a good sustained cry. It had never sounded sweeter.
He remained irritable, jittery, and easily startled in his post-ictal state. Over the succeeding hour, his temperature remained over 40 degrees Celsius, and he threatened to seize again. But that terrifying vacant look never reappeared.
G was discharged within a couple more hours after blood and urine were collected.
Over the next day, I watched him carefully for signs of permanent or acute brain injury, my greatest fear given the duration and intensity of his seizure.
With my first son (the twins are my third and fourth), it took several years for it to dawn on me that he was not perfect. I aspired to his perfection as a parent. But when his lip was scarred by a fall to the pavement, when he needed his tonsils out to deal with his sleep disturbance, mouth-breathing, and venous stasis, when he ultimately needed glasses at six, I realized that he was not perfect. He was just a talented, affectionate, intelligent boy, and that's all I could wish for.
Now I was scared that G was beyond mere imperfection. I was concerned about a lasting impairment, cognitive or physical. He played with me later that day before bed, deftly repacking some wooden blocks into their box; listening to a favorite story, turning the pages; vocalizing some toddler conversation as I tucked him and his brother in. He was still febrile, still acted sick, but he seemed undamaged. I feel so goddamn f-ing fortunate that he is unscathed.
The next day, his fever rocketed to over 40 again (40.2). And again, shortly after I got him up from a nap, he seemed jittery, easily startled, and generally miserable. But he never had a repeat seizure. And it appears that he is now getting over whatever virus he was suffering from. We gave him antipyretics like clockwork, the ibuprofen every six hours and the acetaminophen every four, skipping an overnight dose when a hand to his forehead revealed a satisfyingly normal temperature.
I wanted to write about this awful experience to let you know what happened to us and also to reach out to other parents trying to make some sense of this condition. As physicians, both J and I have counseled parents going through what we just did. That didn't really make it easier to handle it though. We were scared.
For more, check out this fantastic parent-oriented page from the Mayo Clinic. Here's another from the NIH. An excellent review article appearing in the Archives of Disease in Childhood can be found here. In the scholarly literature, there is evidence of a familial association of febrile seizures, and thus, unsurprisingly, genetic susceptibility loci associated with the condition. Consequently, concordance rates in monozygotic twins are higher than in dizygotic twins.
I hope your child never suffers such an alarming episode. But if they do, I hope knowledge of our experience with this condition gives you some comfort.
Technorati tags: febrile seizure, identical twins, monozygotic twins