Fried Soup

Welcome to Cairns, QLD, Hospital

Over the course of a mere seven days – July 12 to July 19 – we went from Breckenridge, CO, to Bangkok ,TH, and then on to Cairns, QLD. We covered three continents, two continental divides, and four distinct time zones spanning 14 hours shifting (if you count the several hours’ layover in Tokyo). We spanned from 34 degrees F to 98 degrees F, from extremely arid to extremely humid. From over 10,000 ft in elevation to -10 ft (yes, negative – Bangkok is below sea level in places). Talk about a week of changes . . .

[Hathai will add pictures to this post later . . . ]

As a whole, our kids have become quite good troopers at travel, and our purchase of the new Asus ME176CX Android Tablet – one for Jeliya and Brieana each – as a travel entertainment device has more than paid for itself in various ways, including discounted airfare on the Thailand-Australia route with those cheaper airlines Jet Star and Tiger Air. Those discount airlines literally charge for everything, and only begrudgingly allow water to passengers that did not purchase directly at booking from their food programs or else from their in-flight menu. I find that behavior questionably ethical, as the airport security screening disallows all liquids, and then the boarding gate additional screening further ejects all liquids you may have picked up after the full security screening. If you can’t carry on any liquids that were legitimately acquired before boarding a 10-hour flight, and are then denied access to at least drinking water, isn’t that a violation of the Geneva conventions?

Hmm. Maybe my earlier vision of “Clockwork Orange” airlines didn’t go far enough.

Unfortunately, things seem to have caught up with us during this week. We remain unclear of the root causes, but Jeliya is – as I write this – laid out in a bed in the Cairns Hospital, whilst busily tapping away at the free “Little Things” Android puzzle app on her tablet. We have one definite diagnosis – mesenteric adenitis – that came from an ultrasound. We have inconclusive but probably negative diagnosis for appendicitis. We have been admitted to the full hospital for an overnight monitoring and evaluation. If she’s better in the morning, then we’re free to go with the typical “take fever breakers as needed, return if conditions don’t improve” medical clause. If she’s not better, we may spend another night or two in the hospital. (Why do the British affiliated grammar people not put “the” before “hospital” in that sentence? After all, you don’t say “I’m in bank” or “I’m in library”, so why is “the” dropped only for “I’m in hospital” as a rule?)

What’s clear is that she definitely has some type of bad intestinal bug. Before leaving Colorado, her younger cousin Ollie also came down with some kind of stomach issue, throwing up and whatnot. Jeliya was complaining a bit about her stomach around the same time, and we kept an eye on her, but she mostly continued on with eating willy-nilly and being a kid surrounded by playmates. She even wore herself out, complaining that she needed quiet time because her cousins made it impossible to have private time to think or just relax. I suppose all-play, all-day, run-run-run, go-go-go can be a bit draining to a 7.75 yr old.

By the time we got to Bangkok, Jeliya and Brieana both were excellent jet-setters with the United 787 and ANA 777 flights, arriving in good shape and happy. Sleep was erratic and verbally exaggerated, but that’s pretty normal for airplane trips. A side effect of a week in Breckenridge at over 10,000 ft of elevation, however, was that none of us felt tired from the standard airplane’s fractional atmosphere pressurized cabin.

Jeliya continued a bit of erratic complaints about her stomach in Thailand, but happily ate some of her favorite tropical foods in Hathai’s mad dash to eat her bodyweight in such delicacies we just can’t get in Oregon. Mangosteen, rambutan, the short-fat-sweet bananas, a variety of real mangos, other fruits we have never found a translation for like long-gong (duku) . . . the food in general in Thailand is plentiful, cheap, and simply awesome. (It’s also cheap if you buy it in malls and at fancy restaurants, but not nearly as cheap – and in our opinion, not nearly as good – as the street markets and night vendors and open air stalls.)

When we lived in Thailand for a year (July 2010 – August 2011), we were quite adventurous in our eating and risk-taking along the epicurious lines. During our four day stint in Bangkok this time, we were conservative with the kids – fruits, moo ping (BBQ pork), kao neow, kao mun gai, that sort of safe generic food that is over-cooked and you can even get in the USA if you know how to ask for it. Between the midnight-Sunday arrival and the late Thursday departure, however, Jeliya started to get more difficult about eating and how she felt. She was sleeping quite poorly, due to the +15 hr time zone change from Colorado, and her stomach issues weren’t helping. Not even the trusty standby foods she adored or some OTC medications were helping.

We finally observed a direct fever – after a few sporadic checks – the night we left. I wound up carrying Jeliya down the Bangkok airport “G” terminal, as she wasn’t really in the mood for much and was quite sleepy. She slept most of the way to Australia, and wasn’t interested in food or drink at all. We knew she was sick, and were giving her broken up ibuprofen tablets to hit 100mg doses on the plane in a seven-hour dosage windowing scheme. We needed a weight chart to figure out the correct dose, but our liquid children’s ibuprofen had to be checked due to the volume of the container, and the adult pills neglect weight tables. Based on weight and back-of-the-envelope thinking, we knew 100mg would be safe, but were unsure about higher dosages.

Ironically, as we were told to prepare for landing in Melbourne, the standard PA announcements of the airplane included a new line item: due to the sensitive environment and isolation, strong quarantine procedures were in use, and please notify the flight crew immediately if you, or your companions, are experiencing a fever or chills. Since that definitely applied to us, I rang the flight attendants and explained the situation. It was almost comical to see the panic in their eyes: they obviously expected no one, ever, to respond to that question. A succession of flight attendants of increasing seniority stopped by, and then they decided that since she only had a fever with slight chills, yet ibuprofen made her feel better, they didn’t need to do anything.

As we went through immigration and customs, that same reaction happened again, where we repeated the story and the flight crew reaction to our health risk advisement to the officials. They simply waved us on as well, and said not to worry about it. They were far more interested in what we had declared to be carrying as food items, which ultimately turned out to be much ado about nothing. When we got to the final customs clearance, we were again asked that magic question about health, and replied honestly. This time, the immigration officer stopped us in line, and asked a bunch of questions. He finally asked, “Well, it sounds like nothing major, but it’s up to you. Would you like us to take a look at her?” to which we kind of shrugged, knowing we had a connecting one-way flight we needed to make, and said, “No, but we thought we should let you know due to your quarantine statements.” He waved us on, told us we had nothing to declare, and we were out of Melbourne immigration with a snap.

I pause here for a moment to make a few comments on the Melbourne airport. As someone that has been flying internationally for over twenty years on a regular basis, all over Europe and Asia, as well as a tremendous number of domestic USA flights . . . I have identified a few airports I will pay extra to avoid at all costs. Places like LAX are at the top of my list. There is no justification for the insanely stupid layout or people-moving systems in that airport; I doubt someone with a malicious intent could make it a more miserable experience than it already manifests. I have now firmly affixed Melbourne as an airport to not fly into for international customs – without making comments on domestic connections there. The organization of the airport, the signage, and the massively under-staffed positions for clearing passports, then bags, then bag checks, then final clearance . . . led to twisty lines of people that stretch out of sight, very poor signs with misleading and factually wrong arrows, etc. Note to self: never fly through Melbourne if you are clearing customs there. Only consider it for domestic and international connections without immigration processes, but have strong reservations about even those until empirical evidence tells you otherwise. I don’t think queuing up for ~1-1.5 hrs should be considered a decent baseline anywhere, whether you are native or foreign, at any immigration location unless you are doing something weird that requires special handling. The broken PA system that emitted high-volume static more than actual content was just icing on the cake.

At any rate, we cleared Melbourne immigration, and after some adventures, got checked in for the next flight to Cairns. Jeliya had a pretty consistent fever at that point, and we had checked the packaging at a pharmacy shop in the Melbourne airport to discover she could have 200mg every 6-8 hours so we switched to a full adult pill. That extra bit seemed to perk her right up, and make her feel quite a bit better. By the time we got a “maxi” (mini-van taxi) and had been shuttled off to our accommodations until July 26, Jeliya was pretty well done. She definitely did not enjoy the quick trip right back out to get materials for dinner – upon which we discovered July 18 is a local holiday in Cairns, and the place is buttoned up shop-wise. The corner Quickie-Mart was highway robbery on prices, but it got us an ad-hoc dinner of her favorite Mac-N-Cheese we brought from the USA, Pancakes, and Scrambled Eggs. Talk about a prestigious first dinner in Australia!

Despite making her favorite foods, she still had nothing doing with dinner beyond a very small portion for her usual standards. We gave her another round of ibuprofen, sent her off to bed, and I mentioned to Hathai that I expected I’d be taking Jeliya to the hospital by Monday if she didn’t get a lot better in a hurry. I was particularly concerned because of where she was saying the pain was in her abdomen, plus jumping up and down made it worse. Both were symptoms of appendicitis, which I had as a child not much older than Jeliya, and others in my side of the family have had as well. The kids and Hathai make fun of me for my paranoia, but anytime one of them starts to have strong stomach discomfort, I run them through a few checklist items to see if it might be appendicitis. When I had mine taken out before rupture, the child across the hospital room from me did not – and had to be surgically opened and his abdominal cavity flushed every couple of days for weeks. I don’t find my paranoia excessive, because the alternative to me is too unpleasant to risk – I don’t want my children to ever experience that if I know how to catch it in time.

Hathai and I made sure there were some lights left on and strategically placed open doors so if something came up, either kid could come and find us in the night. Enter 6:00 AM local time, when a groggy Brieana staggers into our room and announces that Jeliya is holding her stomach and crying in bed. Talk about a fast way to wake up. Within a few moments we were checking her temperature – 103.1 F – and I was poking at her belly yet again which made her feel worse and complain of pain. Hathai knew that I would insist on taking Jeliya to the hospital immediately – Hathai’s just awesome in things like that – particularly given Jeliya’s rolling into a fetal position that made the pain less. So we toss in our contacts, hurry to dress and grab a few items, and off we go with a called taxi zipping us to the Cairns Hospital, formerly known as the Cairns Base Hospital but now undergoing a name change at the cost of a few million dollars and for no discernable reason to us. It must be a local thing, either pride in urban area growth or status or something.

The ER triage nurse ran some of the same diagnostics I do every time there are abdominal issues, and then ran a whole battery I never knew about – probably because my symptoms were so acute no one needed to bother trying them. He decided it was unlikely to be appendicitis, but sent us to the ER pediatric section for a full evaluation. The wonderful nurse there – Charlotte, raised in the USA, 7 years in New Zealand, 2.5 years in Australia – ran through a checklist and said she thought it might be appendicitis, but there were some other symptoms as well. She said the doctor would do a full eval, and we’d see what came out of it. She also laughed at our description of notifying the flight crew, passport control, and immigration/quarantine officers. She said they all received enough training to ask the questions, but not enough to know what to do if someone answered them with a positive statement.

The doctor did come in, did a bit of poking and prodding, and decided she needed blood counts and an ultrasound of the intestines. She explained that in her opinion, it could be either a bad gastro-intestinal issue (virus, whatever), appendicitis, or if we’re particularly unlucky, both. She explained a bit about the limitations of the tests she was ordering, and what they hoped to learn from them. Since we are probably paying for this out of pocket, I just shrug here and believe it’s better to have peace of mind than worry; in for a penny, in for a pound, and all that rot. We have no idea whether our Cigna insurance will cover any of this, but at the end of the day, it’s only money. My daughter’s health is not something I will gamble with over such matters, no matter what it takes to clear the debts accrued.

If you have a sick child, the pediatric ER at Cairns Base is an awesome place to be stuck and worried. The rooms are made up with an amazing décor of great barrier reef sea life, the ceiling is adorned with glitter streamers like Christmas with tropical fish figures attached to the ends, and their special room for procedures like IV and bloodwork has a disco ball, bubbling water columns with changing colored lights, a video projector, cartoons, you name it. As the doctor and nurse explained, it’s all about providing as many distractions as possible. When combined with the numbing cream applied in advance to probable sites for needle work on veins, the overall competency and compassion in amazing. Maybe other hospitals have similar setups, but this is the first true pediatric ER I’ve been in, and it left an impression.

Those positives aside, when you are holding your sick child in your arms, and trying to use those distractions around the room to keep her focused on anything except the IV they are trying to get into a vein, there’s only so much that can be done. When the whimpers start of “it hurts” while you have to forcibly hold her arm in place, despite her tears, as the procedure finishes . . . it’s a different kind of emotional pain. I don’t know that it can be described to people who are not already parents and have dealt with those kinds of issues.

Luckily, the IV took on the first try, and both the doctor and the nurse highly praised Jeliya’s bravery and ability to get that done successfully on one attempt. They were not able to run the projector or the disco ball – both illumination sources had bulbs out for maintenance at the time – but the other components of their room-of-distractions worked somewhat. An episode of Phineas and Ferb, with Perry the Platypus as the secret undercover agent, was helping until the screen saver kicked in and locked the screen. Only audio was running from that point onward.

After the bloodwork and ultrasound, the medical diagnosis – since they could not get a visual of the appendix – was what we know for sure: significantly swollen lymph nodes in the fibrous material that surrounds and binds the intestines. There are various reasons that could happen, but some of the side effects of those swollen immune symptom components include the pain reactions that mimic appendicitis. What they cannot tell, due to everything else, is whether she is having any appendix issues as well. Given her non-interest in eating or drinking, now aggressive diarrhea, and her dehydrated state, we’ve been admitted to the full pediatric unit for an overnight stay. Depending on how she reacts to fever reducers, IV liquids, and whether her appetite or thirst return, we may be free to go tomorrow AM. Or we may be here for a while. While the full admitting pediatric unit is not nearly as cool or fun as the ER pediatric unit here – in fact, it looks much like other pediatric units we’ve been in – the staff is very friendly and helpful. I choose to believe they are always this nice, rather than we’re just crazy vacationers they happen to feel sorry for and are going out of their way to help.

In the time it’s taken to write this summary, many hours have passed, many people have come and gone, and Jeliya has drifted off into a fitful sleep since the most recent round of acetaminophen has lowered her temperature from 102.9 to just 99.9. She’s still not eating or drinking except when forced to, and then only in small amounts, but we’ll see what happens. One of us needs to stay with her overnight in the hospital, and she asked me to be here, so Hathai will be with Brieana working out our supplies and home base back in the apartment. Of course, Hathai’s conference also starts tomorrow afternoon, so she’s got a lot of things she needs to be preparing for anyway. Meanwhile, I am dealing with doctors, nurses, buzzing alarms from myriad medical devices, British-in-disguise food (Lamb pie, vegemite sandwiches, . . .), and whatnot while trying to keep Jeliya happy and comfortable.

One day at a time . . . life is an adventure, not a destination. I would prefer a few less adventures to medical facilities, however. Over the past couple of years, as a family, there have been far too many days in hospitals and special clinics. For now, the doctors here have told us not to change any of our plans – a snorkel day on the Great Barrier Reef, running around Queensland in general, flights to Perth and back to Thailand. Once they get a better handle on Jeliya’s situation and what procedures we might need, they’ll re-assess. Right now, we’re all hoping it’s just a bad stomach bug that took a while to manifest. We want to see after a few days of mostly resting that our adventure girl is back – the crazy girl that climbed her first rock wall, a “moderate” difficulty three-story tall unit, in Colorado just nine days ago.

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