Kathy Petersen’s Blog

Seth’s first trip to the ER

Posted in children by Kathy on April 4, 2008

Background: I have two sons, Keith (3 y/o) and Seth (22 m/o).

On Wednesday, I was cleaning up the house, and ran downstairs to put some books and things away in the boys’ room. As I go through the living room on my way back up, I hear Seth crying his “Keith won’t let me go” cry (I’m unfortunately far too familiar with this sound). The cry continues and then worsens into his “I’m hurt!” cry, so I race up the stairs and see Keith on the seat-side of the couch with Seth behind the couch (it is not backed up to the wall). I pick him up, and Seth is grabbing at his right arm with his other hand. I comfort him for a little bit, but the cry continues. I take him downstairs to try to distract him with cheddar Chex Mix (his favorite snack), and he won’t even look at it. I take him to his room to read to him, and remember the left-over Easter candy on the way, so grab a Hershey’s kiss. He stops crying for about 10 seconds, and then starts crying again, with the chocolate now drooling out of his mouth. Fun. All this time, Keith has been making things worse by non-stop chatter and other basic three-year-old attention-getting techniques.

Fortunately, my husband comes home from work then, and he takes Seth and just holds him, while I settle Keith down a smidge. We discuss the situation for a minute, and decide to go to my mom’s chiropractor to see if he can X-ray Seth’s arm to see if it’s broken or just badly sprained (this was right before 5:00, so we couldn’t go to a regular doctor, and didn’t want to go to the ER for a sprained arm, you know?). He examines him and feels his arm and says he thinks it might be broken (he’s especially worried about the growth plates there at the wrist). However, his X-ray machine is primarily for people’s backs, and without a table we can’t get Seth to hold his hand still in a position that lets us get a good look. Note that all this time Seth has been pretty good, unless somebody touches his arm or it moves. He looks so pitiful, though, with his arm just dangling by his side.

So, the chiro tells us to take him to the ER so they can fix him up. Well, last year, my sister’s daughter was thrown from a donkey and broke her arm, and they took her to the ER, but there wasn’t a doctor on call that could set the bone, so they just put it in a sling and told her to go to the doctor in the morning. (That doctor said the ER people didn’t even do a good job on the sling.) So, we decided not to pay $500 for a bad sling job, and just go to the doctor in the morning. Seth slept pretty well that night, except he’s used to sleeping on his tummy, but that hurt his arm. He woke up several times crying out, but went back to sleep pretty quickly except once. In the morning my mom and I take my son to a nearby large town which has some good orthopedists (the only closer one has been very strongly unrecommended by several people). Long story short, they won’t take him without X-rays, and suggest we go to the ER if we think his arm is broken. Note that the only symptoms of this is that he won’t use his arm, and his wrist was a little swollen.

We get to the ER, and don’t even have to wait in the waiting room — they take us right back to an examination room. It’s the usual stuff — weight, temp, etc. A few different people come in, and somebody says that it looks like it’s his elbow that’s out of whack. [Thinking back, I can see that clearly, but it didn’t register at the time. The difference is slight, but noticeable if you know what you’re looking for. His whole arm was hanging limply from his shoulder; after they popped his elbow back in, you could tell that his elbow was still hurting a bit, but he had it slightly flexed, as opposed to dangling.] When the doctor came in, she concurred with what the nurse said, and called it “nursemaid’s elbow” — I guess because the nursery maid would drag a kid around by the hand, dislocating the elbow. [I’ve heard of this before, but not with the name, with parents swinging a child by the hands, either doing “1-2-3-WHEE” or going around in circles.] But she wanted to do X-rays to make sure. By this time, Seth was pretty tired, having woken up early after not a full night’s sleep, so he wasn’t too happy. We got them done, with both me and my mom holding him so that they could get a clear shot. The radiology technician said that “nothing just jumped out at” her, so it was probably nursemaid’s elbow, and not a fracture. That’s good!

We get back in the exam room, and the doctor comes back in and pops the elbow back in place. It hurt Seth a lot, and he did not like the pretty doctor one bit!!! In fact, when she came back later to dismiss us, as soon as he caught sight of her, he started crying and tried to get away from her by nestling up to me. But it was over, and almost immediately, his elbow came back up in a slightly flexed position. He still didn’t use it, but it wasn’t dangling limply like before. Then the doctor said that Seth should be all well in a few days, but if he didn’t seem to be better, to take him to his doctor or bring him back to the ER. When we left, we got a copy of the X-rays for two reasons: 1) I’m curious; 2) I didn’t want to have to drive all the way back to the hospital if we did end up having to take him to another doctor.

By this time, it was noon so we got lunch, but Seth fell asleep before we got to the fast-food place, so I stayed in the car and looked at the X-rays while my mom went in to get lunch. And I noticed something pretty clearly. It looked like a fracture to me. Not a big break, but a thin line that I didn’t think should be there. But what do I know? I’m not a doctor or radiologist. How should I know if that line is a normal part of the bone or not? So my mom called her chiro again, and we stopped by the office on the way home. Sure enough, it was a fracture. He called it a “green stick” fracture, which is a slight fracture like what might be in a growing tree limb. I’d heard the term. He said it would heal quickly on its own, but I might want to put an Ace bandage around it to help strengthen it, so it wouldn’t hurt Seth very much.

So why didn’t the ER doctor tell us this? It was clearly visible on the X-ray — even I could see it! Plus, the fracture was right underneath the puffy area of the wrist — also visible on the X-ray. Had we not confirmed it with the chiropractor, I likely would have taken him to another doctor to ask about the X-ray (well, probably would have called the ER doctor back, since I didn’t look at the films until we had left the hospital). Also, his wrist is obviously still bothering him. His elbow seems fine — perhaps just a little bit sore. But his wrist is still very sensitive to touch and manipulation. Had I not known about the fracture, I would be concerned that his wrist is still bothering him, since the extent of his injuries was “supposedly” only to his elbow. I guess I’ll have to write a letter about it.

So, piecing it all together, what I heard and saw and suspected first is the likeliest scenario, and what I’m comfortable with saying what happened: Keith did it. The doctors expressed mild disbelief at a three-year-old being strong enough to cause such an injury, but they don’t know Keith! He’s strong. Whether Seth tried to crawl from the seat over the back of the couch and Keith held onto him to prevent him from making it all the way down and/or falling; or whether Seth was behind the couch and Keith grabbed his hand trying to bodily haul him up onto the couch, we won’t know. But the cause of “nursemaid’s elbow” and also of the “green stick fracture” most likely being that the child’s hand was pulled too long and or too strongly, then it’s pretty obvious that whichever was the precise scenario, Keith held onto Seth’s hand and caused the problem. And all in the time it took me to run a few books and dirty socks downstairs.


One Response

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  1. Dorothy Snyder said, on August 10, 2008 at 4:45 am

    I just wanted to say so many times I have been in situations when the doctor was WRONG too with my children. It is so very hard for me to trust my local doctors now.

    Anyway I am glad you figured it out. Sometimes the mom knows best.

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