things about stuff

the boy who ate a screw

6 february 1996

 

It started out as a normal day. Grant ate his “second breakfast” of grape-nut-meal with apples and bananas around 11am, and we were all playing, puttering around the house as usual. Momma was in the office, looking for a bank statement in my piles of papers, Daddy and Grant were in the bathroom, Grant enjoying a few minutes of diaperless freedom, having just used the toilet. It was a little after one in the afternoon, almost naptime.

 

“Zoe!” I hear Kevin’s voice call out with an unmistakable urgency. I run to the bathroom to find Kevin holding a pantless Grant perpendicular over the sink. Grant is crying. I smell vomit. “He swallowed a screw, and I can’t find it!” I immediately did what Kev had already done: sweep my finger from one side of Grant’s throat to the other. Nothing there. I thrust my finger back, Grant vomits. Just a little breakfast. I try again. No screw. It’s gone.

 

All three of us are smeared with vomit. “We have to go to the hospital,” I say. “Let’s go,” says Kevin, walking out of the bathroom with the mostly naked Grant. I grab a pull-on diaper, and wiggle it on him as we walk. All the urgency has upset the boy a bit, so I calm him as I carry him downstairs. After a moment, he seems fine. “We’re going for a ride in the truck.” I tell him. He loves to ride in the truck. I grab up the keys and insurance info without pausing, Kevin collects his wallet, and I ask him to bring the green baby bag; there is a set of emergency clothes and things inside.

 

On the way to the small local emergency room, I give them a call to let them know that we are coming, and inform them of the nature of our emergency. I hope that Kevin doesn’t notice that my foot on the gas pedal is trembling uncontrollably from the adrenaline. Three minutes later we pull in and park. I wrap Grant’s naked legs and feet in a blanket and carry him inside. We are met by a concerned but unhurried nurse, who begins the seemingly interminable intake process.

 

I let Grant walk around the room a bit, but wince each time he bends or twists. If he swallowed the screw that I’d kept moving out of his reach the last week or so (I don’t know where it came from), it was about 1.5 inches long with a rounded head and very sharp point. I was worried that he’d move in such a way as to force the point into his stomach lining. I picked him up then, and kept him as still as I could. Being a normally active two-year-old, who was nearing naptime, he did NOT want to sit and be still in my lap. Oh, not at all.

 

Grant learned the word nurse (“noonuh”), and was intent on showing off for her, calling “noonuh” so she would look at what he was doing. To ease the taking of his blood pressure, I likened the cuff to some little gauntlets I made for him out of tin foil that he uses to play “robot”. He put the cuff on himself, and was interested but not upset at the squeezing of his arm. He wasn’t thrilled at the stethoscope use, but tolerated it once he saw it didn't hurt. Same with taking his temperature by ear. All vitals were fine. Grant still showed no discomfort, thank heavens.

 

We were finally visited by the Physician Assistant, who also listened to Grant’s chest. Of course, we would need an x-ray. He explained that it was very possible for the screw to turn its head toward the bowels, and if the screw was small enough, we might be able to allow it to pass. I had a picture of Grant’s wee intestine’s twists and turns in my mind, and was very skeptical that the screw would ever make it through there. We were told to wait while radiology was readied.

 

Kevin had apparently begun to doubt what he had seen with his eyes, and asked if I would mind if he went back to the house to search for the screw. I thought it a good idea, and asked him to get my wallet while he was there. He would call right away if he found the screw.

 

A few minutes later I carried Grant the few steps to x-ray. He was fine, walking around on the table, saying hi to people. That is, until we wanted him to lie down flat and be still. I’m unsure why that scared him, but a nurse and I both got leaded-up and had to hold him down. (A harbinger of things to come…) Grant started calling “Daddy!” (since Momma was being no help), and RIGHT before shooting, Kevin walked in. I think the nurse said something fairly polite, like “Close the door.” At the same time I said the less politic “Get out!”. He got out. They took the shot. We waited to see if the image was clear.

 

And there it was. A nasty, pointy screw in Grant’s belly, its tip pointing right at the stomach’s exit to the upper bowel.

Bad news. Although I don’t think it would really have mattered WHAT position the screw was in. It would HAVE to come out. But seeing it in there… It looked so ominous, ready to puncture my baby’s wee insides. I became even more vigilant about his movements: tried hard to keep him from any kind of bending or twisting. Right.

 

The PA took the x-ray film across the street to the doctor’s office, and the doc apparently agreed that endoscopic surgery was the best/only option. The hospital here in town did not have the needed equipment, so they called the hospital in a larger town nearby. There was more delay while the larger hospital checked to see if they had a scope and grasper small enough for the esophagus of a two year old. Kevin asked if it wouldn’t be best for us to get on the road; begin the 40-minute trip while all the discussion took place. Then when everyone was sure, they could call us with our final destination. Much faster, yes? (Sigh.) Medical folks are truly amazing, but sometimes the “we know best” attitude is frustrating. All we wanted was for them to hurry up and tell us where to go so we had the best chance of getting to the screw before it was digested.

Bad news. Although I don’t think it would really have mattered WHAT position the screw was in. It would HAVE to come out. But seeing it in there… It looked so ominous, ready to puncture my baby’s wee insides. I became even more vigilant about his movements: tried hard to keep him from any kind of bending or twisting. Right.

 

The PA took the x-ray film across the street to the doctor’s office, and the doc apparently agreed that endoscopic surgery was the best/only option. The hospital here in town did not have the needed equipment, so they called the hospital in a larger town nearby. There was more delay while the larger hospital checked to see if they had a scope and grasper small enough for the esophagus of a two year old. Kevin asked if it wouldn’t be best for us to get on the road; begin the 40-minute trip while all the discussion took place. Then when everyone was sure, they could call us with our final destination. Much faster, yes? (Sigh.) Medical folks are truly amazing, but sometimes the “we know best” attitude is frustrating. All we wanted was for them to hurry up and tell us where to go so we had the best chance of getting to the screw before it was digested. When Kev asked the nurse this question, she stopped dead in her tracks, and began to explain v-e-r-y---s-l-o-w-l-y that it wouldn't help for us to get there earlier, because the surgeon wouldn't be ready yet, blah, blah. We both nearly jumped on her to get her moving back down the hall. Forget about our question, just keep it moving!!! Not only was Grant getting sleepier, and therefore antsier, but we both knew that Grant had not yet moved his bowels that day. That screw was right down there at the drain, just waiting for a little room in his pipes. Tick, tick, tick. Move it, move it, MOVE IT, PEOPLE! Externally we were quite calm.

 

The PA came back one last time to advise us of the plan, the surgeon’s name, and let us know not to squish Grant’s stomach (thanks for that). He told us that he had asked about an ambulance for Grant, but was told that the surgeon would be in another surgery for 40 minutes, so a rush wouldn’t help. I later mentioned to Kevin that there would have been no need for an ambulance. If speed were required, my truck is bigger and I’m a better driver at speed and in traffic than any Nebraska EMT.

 

It finally occurred to me that the best place for Grant was in his car seat. Comfortably restrained in a familiar place, he would simply fall asleep. He would NOT be able to twist and jigger the screw into his flesh. While Kevin waited for them to gather “the info the surgeon will need” (I looked at it, it was the x-ray and two pages of Grant’s intake forms), we dressed the boy in the emergency outfit and I took Grant out to the truck and strapped him in. He sat happily playing with a plastic Barney doll, trying to get its painted swim trunks off.

 

While waiting for Kev, I called Grant’s pediatrician. I didn’t ask for her to take any action, I just wanted her to know what was going on. Perhaps she could come by if there was a need for post-operative care. Through her nurse she asked to be kept appraised.

 

My next call was to my Mom. She and her companion come over to our house for pizza on Fridays, and as it was now about 2:30pm, I didn't think that pizza night would be happening. And I thought she’d like to know, even though there wasn’t anything she could do. I called her at her new job at a bank here in town. The woman who answered the phone kindly explained that she was with a customer, and asked if Mom could call me back. I told her that we were on the way to the hospital with our son, and she immediately said, “I’ll go relieve her, just one moment.” As I was telling Mom the shortened story, Kevin got in the truck, and we took off. (Please note that I did keep telling people that Grant had swallowed a 1 ½ or 2 inch screw. I wasn’t trying to exaggerate anything; that is the only screw I had ever seen lying around, so truly thought that was the screw he’d eaten.) Mom told me later that with great trepidation she asked her new bosses if she might leave work two hours early, at three. Without a beat, they told her to go right away; they would take care of balancing her money drawer and checking her out. She was very touched by their caring attitude and priorities.

 

One might think that I pressed the speed limit all the way there, but I was careful to do the opposite. If we got there too quickly, it would just mean more waiting around at the hospital while Grant squirmed in my arms. I kept a safe speed, and after about 15 minutes, Grant drifted to sleep. Kevin and I decided that when we got to St. Francis (where Grant was born, by the way) I would go in and get the intake completed, and Kev would stay in the truck with Grant for as long as possible.

 

They were waiting for us in the surgical wing, and the intake forms were completed with a minimum of delay. Grant had just awakened when I motioned to Kevin that we were ready to bring him in. Kev began getting the bags and helped me bundle Grant up. We were shown right through the waiting area to a room, and a kind nurse began with taking a history and getting vitals. We put him in the tiniest little hospital gown; blue with doggies holding balloons. My mom arrived. Grant wanted to get down and explore, but was otherwise okay. The surgeon didn’t even look at the x-ray from earlier (which kind of makes sense, since he needed to know the CURRENT position of the screw). It got under my skin a bit, though, since we had waited quite a while to get the films. This time the x-ray was done with portable equipment (painted to look like a giraffe) right in our little room. Grant was no happier about it, but we got it done okay with the same procedure as before. It looked this time like the screw had turned some, now moving toward the stomach’s exit sideways. I didn't quite understand how that had happened, but there it was.

 

There were so many people coming and going… At least three nurses, radiologist, doctor, surgeon, anesthesiologist. I was just trying to keep Grant calm and still, and grasp what all was going on. Everyone was very nice, and quite professional. They all tried to relate with Grant on some level; get him to relax and trust. Finally a picture began to solidify. Grant would need an IV.

 

Anyone who has had surgery knows that one is asked not to eat or drink for at least 12 hours before the procedure. This is so that one will not choke on or breathe in the vomitus common with anesthesia. Grant had eaten less than four hours earlier. I don’t understand this entirely, but because of the food in his stomach, it was REQUIRED that Grant have an IV, and that it be administered BEFORE any sort of calming drug.

 

Gosh, you know, my stomach has started twisting up, and my heart rate is increasing just thinking about this next part.

 

This whole time, I had been talking with Grant about what was happening and why. I explained that we told him not to put a screw in his mouth, that a screw is not food. At first I told him that the screw was in his tummy, but he kept digging at his navel, looking for it, so I told him the screw was way back in his mouth, and we had to get it out. He seemed to understand this somewhat. Early on, I was unsure if he might be awake for the retrieval, so I explained that the doctor would be putting a hose in his mouth like a straw to get the screw out. I almost likened it to a vacuum, but Grant was just getting over his fear of vacuums, so I decided to stick with “hose” and “straw”. Kevin later told me that he had covered the same points in the truck.

 

If you have ever had an IV, you know that it is very different from an injection. If you haven’t, count your blessings. An IV needle is a lot thicker than an injection needle, and is made of plastic rather than metal to prevent it from breaking off inside. This means that it is not as smooth as a metal needle. The needle must first be poked through the (often tough) outer layer of the vein (or artery? whichever.). Then the needle needs to be worked up, still in the vein, until it is entirely embedded in and along the vein. The sharp point of the needle, while effective in getting through the outer membrane, makes it difficult to thread the needle inside the vein. It is very easy for the needle to poke through, or catch on the inside of the vein and pull a bit. This is intensely uncomfortable, to say the least. I do not have good veins, so I have had a lot of experience with all sorts of needle troubles.

 

When it became clear that an IV was needed, I explained to Grant that there was going to be a hurt in his arm. I told him that it would hurt, but it would be fast, then it would be all done. (Momma’s first lie, as it turns out.) Grant stayed on my lap, and two nurses came close. They readied the needles, and crouched down to us. I positioned my arms to restrain Grant without pressing on his midsection in any way, basically across his collar bones and thighs. One nurse pressed her chest against us, pinning his legs to me, and held out his arm. The other began with a small prick of lidocaine to numb the surface of his skin. He jerked away (even with all of us holding him), and only about half the dose got under the skin. She began inserting the larger IV needle in a vein.

 

It’s strange, these events are in many ways crystal clear to me, sharp and glaring and exact. In other ways… I was concentrating so much on trying to calm him, trying to keep him still, trying to make it as easy as possible; I didn't get a view of all the details.

 

Grant yelled and wiggled. The needle got about half way in and then fouled up in some way; I think it poked through the vein. Unusable. We would have to do it again. The nurses found another vein, also near his wrist; Grant began crying even before the poke. No lidocaine. We all held him down. She poked, worked to keep the needle in the vein. Grant screamed and bucked. She lost it. We would have to do it again. The nurses decided on a different type of needle, found a vein in the other wrist. Grant was just screaming in fear and pain, screaming and saying “Momma, Momma, Momma!” over and over again. I held him close to me: cooing and singing and talking. It didn't help. We went through it all again, but by now he was so tense and upset… with his muscles contracted… thrashing in our restraining arms… he is so strong… crying, screaming. It was horrible. She poked with another needle, began working it in. Grant just wouldn't look away; Kev and Mom were trying to get his attention away from the site of the stick, to no avail. I heard my mom say something like “almost done, almost over” and I said something very sharply to her – “don’t say that!” (Mom couldn't see the needle entry.) She apologized, she thought it was done. The nurse looked up at me, shook her head. No. We would have to do it again.

 

So many things in my mind, not to mention my heart. Grant trusted me, and from his point of view, I had LIED to him. How could he possibly understand that? The screw was in his stomach, lurching and surging as his stomach clenched and churned with his writhing and screams. Would his upset cause the screw to puncture him? And of course: WHAT THE HELL IS WRONG WITH THESE PEOPLE?!?! Why can’t they get this DONE?! Don’t they know what they’re DOING? Anyone with kids can put themselves here. If you don’t have kids, just picture yourself holding down any two-year-old, even a stranger, forcibly holding him down while someone causes him pain. Now multiply that feeling by about a thousand. My boy, who loves and trusts me above all else, and I pin him down so some stranger can hurt him over and over. Without doubt the most difficult thing I have EVER had to do. I need to take a little break from this writing now.

---

There was a respite. The nurses discussed options. We confirmed that there was no way to give Grant something to calm him before the IV. I saw the surgeon just outside the door discussing things with Kevin. Grant was SO distressed, and I couldn't tell him what he wanted to hear. (All done. No more.) I knew that he didn't understand what needles in his arm had to do with getting the screw out of his mouth. I knew that at this point he didn't care. I breathed with him, tried everything I knew to calm him. But I knew it would be happening again. I cuddled and sang, talked and hummed. The nurses began to prepare a board to strap his arm down to. Why didn't they do that in the first place? I don’t know. I knew if I said anything at this point, I’d be reaming someone so hard they wouldn't sit for months. I held my baby.

 

“We have to do it again, honey. I’m sorry. Momma is sorry.” As the nurses got into position, Grant tensed and began to cry again. Just getting his arm on the board was a trial. He wailed and fought. We held him down. I pleaded with him, “Be still, baby, like a doll, be very still, be like a doll, don’t move, baby.” Again and again, crooning in his ear as he struggled. The stick, the nurse working it in. Pleading, praying, willing it to go in. Finally. Yes. We continued to hold him while the tubes were attached and the IV was taped in place. Very sad wee boy. I began to calm him again.

 

But we had no time. The anesthesiologist was there, and told me I could carry him up to the restricted area. I had already asked if I could go in with him, at least until he was sedated. Blah blah blah, sterile field, blah blah, insurance, blah blah, no. So after all this, after getting him calm (relatively quickly), I had to hand him over to a stranger. Big smile, Momma! “Bye bye! It’s okay, baby! Momma’s right here, it’s okay! See you soon! Love you! It’s okay!” Wave, Momma. Big smile, Momma.

 

The nurse who had wielded the IV needle approached me. Gutsy. She apologized, quite sincerely. She really felt bad for causing so much pain to my son. I tried to be gracious. I don’t know that I succeeded.

 

And then the Wait.

It was 4:12 when I walked back to our little room. Mom and Kevin were waiting. We talked a bit. Hugs. Nurses asked if we needed anything. Something to drink? No, thank you. Kev asked if I could eat. I said no. He said that he was going to get me something; if I could eat, what would it be? I had eaten some toast for breakfast, I knew I needed something. Mom hadn't eaten either. The surgeon came by to talk to me about the procedure. I found this very kind, as I knew he had already talked with Kev. He would thread the scope down Grant’s throat, and use a camera to locate the screw. He would attempt to grab it and ease it back up. If unsuccessful, he would have to open Grant’s belly. I asked if he had experience with someone so tiny, he said yes. I asked how long it would take if it worked. He said that the actual procedure would take 15 or 20 minutes. He could see that I was concerned, and told me that Grant was fine, playing with the nurses. I called him a big fat liar. He laughed and said that they showed Grant the little camera on the scope, and he was playing with it, watching himself on the monitor. That sounds like Grant, but I still think he was lying. 4:20 when the surgeon walked away.

 

Kev went out to put gas in the truck and get Taco Bell for us all. Mom thought I should cry, let it out. It didn’t seem to be helpful, so I didn’t. I stood there. I started to wander back down the hall. Slow day in surgery. Thirty or so rooms, three filled, including us. I walked down to the OR area. Stood there. Heard a radio playing Cher’s “Half Breed” softly. Began to wander back to the room, exchanged a few words with Mom; her companion Jack hadn’t arrived, she wondered where he was. I stood there. Looked at the clock. 4:28. I started to wander back down the hall…

 

I tried not to pace. Talked with Mom between each lap. Looked at the things on the wall. Kev got back, food and Jack in tow. There was talking. Hugs. Kev hadn’t gotten gas yet, wanted to bring my food right away. Went back out for the gas. Some talking; Mom caught Jack up with what was happening. Jack offered me a chair. No, thanks. I stood there. Began to wander back down the hall. Listened hard for Grant; nothing. Went up to the doors of the OR area, looked in the windows. Nothing to see. Hall. Laundry cart. Walked back, talk, bite of food, walk. 4:50. Half an hour since the surgeon walked away. When had he started? I don’t know. Another bite, another lap.

The IV nurse was off shift. She shifted her gaze away from me, then approached. Another apology. Over again: “I’m so sorry.” What does one say? “Oh, that’s okay!” … I think not. I said something about it being her job; it had to be done. Something like that.

 

More walking. News on the radio now, soft. 5:03. A nurse told me that the surgeon was working to ease the screw up. Said it was tricky. I asked the nurses if they could save the screw, “for Grant’s baby book”. They laughed. They asked me something about how he got the screw, I shook my head, responded “He’s so FAST.” More wandering. Bites of food. Some chat. I stayed in the room each time as long as I could, then went for another walk. Looking around, listening to the nurses in case they said anything about Grant. Took another bite, 5:09. Turned to walk, and the surgeon was coming down the hallway.

He had a piece of paper and a plastic bag with a screw in it. It was done.

 

The paper had two photos from the scope. There was more food in his stomach than we had thought.

The screw was covered in the oatmeal. Although this insulated the screw somewhat, perhaps preventing it from puncturing the stomach lining, it made the extraction quite a bit more difficult. Turns out that the tool doesn’t have a little claw on it, as I had pictured, it has a lasso. To get to the screw, the surgeon had to find it in the food, then use a wee little sprayer to clean it off a millimeter at a time. Only after he got it clean could he get the lasso around the head of the screw. The first time, the screw slipped back out of the lasso as he dragged it upward. Plunk, back into the oatmeal. Back to square one, cleaning it off bit by bit. Lasso around, then ease it up.

Slowly, so no poking or scraping. In a stomach space the size of a lemon. With a tool as big around as the hole in the tip of a click-type pen. He got it out. Grant was in the recovery room.

 

The doctor and nurses explained that Grant would need to remain in recovery until he woke from the anesthesia. Not long, they said; a few minutes. I felt some relief, but wouldn't feel right until seeing my Boy. I began the walk again. Kevin returned around this time, but I was truly so distracted by the idea of seeing Grant that I don’t know what I said to him other than ‘Grant’s out of surgery’ or some-such.

Hugs. Still so antsy: more walking. Looking around, listening for any sign of him. After another 10 minutes or so, I heard something. Not Grant, but... yes. Baby talk. Some adult was talking baby talk. I traced the sound back up the hall, and saw two nurses in a restricted area, leaning over a gurney. And there was a cry. I hardly recognized it, it was so low, harsh and raspy. But it was Grant.

The nurses moved a bit, and I saw his tiny form, arm still strapped to a board. How can I describe his movement? Not frantic, but... almost like someone struggling under water. Poor guy. I knew that if he saw me (could he see this far away?) he would pitch a fit, so I stepped back and peered around the corner. After just a few minutes, one nurse picked him up, patted him a bit, and passed him over to the other nurse. I heard her say “Like to see Momma? Want to go see Momma?” So I stepped into view. She pointed me out to him, but I don’t think he could see clearly. Another nurse told me that they’d be bringing him to the other door. I moved as quickly as I could back down the hall and around to the other door. They were bringing him out. “Go to the recliner in the room,” I was told, “he can’t support himself yet.” I speed-walked to our room, and unceremoniously ousted Jack from the big chair, got a pillow. They brought my baby back to me, limp and fussy, attached to an IV, drooling, and the most beautiful thing I’d ever seen. He wriggled and fussed, “mmooommaaah”. I began our little mantra: “Momma loves Grant. Momma loves Grant. All done. No more. Momma loves Grant. All done…” He calmed. He put his head down on my chest and slept.