It was two Wednesdays ago when Sophia ate the cashew. Wednesday March 15, 2017. Later I realized I wanted to remember the date as clearly as I did her birthday. The day she took her first breath and the day she was once again, given breath upon breath despite the odds.
It was cool for the south that evening, about 60 degrees, and with the humidity we were chilled standing outside watching the kids play AWANA games. She didn’t seem to notice, but of course I was worried about her with her tendency to develop bronchitis.
“I hope she doesn’t catch a cold,” I’d commented to her AWANA teacher. “Her hair is a little damp.”
“She doesn’t seem to notice…maybe she won’t.” Her voice indicated knowledge of these common motherly worries. I felt reassured. Everyone knows it isn’t wet hair that causes colds anyway.
No milk, no peanut butter. QVAR, singulair, essential oils. She should be okay I reasoned. She really hasn’t been sick since before Christmas, since we added the new inhaler and took away two of her asthma triggers.
After church, I set out their dinner and got in the shower. It was about 8:20pm. Brad was in the kitchen making sure everyone ate and got moving toward bed. We never ate dinner after church, but this night they had been late getting home from school. I was out of the shower and drying off when I heard Sophia banging on the door and crying. Interruptions are continually expected in a house full of small children, but there was a strange urgency in her voice. I cracked the door open.
“My throat hurts!” she squalled.
“Go tell your dad! He’s in the kitchen, and I’m just getting out of the shower!”
She turned and ran off. Sophia can be dramatic although, of all our children, she takes doctors’ offices, illnesses, and medications more easily than the others having had much more experience than they. I threw on my clothes thinking, “Could she possibly develop a sore throat that quickly?”
As I came out of the hall, across the living room, and into the kitchen I heard her crying and saying, “It hurts, it itches!” Brad was standing in front of her and told me she had been eating chocolate covered almonds. The baby was in bed, and the other two kids were walking up the stairs exhausted and willing to put themselves to bed.
“Oh, almonds can stick in your throat when you chew them,” I said. “That happens to me sometimes.” Brad was pouring almond milk for her and broke off a piece of a soft muffin.
“Eat this to help push it down,” he directed. She chewed and swallowed. It seemed to help. I picked up her oils to rub on her chest and back. Brad left the kitchen to get ready for bed.
“It still hurts!” she wailed.
I gave her a piece of banana thinking how stubborn those almond pieces can be, how you feel like you’re going to choke, but this seemed strange. My subconscious registered the words ‘allergic reaction’ but my conscious mind pushed them away. Allergic reaction to what? She’s never had a reaction like this even after we had her tested for food allergies and then decided to eliminate peanut butter and cows’ milk. She’s had milk and peanuts all her life until several months ago, and even then her reaction takes 24 hours and manifests as wheezing, then bronchitis, then pneumonia. There were no peanuts in the mixed nuts she was eating.
I rubbed her oils on her chest and back, then gave her a singulair. She chewed it and swallowed, but as we started out of the kitchen she said, “My tongue feels itchy now!”
“Stick out your tongue,” I said turning toward her. “It looks perfectly normal, my girl.” Fear was growing in my abdomen and sliding up toward my chest.
“Maybe you should look in my throat,” she said. A simple sentence that now haunts me like a specter because I should have thought of it myself.
I reached for a small flashlight sitting on a cabinet shelf and leaned toward her. Even without asking her to say Ah I could see it, the soft tissues of her throat bulging and her tonsils blown up like two shiny, pink balloons. All thoughts of bedtime, almonds, and safety fled like darkness on a well-lit ball field. My temples felt a rush of blood; I felt my heart interrupt itself in a preventricular contraction-the feeling of your heart turning over in your chest.
Suddenly I defaulted to my husband. He needs to see this I thought. “Come on,” I said and took her hand as I began walking to the bathroom where Brad was just wiping his mouth after brushing his teeth.
“Look in her throat,” believing I sounded as normal as anyone with an urgent request. I handed him the flashlight.
“Allergic reaction,” he said immediately after looking. Sophia began to cry; she sensed the fear that had wrapped around me like a tight, white jacket the laces beginning to bind. Brad spoke to her gently and lead her toward the couch. I made strides toward the kitchen, my mind a wreck of jumbled bullet points:
“How much time do we have? How much time have we lost? I don’t know what to do,” even as I searched first one cabinet and then the next for Benadryl.
“She’s breathing fine. Dear God. Benadryl. Do we even have Benadryl? This has never happened before. Epi pen, does Brad still have that epi pen? I don’t know what to do.” Brad is allergic to escargot, but he had not replaced that pen since the turn of the century.
I found a box of store brand Benadryl and opened it. There were two left, two capsules.
“She’s never swallowed a capsule before. She’s never had Benadryl before. Dear God, help me. Help me.”
I looked at the box and saw that it said children six and over can take one capsule. I felt like a doctor was standing over me saying, It’s okay to give your child this Benadryl. But for some reason in my mind, I still had to default to my husband.
“Here’s two Benadryl,” I said showing Brad where he sat with Sophia quietly on the couch. “Do you think she can swallow this?” I asked him even as my subconscious told me he has far less experience with her ability to take medication than I do. She still looked fine, no stridor, no discoloration.
I walked back to the kitchen because he took too long to answer, and as I pulled the honey from the cabinet I could hear him saying, “Mix it in a little almond milk, not too much, it won’t taste good.”
“She’s too old to take medicine in that way,” I thought as I took a tablespoon from the drawer.
“Honey. Honey has a high allergy rate too. What happened to her anyway? She eats honey all the time, if I mix it in honey she can eat it. She’s such a good medicine taker,” my thoughts raced as I cracked the capsule open and mixed it in a little honey I’d poured in the bottom of the tablespoon. I brought it to her with a cup of almond milk.
“There you go, eat what mommy fixed for you,” Brad prompted Sophia in that voice he uses when he wants to cajole the children. She willingly ate the honey, face scrunched at the bitterness but obedient to clean the spoon.
“Okay now we just wait a few minutes. She’ll be fine,” Brad said to me as calmly as if Sophia had shown us that she had a splinter in her finger.
“Let me look in your throat again, my girl,” I said. She opened wide; it seemed the same. We must’ve checked four times already, twice each. It didn’t seem to be getting any worse. My heart was now a hammer pounding railway ties. Outwardly my face was a mask, my voice suited for a cathedral, my body like a statue.
“It was the cashew,” Brad said after several minutes. “She’s never had a cashew before and they have a very high allergy rate.” He paused while we both thought about this. “Yep. That’s what it was.”
“Cashews,” I said thinking for the first time about the nuts she had been eating. After realizing she was having an anaphylactic reaction I had not rationalized what might have caused it. I was thinking only of how to stop it. But Brad’s deduction made sense. Sophia’s nose wrinkled as we talked and to help her remain calm I expressed my dislike for cashews. “Oh those are yucky nuts,” I said. “They taste kind of strange anyway.”
“Yeah,” she agreed. “And they’re white and funny looking.”
We became silent again, and I stood up holding my robe around me. My hand held the robe closed near my neck, a classic sign of fear I heard my subconscious saying.
“She’s going to need an Epi pen,” I said quietly, never imaging this would strike fear in my child. She began to wail. A good sign of perfect airflow I thought regretting that I’d said anything. We both tried to use soothing voices to let her know this meant nothing to her at this moment; nothing was about to happen to her.
After 15 minutes it was 9pm, and Brad told Sophia to go on go to bed. She hesitated and I saw immediately her fear of going upstairs to the room she shared with her sister and brother. “Go lay down on my bed, honey,” I said referring to my side of the bed Brad and I share. “I’ll be right there.” I didn’t want her out of my sight, but I needed to talk to Brad and frightening her would accomplish nothing. Brad looked like he was wrapping this situation up in his mind while it was just gearing up in mine. Sophia quietly went to lay down no more than 50 feet from where we sat talking.
“She needs to be seen,” I said still standing.
“Well, what do you want to do?” he remained on the couch placidly looking ahead. We are both analytical thinkers, but later he would point out that he finds it difficult to make split second decisions. I tend to come to conclusions quickly in an emergency, and then later suffer horrible repercussions of trauma fatigue and re-analyzing my every action.
“I don’t know,” knowing she had to be seen, but wanting Brad to agree. “I mean take her to the hospital? I mean, I hate to but I don’t know if this will get worse later tonight as the cashew digests and the Benadryl wears off.”
She was two years old the night we rushed her to the ER with labored breathing. It was her first time having pneumonia, her second time with difficulty breathing. Brad had stayed in the ER room while the nurse started an IV. I had been the one to leave the room unable to hear her crying in pain and fear. When she was admitted for oxygen, breathing treatments and antibiotics, he had gone home with our oldest daughter. I had roomed with Sophia and our tiny son, only a few weeks old.
Three years later when she was five years old he told me, “That was the worst day of my life. Seeing that happen to her. I never want to have to go through that again.” He couldn’t stand to see an IV started on his little child’s arm, strangers touching her, treatments and foreign equipment being placed on her. He couldn’t stand the fear in her face and voice. As he told me, I realized this man I had known for ten years was opening a window into his soul. I was shocked at the words he had clearly chosen, “the worst day of my life.” He had been so calm that night; he had been the one to volunteer to stay for the IV.
As a 13 year old, he had witnessed his own father’s sudden death and, even knowing he was dead, he had performed CPR on him right there in the front yard. He remembers his daddy’s last word, the way he fell back onto the ground, the look of his glazed eyes, his mama calling his uncle to come quickly. Then the frantic efforts to get him to the hospital in time by throwing him in the back of the truck, and the futile rush to the small town ER. And yet that night four years ago, the night we could’ve waited just a little too long to bring our daughter to the ER, the night she screamed and cried not understanding why her daddy would let strange men and women hurt her–that had been the worst night of his life.
But there we were in the living room on this scary night looking at each other. He seemed to be willing any further problems away while I was not satisfied that our nightmare was over.
“Whatever you feel like we should do, I’m fine,” he said.
I was deeply afraid. If I took Sophia to the ER now and terrified her only to find out she was perfectly fine, I would regret her terror, the waste of time, the hassle of a late night trip. But if I didn’t take her in, and she became worse, she could die.
“She has to go,” I said.
“Okay fine. You better call,” he agreed.
I picked up the phone as Sophia came out into the living room. “It still hurts,” she said in a puny voice. Brad got up from the couch and went to her. As walked to the bedroom with her, I dialed 911.
Twenty minutes later two police cars were at our house; an eternity later an ambulance was there. Brad commented on how quickly they had gotten there while I looked at the clock and saw it was 9:30. It had been a full hour since Sophia had eaten the cashew and 45 minutes since she’d taken the Benadryl. I concentrated on giving the details of the evening. Sophia was drowsily sitting up in our bed, dutifully opening her mouth for first the policewoman, and then the paramedic. The paramedic said she looked fine to him.
“She’s not having any wheezing,” he said straightening from listening to her with his stethoscope.
“No, she never had any wheezing,” I said.
“If her throat was closing you would hear wheezing.”
“She never had stridor,” I specified.
“Are you a nurse?”
“Yes but not peds and I’ve never dealt with anaphylaxis in the early stages. I needed someone else to look at her.” My incessant need to explain myself, I thought.
“Well we can take her in if you want us to.”
“I don’t want any more drama than we have to have,” I said. “If you think we should, I want her to go; I don’t know if something might happen later. But if she’s okay—“
“She looks okay to me.”
We walked out to the dining room and I signed his electronic form while the others waited by their vehicles on our driveway. Brad stayed in our room where he and Sophia fell asleep.
As the paramedic walked out the door I thanked him for the fourth or fifth time. He turned, the computerized clipboard dangling like a weight in his hand. From the shadows of the carport and slightly stooped he said, “Oh we can’t do much for anaphylaxes except Benadryl and Epi pen. They can’t do much more than that in the ER either. Benadryl and Epi pen…and emergency trach.”
“I know. Yes. I know.” My hand clenched my robe again. And I have no straws in the house, I thought, as he walked away. No Epi pen and no experience performing emergency tracheotomy in which to insert a straw, that I don’t have, to give breaths until an ambulance could arrive.
I walked into our bedroom and lay down quietly. A sleepy Sophia instinctively moved toward me. She has slept in her own bed since she was an infant, but that night I kept her close. I held her hand. I listened to her breathe as I’ve listened for years now, ears straining to hear clear sounds, but so often hearing wheezy wind instruments, coarse mucous-ridden rhonchi sounds, and snoring deep in her chest. Rubbing essential oils, giving treatments, teaching her to cough and deep breathe repeatedly, listening with my stethoscope at least monthly when she was well, multiple times a day when she was ill, teaching others to give her medications and look for signs of respiratory distress. I knew how to head off pneumonia at the first sign of a clear, snotty nose. Coming home from work I always knew if she was wheezing immediately while everyone else thought she looked fine. Soon she could tell me herself.
It was a new twist in her lung history when, over the summer, she had developed a cold that mostly cleared but was followed by a week of nausea and diarrhea. “Classic signs of pneumonia,” her doctor had said when I took her in. “The infection sets in and manifests as GI tract illness.” Sure enough the chest x-ray had shown a right lower lobe pneumonia. Not her classic signs, I had thought at the time. Then early this past fall we visited an allergist, had learned her asthma triggers. Dust mites were off the charts registering in the 100s, but there were a host of others registering in less than 1 that needed to be looked into. We eliminated a couple foods, and she had been mostly clear for months.
Now this. Anaphylaxis.
We’ll make an appointment first thing and get an Epi Pen, I thought. In the meantime, it was another moment to thank God for presence of mind despite fear, for knowing years ago we would need Benadryl in the cupboard even though Brad and I don’t take it, and for giving her breath upon breath.
I fell asleep, though I felt I was walking in the valley of the shadow of death. He is here though, I thought, I know He is here.