Boy’s minor surgery that took scary turn

Monica* signed on the dotted line with a sigh. She had just committed to putting her son out of his misery.

Little Jay* was only four and was oblivious of the huge commitments being made on his behalf.

By age two, though the snoring in Jay was a permanent feature, nobody was really concerned. He slept restlessly but deeply and would breathe through the mouth when he had a cold. Luckily, his infections were never serious and would be relieved by antihistamines and saline nose drops.

By the age of three, things appeared to take a downward trend. Jay developed coughs that would not go away.

The coughs would wake him up from his sleep and over time, he was not getting adequate sleep. Sometimes he would cough so badly, he would vomit in bed. On some nights, he would startle out of his sleep with a scream before dropping off to sleep again. This was compounded by loss of appetite, affecting his weight gain.

Jay was diagnosed with adeno-tonsillar hypertrophy and Monica was reassured that most children outgrow this with age. He was put on all manner of medication for his symptoms but there was no permanent relief.

Monica was tired of the prescriptions, especially the repeated antibiotics. She had a whole shelf in the kitchen looking like a pharmacy. Jay hated the nasal sprays.

Respiratory infections

Adenoids are tissue patches present in the back of the nasal cavity while tonsils are at the lateral aspects of the throat. These related tissues serve an immune function by producing antibodies.

As children grow and are constantly exposed to respiratory infections, they respond by increasing in function and hence in size. For some children, the enlargement may be excessive and permanent, obstructing the flow of air during breathing.

Jay did not seem to outgrow his adenoid and tonsillar enlargement and a review by an ear, nose and throat specialist was necessary.

The X-ray noted marked narrowing of the air passage, requiring surgery. By this time, Monica’s online research on adenoidectomy had indicated that surgery would be the solution for Jay’s problems and her mind was made up. All she wanted was scheduling of the procedure.

Monica and Jay arrived at the hospital before daybreak and proceeded with the admission process. Jay was changed into a small surgical gown and she kissed him goodbye at the operating theatre door.

The surgeon reassured her that they would be done in no time and would be able to go home the same day. Monica sat at the waiting bay outside and whispered a prayer. She was suddenly scared as the countdown began.

An hour later, the nurse came out and called her in. She was given a gown to wear over her clothes and changed her shoes into hospital clogs before being led to the post-operative recovery area to see Jay.

Jay was asleep, with oxygen flowing into his tiny nostrils through nasal prongs and connected to several gadgets leading to a monitor beeping rhythmically. She was given a seat next to his bed and was allowed to hold his hand. He was still snoring loudly but he was peaceful.

The surgeon came by and reassured her that the surgery went well and once Jay was fully awake, he would be transferred to the day care ward for further observation before release in the afternoon. He went back to the operating room for another surgery. Monica whispered a prayer of thanksgiving and sat watching her little boy.

Suddenly the monitor went berserk, beeping continuously with red lights blinking furiously. The nurses in the unit dropped everything and ran over, calling for backup along the way.

Monica was firmly pulled away and her protests fell on deaf ears as more personnel went into the cubicle. It was a harrowing moment and at some point she stood all alone outside the unit, with her nose pressed against the glass staring at the curtains beyond.

Covered in tubes

About half an hour later, the curtains were drawn back and little Jay emerged all covered up in tubes and was wheeled away to the intensive care unit.

What started as a simple day surgery ended up in 24 hours in ICU and another five days in the ward before Jay could go home. Monica was shaken.

Jay’s father, with whom she was separated, was livid at first for not being informed that Jay was going for surgery, only finding out when complications had set in.

During review in ICU, Monica sought to know what had gone wrong. The doctors explained that Jay sustained a relatively uncommon complication following surgery.

He suffered respiratory failure that was an indirect result of the anaesthetic medication used during surgery. This slowed down his breathing, decreasing his oxygen and building up carbon dioxide, triggering a cardiac arrest. The close monitoring in the unit had caught it in time and Jay was resuscitated successfully.

Monica was greatly relieved that her son was going to be alright but she still feels cheated that she was never informed of the possible complications of the surgery and the attendant anaesthesia before consenting to the procedure.

It may have been willing and uncoerced consent but it was certainly not informed!