Well, after an at least half an hour of uncontrollable coughing (and not just any old kind of uncontrollable coughing but really violent, gut wrenching coughing), I called the ped's office last night around eleven. The after hours nurse (who pulled up Hallie's chart and was very much on top of things) got in touch with the ped on call (it's a faculty practice, so one of them is on call 24/7. It's one of the things we really like about our ped's office. That, and the fact that they can get you in for a sick appointment by six if you call by four pm). The ped on call heard the update and had us take Hallie in to the CHOP ER. After gathering her stuff (I always pack as if we're going to end up being there for a few days. That's partly out of habit (after all, this did happen a couple of times) and partly out of the take-an-umbrella-and-it-won't-rain philosophy by which I live. Anyway, for the sake of reference, I might add that we only live fifteen minutes by car from CHOP. But still, it pays to be prepared for all eventualities and it's really hard to leave a sick kid if she does have to stay in the hospital. Plus, remember that I used to go to the Soviet Union to study Russian and things like that back when it was the Soviet Union and there is nothing like being prepared for anything in an economy of scarcity.
Anyhow, the ER wasn't busy but we still waited quite some time. Hallie was a doll. She was wide awake (this was the middle of the night, and that is not typical at all for her) but not in distress at all (of course...this is how it usually is. She usually perks right up and seems a whole lot better the second we get to an ER). She was still barking off and on, but she weathered the wait brilliantly. She recited her alphabet about a gazillion times, read the "welcome" sign letter by letter, said hi to all the other kids waiting to be seen, drew in her complimentary coloring book with her complimentary crayons (which she then skinned, as she is wont to do), and was great even when they triaged her (oddly enough, she did not scream in pain and fear when they took her blood pressure and did a pulse ox this time). Her pulse ox was fabulous (96-100) and this was reassuring, but given the complex history and the barky cough (which she demonstrated for the triage nurse), they decided to take her back to be seen.
The docs ordered a chest xray (thankfully negative, ruling out pneumonia or a swallowed foreign object) and, after a bit of testing (a swab for pertussis), ordered up a dose of oral dexamethasone (a familiar drug that saved her life, but one not used lightly---my sense is that she REALLY needed this or orapred or something...I'd been mentioning to Sharon for days that I thought the kid needed steroids for this cough) and an albuterol treatment (Hallie helpfully counted to ten for the RT and even pushed her own puffer plunger....it's sort of sad and sort of great that she is able to participate in her own medication). So, five hours after we arrived (we hung out for a bit of observation), the family headed home in the faint light of the Philadelphia dawn.
We're exhausted (slept 'til noon, but that meant a total of six hours sleep for Hal, who woke herself up from her nap yesterday coughing and could not sleep last night at all, and no more than that for either of us). But I think this regimen is working. The albuterol, as usual, makes Hallie really wired (this too could be the after effects of the steroids) but her cough is MUCH improved. Her eating is still sucking, but she is able to take her bottle without vomiting again (every bottle last week was deposited then refunded with a cough) and she seems to be feeling better. So this mystery is solved, at least. And, even though today's intake was no more than 800 calories, they ALL stayed in her this time. So chalk up day 157 for us, even if the victory is bittersweet since 800 calories is what she needed when she was under 1 years of age, not closing in on 3.
Our big family meeting with the docs is on Wednesday so maybe we'll have some more information about where we are going with Hallie at that point, but meanwhile, we're just grateful she's feeling better.
In terms of other stuff: she did a couple of cool things today. First, back in the ER, as usual, they 'banded' her with a couple of wrists bracelets (for allergies, for ID purposes). She hates this and they really bug her and she likes to take them off. Usually they are loose enough for her to wriggle out of on her own, but not this time. So, after hours of being tortured by them, she looked at Sharon, pointed to the bracelets, and said: "It hurts." While they didn't really hurt, so much as bug her, that's pretty huge since it indicates that she is going to be able to tell us when something is amiss.
Second, when the mail came today, I was feeding her in her highchair. She looked at me and said: "the mail!" Who knew that she knew that?
And finally, one of the things we got today was yet another kids' toy catalog (we get a serious number of catalogs and one wonders if it would not be more profitable for companies to cut back on these in this economy since no one is buying stuff anyway). Inside the catalog (I think it was a Highlights Toy catalog) was a picture of a toy guitar. Hallie pointed to it, said "guitar" and began to strum it. Very smart.