March 17, 2009 - By David Fetterman
David Fetterman chases his son, David Jr., on campus. Two years has passed since he took his son to the hospital for pyloric stenosis, just as his own father had to do for him.
Our 13-day-old son, David, was growing increasingly frantic as the hours passed. He has been a joy to behold, a marvel actually, with his tiny fingers and cute little nose, but on that winter's night two years ago, he was vomiting non-stop - projectile vomiting - and was not keeping down any liquids, in spite of the best efforts of my wife and me. I had been on the phone with the advice nurse, trying to solve the problem at home and trying to push aside the mounting terror. I could tell that if we didn't act quickly, he would become dangerously dehydrated. I knew that I had to stay calm.
At the time I worked at Stanford University Medical Center, evaluating programs and procedures, so I know how hard it is to tap a vein when the babies are small and they have gone too long without fluids. Normal procedures can suddenly become major obstacles to keeping the little patients stable and alive. I had all my medical books out on the bed next to him, trying to pin down a diagnosis, but I already knew exactly which page to turn to. My parents had experienced the same thing with me when I was his age. It was pyloric stenosis, a blockage between the stomach and the small intestines where the muscle gets so thick that it does not let food pass through it.
Five decades had elapsed since my case and, while modern medicine has made dramatic advances, I was about to discover how some of the challenges of caring for a child are timeless.
I had often heard my father tell the story of my brush with death. I had been struck by how mechanical he was when he told the tale. There was no emotion or tone as he recounted the series of events. When I began having my difficulties in 1954, the doctors first had my parents try feeding me formula for a few days. In the process, I lost 3 pounds. My tiny body was not prepared to sustain that kind of assault. My father sized up the situation, saw that I was fading and said 'the heck with this.' He wrapped me up in a blanket and drove through the snow from our home in the northeast corner of Connecticut to Boston Children's Hospital. I was so small that they simply put a flashlight to my abdomen in a dark room to make the diagnosis.
So like father, like son. There was no room for panic when dealing with my David's suffering. I too wrapped my little one up and ran to the hospital. This time around, however, we had a pretty good guess about the diagnosis, and there was no delay to further complicate and compound his condition. We drove David to our local HMO-approved hospital knowing that it was a perfunctory visit. They saw David and then authorized us to go to Lucile Packard Children's Hospital, which had the expertise to handle such a condition.
From that point on, the evidence of how medicine has advanced became readily apparent. Ultrasound was used to confirm David's diagnosis. The doctor reported with precision that the pyloric muscle had a thickness of greater than 4 mm and a pyloric length greater than 16 mm. He told us that we had made the right decisions and had moved fast enough to avoid dehydration, which would have resulted in additional delays. Instead, David's surgery was scheduled for that morning. I felt more assured at each stage of the process, less vulnerable, and also less in control. But I did not mind being relieved of duty as it were. I was confident the doctors knew what they were doing and that David was in good hands
My son's operation was laparoscopic, a procedure unheard of when I was a baby. It takes place without significantly disturbing the bodily organs. A simple cut is made in the muscle. The camera goes through the belly button. The two tools used to cut the muscle are attached to small wires inserted through the abdomen. In my day, the intestines were pulled closer to the surface to work around them, creating more stress on my little body. Today, the operation takes about an hour, including prep and recovery. The tiny patients can eat the same day and go home the next. In contrast, I was in the hospital for almost a week, largely due to delays in diagnosis resulting in dehydration.
My son's scars are almost impossible to detect - a tiny plus and a minus sign on each side of his belly. My scar, on the other hand, which has grown along with me over the years, is over 5 inches long. What a difference 50 years makes in the world of pediatric surgery.
But the experience has done more than make me grateful for the wonderful treatment my son received at Packard. It makes me understand better a father's love.
I had always been a little puzzled, maybe even a little hurt, at how detached my father, a successful small business owner, could be in telling the story about what happened to me - and about helping me when I was sick. I still remember another occasion, when I was older and throwing up in the middle of the night. My father was by my side and in a contemplative moment, he mused, 'Isn't the human body an amazing machine? It knows precisely what to do to take care of itself.' I, of course, thought I was dying at the time and wondered why he was waxing poetic.
Yet when David's problem arose, I also remained calm, logical and decisive. I initially chalked this up to my professional training in evaluation, which requires a detached analysis of facts. But these traits probably came as much from my father as they did from my formal training. He responded calmly to my crisis. Any display of emotion at that moment would have been a luxury. I now can see the desperation that my father hid from me and how it was the result of a bottomless love. The only thing separating our experiences was time and space. He was on the East Coast and I was on the West Coast, with a half-century between our brushes with death. Our fears and commitment to saving our sons, however, were the same.
David Fetterman, PhD, was director of evaluations at the School of Medicine and his firm, Fetterman & Associates, now does evaluations for clients worldwide, including the medical center. He wishes to thank Karl Sylvester, MD, not only for conducting the surgery, but also for his contributions to this story, and to Suzanne Bethard for encouraging him to share the story.
Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford School of Medicine, Stanford Health Care, and Stanford Children's Health. For more information, please visit the Office of Communications website at http://mednews.stanford.edu.