'The chocolate smell put me to sleep!'

We knew when Alyvia was just 6 months old that she most likely had enlarged adenoids and tonsils. She was a ‘mouth-breather’, ‘snorer’ and had a nasal voice. Many children’s adenoids reduce in size as they grow and no longer have symptoms but as Alyvia grew, it became clearer that we needed to address it.

Her nighttime sleep was of poor quality which resulted in her being tired during the day and still needing an afternoon nap (which isn’t too bad as both girls nap together and I get my much needed ‘me-time’). However many children her age had grown out of it. She was unable to eat much as she couldn’t breathe through her nose properly while eating, so foods that required chewing for longer, were difficult to eat.

Her growth rate was slow and her speech was affected. Don’t get me wrong, she was still able to function well and live a normal life but we knew that she had adjusted to these changes.

The worst times were the winter periods when common viruses would cause the adenoids to enlarge even more due to inflammation and she had persistent green nasal discharge, snoring at night but even worse, her sleep apnoea (periods of stopping breathing) became more pronounced.

She still sleeps with us and often I would stay awake all night making sure she didn’t stop breathing for too long. When she had a period of apnoea, I would nudge her or wake her to get her to take a conscious breath. This would happen every night and resulted in poor quality sleep.

Every winter, we entertained the thought of having her operated on to remove her adenoids and tonsils but when the summer came, her symptoms improved and we put off the idea. Selfishly, we didn’t want her to go through an operation.

As you know clever.doc is an ENT surgeon and has performed many tonsillectomies at work and has also seen many children with similar symptoms as Alyvia in his clinics. For these children, he would advise having an operation. Following these procedures, and reviewing children months after the operation, the majority were completely different children! They were grateful for such a change in their lives! They slept better, ate better, thrived in school and grew. But why wouldn’t he do the same for his own child I would ask him. ‘I just don’t want her to go through with an operation and risk having potentially life-threatening post operative complications’. He was talking about post tonsillectomy bleeding, which is life-threatening and needs to be dealt with urgently. It usually occurs between day 5 and 10 post op. It’s the one reason he gets called into theatre in the middle of the night for.

I would argue that we would keep an eye on her and we had the advantage of knowing what signs to look out for to prevent anything dangerous from happening. But then summer would approach and things would settle and we hoped that each year was the year that everything would resolve on it’s own.

At 3 years old, she was still suffering with the above symptoms and we then decided that we would need to intervene. Clever doc spoke with his colleagues at work and approached one who he thought would be best for the job. We got her referred to his hospital and went to see the ENT surgeon there the following week. Having agreed that we would go ahead with the operation, we then needed to decide on a suitable date. I only had a few days of annual leave left so I took all of it in one go so that I could be with her during the post op period and we scheduled a date. It was 2 weeks away. She was put on the list and that was that.

We broke the news to our families who had their reservations but understood our reasoning, then we waited for the day.

On the morning of March 18th, Alyvia woke up at 6am and we told her we were going to daddy’s work. She would stay there for some time. She would wear a mask which gave out a sweet chocolate smell and she would go to sleep.

She was excited and felt special. Her sister was not accompanying us and she had a bag packed with all her favourite toys and snacks for the day. Little did she know.

I had a knot in my stomach that morning and dreaded that moment when I would have to take her to the anaesthetic room. We both agreed early on that as only 1 person could take her, I would do it.

When we were taken into our cubicle to change and wait, we were given a practice mask to show her how she could ‘play’ with it later. She thought it was very exciting but as each member of staff introduced themselves to her, she began to grow slightly suspicious. The surgeon came, explained the procedure to us again and asked me to sign the consent form. This decision I was making for my daughter, was without HER consent I thought. As the guilt flooded me I began to think what gave me the authority to consent? She was her own person, a separate human being but yet I was so easily putting her in this potentially life-threatening position. I felt sick. I was a hypocrite. Clever doc nor I had ever had an operation ourselves yet we thought we would allow our own daughter to have one out of our own free will?? I signed the consent form and fought back tears. Then we were told it was time. The lump in my throat appeared and the knot in my stomach got tighter. Clever doc warned me that Alyvia would be able to sense my fear so I had to be strong. We began the walk to the anaesthetic room. ‘Where are we going mummy?’ My heart sank. I told her I wanted to show her the hospital and we were going to see a few rooms.

In the anaesthetic room I was told to sit her on my knee facing the wall. She sat down and then many new faces began to introduce themselves to her. She didn’t want to know. She looked at me and I reassured her that I was there with her. Out came the mask. I got excited for her to smell the chocolate and she hesitated at first. As the anesthetist sensed this hesitation, she decided we would wrap Alyvia’s body in a blanket. ‘Because it’s cold in the room and we don’t want you to feel cold do we?’…a tactic to prevent her arms from pushing away the mask that would soon be placed on her face. I told Alyvia that the lady was going to give her the mask to smell and my voice began to shake. I had to keep it together. I began talking about her favourite chocolates and all the chocolates she loved. She allowed the mask to be placed on her and began to breathe in and out. I asked her if she could smell it, she nodded and continued to look at my eyes for reassurance. Then I said the smell would get stronger and she would love it. She stopped responding and just continued to look at me while breathing calmly. A few seconds later her eyes closed and as they closed I whispered to her that I loved her and kept repeating it so she could hear. Then the tears came gushing out, uncontrollably. She was asleep in my arms and the blanket was removed. She lay in my arms helpless, with no idea what was about to happen. I was asked if they could take her from me to place her on the bed. ‘No, I will put my daughter on the bed.’ I said firmly. I placed her there gently, fixed her hair, kissed every part of her as helpless as I was feeling and left the room. That’s it I thought. I can’t do anything now. My whole life was in someone else’s hands. I couldn’t be with her anymore, mummy wasn’t there to protect her. I felt so vulnerable and helpless just as Alyvia did a few minutes ago. I realised she knew something was happening to her and that even if she tried to, she couldn’t fight all those people, so she just trusted her mummy…

I met up with clever doc and cried some more. Then spent the whole hour crying and reliving the scene from the anesthetic room. ‘Did she cry?’ ‘Did she resist?’ ‘Did it take ages to get her to listen?’ No was my answer to all of them. I was amazed at how calm she had been. She was a good girl and I was so incredibly proud of her. I’m sure she thought that if her mummy was there, she would be safe. But her mummy wasn’t there now. I hated myself for this whole thing. I wondered what part of the operation they were currently doing. I kept checking the clock and returned to our cubicle pacing the corridor.

After the longest 60 minutes ever, I was told the surgery was over and that she was in recovery. I wasn’t allowed to see her there and had to wait for her to wake up and bring her to us. You can imagine how frustrated that made me. She would wake up and scream…obviously. 5 minutes later, I heard crying and my little girl was wheeled round to me. She was agitated, drowsy and crying. It was her angry cry. I felt guilty. I cried again and hugged her. I held her in my arms until she finally calmed down and fell asleep on me.

The surgeon came in and said he was happy with how things went, her tonsils were removed along with her adenoids as they were very big. We thanked him and waited for Alyvia to wake up. She slept for 2.5 hours. We woke her gently after that and offered her some food and water. Thankfully she was hungry and wanted to eat anything. She ate a sandwich, crisps and water. The nursing staff were happy with her progress immediately post op and we were discharged after 6 hours.

‘Now MY worry starts,’ said Clever Doc as we drove home. He feared the potential complications. ‘Let her eat anything and everything’. He said. She had to have all textured foods to allow the area to heal and get used to foods. ‘The children that I see who have complications have usually not eaten or drunk anything due to pain or fear or have only had soft foods and they end up having a lot of bleeding.’ That was literally the last thing I needed after the ordeal I went through. At home she ate again and we encouraged her. When she swallowed I could see that she flinched but I didn’t allow her to think something was wrong.

Later that day we asked her what had happened earlier on ‘I went to Daddy’s work and I was given a mask, and the chocolate smell made me go to sleep. Then I woke up and came home!’ We both started crying and hugged her.

Now we are Day 4 post op and Alyvia is eating well, she has a fever, which is common post tonsillectomy and has intermittent pain. Her breathing is a little better, but nowhere near how I want it to be. She is snoring a little at night, but there is no apnoea. Hopefully after two weeks have elapsed, things will be different.

Speaking to friends about the entire process raised a particular question that many people often ask me, ‘But you’re a doctor, you’ve seen this so many times, know what is going on etc, so why were you so upset and worried?’ First and foremost, I am a mother and have the same struggles, concerns and feelings as every mother. I can’t be a robot unfortunately and turn on ‘doctor mode’ and then ‘mother mode’ when I want to. Behind those two roles is a human being with real emotions. In situations like this, my ‘doctor mode’ is always flickering in the background helping me understand, allowing me to weigh out pros and cons of treatments and to also be empathic but on the ‘other side of the curtain’ I am no different to any one of you.

So here I am writing this post and hugging Alyvia.

If anyone is gong through a similar procedure with their child and wants to talk, feel free to email me. I wish you all the best.

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