The Pediatrician Speaks

We met Robert’s dad in town, and he gave us a lift to Cape Town Medi-Clinic where my son was born. I was determined to make the effort of seeing a proper pediatrician this time, because it seems like too many GPs and medical interns have tried their hands at treating my boy recently.

Robert did not throw up again yesterday, but he still had no appetite and gagged on almost everything I tried to feed him, he even snubbed his favorite foods such as yogurt and baked beans. He did not even accept his milk bottle and reverted to nursing three times a day. Of course my attempts at weaning him were abandoned two weeks ago already, when he had the ear infection.

I forgot how pleasant the practice of Dr. I was. The waiting room looks like a comfortable living room with many oversize teddy bears and toys thrown around. There are also toddler size chairs and a REAL telephone for the kids to play with. During the examination Dr. I produced a toy stethoscope which kept little one busy as his doctor listened to his chest.

The doctor pronounced Robert well, and free from ear infection. The anti biotic was unnecessary, he said, and he expected his appetite to return gradually to normal. Unfortunately, Robert’s prolonged fasting made him loose at least 200g of his weight. He is now under average in weight, while he remains above average in height.

The measurements for today:

Weight : 10 kg (less than 75% of children his age)

Length: 80 cm (more than 75% of children his age)

Circumference of Head: 46 cm.

Dr. I also made notes about Robert’s general development. Stranger anxiety was the norm for toddlers his age, but it made examining him difficult. A toddler only becomes more tolerant of doctors’ poking after two-and-a-half years of age. Robert’s ability to point, indicated his attempts at communicating and along with his vocabulary (half a dozen words or so) meant that he is an intelligent child, of course I knew this one already.

Good news all around it seems.  The biggest event in the world today is the election of Barack Obama as the 44th President of the United States. This gave many people something to smile about. I am in the happy crowd today.

Feverish Daze

I do not want to forget how difficult these first few weeks in April were. I was trying to cope with the new environment, the new territory, and the rules of my new house mate. However, I still had to be thankful for having a friend to stay with. I don’t think I could have coped by myself for the first few days. On our second day at our new home I was off from work, Robert was recovering slightly from the injection’s effects and I was busy trying to organize our room and our life. On Thursday I started what will be my routine for the rest of the month for morning shift work. I woke up at six – before sunrise, fed and clothed Robert, then took him in the pram towards his dad’s place. The walk takes about twenty minutes, and I always aimed to get there at seven or just after. I delivered Robert to his dad, with a bottle a change of clothes and diapers then ran down the hill to catch a taxi to work. When my shift was over I picked up Robert and walked back home with him.

The interim arrangement I had for April was to continue in this way, with dad looking after the baby when I worked morning shifts and Lucy, Jackie’s nanny/domestic worker taking over on the afternoons when she is off. Miriam let me completely down and I was left without a back up plan. To complicate matters further, I could not just employ whomever I choose, because Jackie is extremely paranoid about admitting strangers into her place.
I thought that the best solution to work around these problems was for me to work at night. I put in a request through to my managers for permanent night shift work. My rationale was that Robert sleeps through the night, and only needed someone to be there in case he woke up, which he rarely did. I was waiting for an answer for over a week now, and as luck would have it, I received my answer on that first day at work after moving out.
When I was notified by their refusal I was so upset I broke down and cried. It was something I have never done before in a professional environment, and it made me feel so ashamed. It was really enough for me to deal with the humiliation of telling my story, and asking for special working conditions, and now this. What I thought was the perfect solution for my problem was no longer possible but management compromised by allowing me to plan my own schedule, working whenever I can, until such time when my boy can be accepted in day care, and I can have normal working hours like everyone else. I was back to the drawing board on that one, trying to find another plan at work.

As if I did not have enough on my plate, Robert became feverish on Thursday afternoon. I gave him infant drops, bathed him and expected the fever to break quickly but it didn’t. I wasn’t feeling great either, my immune system must have buckled under the strain; I had a runny nose and the symptoms of the cold. I did not feel like facing the floor either, so I called in sick for then next day (Friday) and planned to take Robert to the doctor as well. Early on Friday morning I had a very bad fright; Robert woke up at dawn, and he was boiling hot. I took off all his clothes and started putting cold compresses on him, but I was in panic when the ear thermometer showed 42 degrees. I didn’t know what to do but wake up Robert’s dad and ask him to take us to hospital. In his usual calm manner he pointed out that at a temperature like this the boy would have been comatose, so perhaps it wasn’t correct. So I took another measurement with the rectal thermometer which arrived in Auntie C’s package, and this time the temperature reading was 39 degrees. This was still fever but not a death threat. I gave Robert more infant drops, and stayed up with him giving him cold compresses until he felt a little cooler and went back to sleep.

In the morning I made an appointment for him to see a GP in our area. Since I did not have access to the car I thought I might as well get used to the services available at walking distance from us. My appointment with the doctor was at eleven and after that I had also a meeting with the lawyer at 12 in town. The timing was a little tight but still doable. We took the long walk to the doctor, and made it just in time to see Dr. L. I was impressed with her gentle and thorough manner. It was clear that she was a good physician who was very good with children, she looked like she was expecting one of her own too. Robert’s diagnosis was upper respiratory tract infection, and Dr. L advised symptomatic treatment. She gave him a prescription for a different type of syrup to alternate with the infant drops I was already giving him. She also instructed me to monitor him for the next few days, and bring him for a follow up if the fever didn’t break. On Saturday I was supposed to work an early morning shift starting at five, so I had to get a certificate from Dr. L. to prove the reason for my absence. The last thing I wanted now was trouble with work. After the doctor I had to rush into town to catch my meeting with the lawyer. I had to call Robert’s dad to fetch him, and save me the time and effort of walking all the way up the hill to his place, then running down again to the taxi stop. Ron met me halfway up the hill and I rushed into town.

At the lawyers I had to sign some legal paper, then he gave me an affidavit that needed to be signed in front of a commissioner of oaths. So on my way back I had to make yet another stop at the police station to get this done, before walking back to get Robert. When I arrived he was asleep, and his dad said that he did not mind if I stay with him until he wakes up; he was leaving to gym anyway. While I waited I checked on my internet accounts and downloaded my mail. This turned out to be the last time I would use my computer in a month.

Robert recovered slowly from his ailments and fortunately I had three days off work where I could finally relax from running around. I just sat at home, played with Robert in our backyard, warmed my chilled soul in the gentle autumn sun and read. Jackie is very supportive of us, she loves Robert and interacts with him all the time. He responds to her quickly when she asks him to “clap handies” and loves it when she rough-houses with him. Robert is benefiting from our different styles of play, and Jackie has somehow -at least during playtime- jumped into what is supposed to be dad’s role.
When I am home I still have many things to do. I need to go shopping every other day, because I cannot carry too many groceries while pushing Robert in his pram; I wash our clothes by hand on every dry and sunny day; and I cook us some extremely simple meals. In the meantime I am still taking a lot of emotional strain; I am deeply aware of the chaos of my life, and I find myself craving the perfect order I used to reject in my previous life. I know that I am grasping at the outward order to compensate for the complete emotional and personal collapse. I get stuck on small details, and cannot get past the need to organize things that under normal circumstances I would have found unnecessary. A few days ago I wanted to replace the silicon nipple on Robbie’s bottle, and I walked all the way down our main road, asking in every shop. Then I retraced my way back to the other end of the main road where I finally found a replacement set. The exercise took two hours and Robert and I arrived home past dark, both extremely exhausted. It was one of the few days where I put him to bed without a bath.

Although things are extremely difficult for us at the moment, there are also moments of happiness that shine through, and kindness that comes when least expected. Jackie’s mom bought Robert a set of colourful stacking cups which I am now use for his bath. She also bought him a couple of jars of baby food. I guess Robert now has a Cape Town granny.

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The Doctor Said..

This last week of November has been quite busy for all of us. I am still working on my translation assignment, and I am finding it very hard to stay concentrated while trying to keep Robert happy at the same time. Ron has his hands full trying to help out and keep everything else in order. I would have never been able to pull it off without him.

On Wednesday I had my dreaded interview at work. It went unexpectedly smooth, and I did not have to negotiate down at all from my initial request. I now have two additional months of leave. The finances have to be thought out and planned later, but for now Robert and I are sorted. When I return to work in March I might have the option of working half days which means that I can spend maximum time with the little monkey. In theory I can continue breastfeeding for as long as Robert wants, and I needn’t worry anymore about pumping breast milk.

The news from work was positive. I got a T-shirt, a pro-rated bonus for the eight months I worked this year, and an invitation to the year-end function. In short I was made to feel part of the team, which makes going back to work next year not a totally bad idea. The only technicality I need to grapple with in the next few days is the imminent expiration of my Dangerous Goods License on December 1st. People who work in the transport industry have to take a refresher course every two years to keep the certification current. It just happened that I had to do this refresher and test within the next two days.

I opted to take the test on the very next day, Thursday. I left immediately after feeding Robert at about two in the afternoon. The course was a module which I followed on a multimedia CD, after which I was required to complete a test. Finally my certificate was printed, and my license was brought up to date. The training module and test require one and a half hours to complete, but I needed more time, because I chatted to colleagues and superiors. As usual there was more than one crisis on the floor to scatter the attention. Near the end of the test I kept glancing between my cell phone and the clock, expecting a call from Ron with a screaming baby in the background. I was heading home on a taxi, when the call finally came. Ron had done his best to entertain Robert. He took him out for a walk and played with him, but once the baby got thirsty there was nothing he could do to calm him down. Poor Pea was hot and thirsty, and so worked up it took some time to get him relaxed again for his feed. All of us were exhausted by this exercise, and I am glad we won’t have to do it again. I was only away for a little over two hours, but obviously it was too long. Once Robert was fed he regained his good humour; Ron even got a rare laugh when he popped a plastic bag near him.

Today, we had another big excitement on the calendar; Robert’s three-month check up. Ron and I had a long list of questions for the pediatrician, and I added one more after inspecting an abnormal diaper surprise in the morning. The doctor put our doubts to rest: Robert was NOT teething, and the little white spot we saw was a normal discoloration on his gum. The mole on his thigh was nothing to worry about, and the mark on his back is not a mole, but a mark that will perhaps disappear in time. The doctor explained that a child is considered “moley” if he or she has more than ten moles over the body. Such a child requires further monitoring and dermatological tests, but at this point Robert did not fall into this category. My diaper discovery this morning was a sign of diarrhea, caused by a transient virus. It would only be a cause for concern if the diarrhea becomes severe and/or lasts for a longer period of time. We discussed formula, feeding schedule, and the introduction of solids. The doctor reiterated what we read in most medical books and childcare sites: Breast milk is perfectly sufficient for babies in the first six months of life, and no supplements or solids are needed before then. Furthermore he advised against any introduction of solids before four months. Our doctor said that he advises parents to start on rice cereal after four months if their baby wakes up several times at night because of hunger. When we told him that Robert has in fact started sleeping through the night, he said that it was impressive and a little unusual. We shouldn’t brag about it to other parents, he cautioned, because they would be murderously envious. The doctor carried on with Robert’s examination and wrote down his height and weight. The numbers were as follows: Weight 6005g; Height 64cm; Head circumference: 39.5cm. I realized with dismay that he has only gained about 100g since his last assessment nine days ago. He is still on the 50% percentile, but it is obvious that he hasn’t been getting enough food since he started sleeping in. I need to do something about it, perhaps feed him one last time before I turn in for the night.

Before we went home for the day we stopped at the post office. An old friend of mine from Johannesburg had sent us a little present for Robert. We opened the present as we were having lunch. It is something that Robert will surely have lots of fun with in the future. A big blue whale and three little whale pups, they are his future bathtub friends. For now he was just happy to practice grabbing their package and try to get them into his mouth.