Malcolm and the Hip Spica Cast

Most of you know by now that our lives changed on Wednesday. Malcolm, Alice, and I participate in a “mom’s group” Bible study through our church. We are officially on “summer break” and forgoing the study in favor of outdoor fellowship activities. Wednesday was a beautiful morning, so we’d met three of the other moms and their kiddos at one of the girl’s houses in University Village and walked the mile and a half to Ping Tom Park in Chinatown. After about an hour and a half at the park, we started walking back to the car.

We have a Graco Ready2Grow stroller and had it set up in the Stand and Ride configuration, so that Alice’s car seat was clicked into the front and Malcolm was standing on a built-in platform on the back, both facing me. The platform is set up so that it’s inside of the stroller handle and he has the option of sitting on a jump seat with his back to Alice’s car seat. Malcolm was standing in this position as we were walking when I realized that my shoelace had come untied. When I bent down to tie my shoe, Malcolm stepped off of the platform with his right foot. When I stood back up, I didn’t realize he had done this and immediately started to push the stroller again. This caused him to go into a split. His left foot remained on the platform and his leg twisted around behind him in an unnatural way.

He immediately started crying and I picked him up to console him. After, “oh my gosh, oh my gosh” I think my next words to my friends were, “I think he just broke his leg.” One of my friends was standing right next to me when it happened and said she also noticed that how his leg twisted looked particularly bad. I stood for a few minutes trying to comfort him and deciding what to do. He actually did calm down somewhat and it wasn’t immediately swelling, so I second guessed the severity of it and we did decide to go ahead and walk to the car, rather than try to get one of our other friends to drive us or call an ambulance. In hindsight I’ve second guessed this decision, but when I verbalized this to my cousin and mother they were both quick to point out that his leg wouldn’t have been any less broken either way.

I strapped him into the jump seat for the 20 minute walk, and he wasn’t crying, but he did quite a bit of sniffling as we made our way. When we got to my friend’s house, she ran in to get some ice and I took him out of the stroller to see if he would stand. I noticed even carrying him that his left leg seemed completely limp and sure enough he would not put any pressure on it and began shaking. I called his pediatrician’s office, gave a brief explanation of what happened, and asked if I should head straight to the emergency room or come see them. This was about 11:40 a.m. and they said they could get him in at 12:40 p.m. As I was downtown and his pediatrician’s office is by our house, this timing sounded just right, so we loaded up the car and headed directly there. I think Malcolm was in shock, and he actually dozed off for a few minutes on the way there.

I really have to hand it to Loyola for the way they handled the whole thing! They called us back to see the doctor almost as soon as we walked through the door! I held him so he could be weighed by the nurse (although, sidenote, at first she asked him to stand on the scale, and I was like, “you know why we’re here, right?”), and the doctor came into the room just moments after the nurse took his vitals. I recounted the story to her and she suggested we take his shorts off to get a better look at the leg. That was the moment I knew without question that it was broken. His left thigh was literally bent. The doctor said that based on what I told her, and looking at the leg, she suspected that he had a spiral fracture in his left femur. The x-ray technician was already with another patient, so we had to wait just a few minutes before they took us back. Naturally, Alice was getting upset. I managed to feed her while we were waiting and then passed her off to a nurse so I could take Malcolm back to be x-rayed.

I had called Jordan on the way to the pediatrician’s office to let him know what happened, and fortunately he wasn’t teaching a class this week, so he was able to head home immediately. We share a car, but our pediatrician’s office is only one mile from our house, so (also fortunately) he was able to run over (not so fortunately – in 90-deg heat). Jordan arrived on the scene right as Malcolm and I were going back into the exam room after the x-ray and was able to take Alice from the nurse. (Jordan adds – Alice was crying inconsolably in the nurse’s arms, and he followed the sounds of her cries to our room. He also added that there were multiple babies crying, but he recognized her cry specifically.)

The doctor came in to tell us that the x-ray confirmed her initial suspicion. She had called ahead to the orthopaedist at Loyola hospital in Maywood and they were expecting us at the ER. Jordan and I had to decide who would take which child. Alice is not quite four months old, and still exclusively nursing, but fortunately, I have over 300 ounces of pumped milk stored in our freezer (a story for another time) and she will take a bottle if needed. The pediatrician cautioned us that, although she completely believed, based on the way I had recounted the events and my responses to her questions, that I was telling the truth about the injury, spiral fractures are often indicative of abuse and someone else could potentially feel the need to report it. Since I was the one that witnessed the whole thing, I wanted to be the one to explain what happened to the medical staff (and holy moly – I had to tell the story at least two dozen times). Also, my scared mommy instincts were running full force and I just plain didn’t want to leave him, so we decided to drop Jordan at the house with our girly.

I am so glad we saw the pediatrician first because they were expecting us at the ER and I didn’t even have time to text Jordan that we’d arrived before they called us into triage. He seemed somewhat comfortable in the position I was holding him, and he cried a lot when he had to be moved for the orthopaedic residents to apply a plaster splint. We were told that the fracture would not require invasive surgery, but he would have to go under general anesthesia for the procedure to reset the bone and apply the hip spica (pronounced spike-uh) cast (the first time I’d ever even heard those words). The orthopaedist said that the first night is the hardest and they like to observe how the injury is going to swell before applying the cast, so we would be admitted to the pediatric unit overnight.

The nurses had been told a two-year old with a fracture was on the way up and had already supplied the room with a cute puppy pillowcase, a stuffed turtle ball, a Teenage Mutant Ninja Turtles coloring book, and crayons! When we first arrived in the peds unit, we were in a shared room, but when they found out I am a nursing mom and would need to pump, they rearranged things so that we could have a room to ourselves, and even provided me with a hospital-grade pump and offered to store the milk I pumped during our stay! Malcolm completely won the nurses over doing his dinosaur roar, and he didn’t even cry when they put in his IV, even though they had to do it twice since it slipped out of the first arm!

The friend who was next to me when the accident happened offered to come by and stay with Alice for a couple hours, so her husband could run Jordan up to the hospital to see us and get the car. (She actually offered to take Alice before we even left for the pediatrician, but I hadn’t figured out the breastfeeding logistics, so in that moment it seemed better to take her with me for the time being.) She sent Jordan to the hospital with an entire bag full of Panera food and goodies for us to enjoy! (I seriously have the best friends!)

The first night was extremely difficult, as promised. Malcolm woke up every 15 to 30 minutes, crying out in pain, discomfort, and/or frustration. By morning, he was completely hoarse from crying. He was frustrated by the television because he didn’t understand that we just had to watch whatever was on and the hospital wireless wasn’t strong enough to support Netflix on his iPad. The television actually had a VCR mounted below it, so we didn’t even have the option of watching DVDs (even though when we asked for movies, that’s what they gave us, so riddle me that one). He was also very frustrated with the foam cuff covering his IV, which limited the use of his left hand. I was encouraging him to eat and drink up to the midnight limit, and he wasn’t very interested, but naturally around 1:00 a.m. he told me he was hungry. We FaceTimed with Jordan in the morning and Malcolm told him he was “all done” and attempted to sit up and leave. Heartbreaking.

In addition to feeling completely helpless and heartbroken that he was in so much pain and has a long recovery ahead, I was feeling overwhelmed and in mourning for our summer. Malcolm spent the long Chicago winter stuck indoors, and now he’ll be watching summer from the sidelines. He just got a slide for his second birthday that he won’t get to use again for months! That may seem trivial, but it’s just one example of things my busy, busy toddler will be missing out on. Additionally, we had a trip to Dallas planned in a few weeks that is now cancelled because he can’t fly. I was also dealing with guilt because I’m the one who moved the stroller, causing him to lose balance. I’ve never wanted a do-over, so badly in my life! I would give just about anything to go back to that moment and say, “Look out, he stepped off the platform!”

Because we were an add-on to the schedule, we weren’t exactly sure what time Malcolm would be called back to the OR, but they assured me that they would try to get him in as early as possible. At about 7:00 a.m., the orthopaedic residents came in to tell me they would be taking us back in half an hour. We met with the orthopaedic surgeon for the first time outside of the OR. She said it’s like a 50-50 shot of the bones shifting in the cast and potentially having to reset it again. They expect that he will be in the cast six weeks from the date of injury, and during that time we’ll have frequent appointments with her to update his x-rays to check, and we’ll continue to see her for two years to monitor his development. She said that because his body will increase blood flow to the injury as part of the natural healing process, there is a chance that over the next two to three years, the injured leg with grow longer than the uninjured leg.

After the procedure, the surgeon told me she was very pleased with the way the bones reset and that he even has a little “wiggle room” if they shift slightly. She said that one of the trickiest things about this type of cast is keeping it clean, particularly with a child in diapers. The cast covers his entire left leg above the ankle, connected to his right leg with a fiberglass bar, casted just above the knee, and reaches all the way up his chest, stopping just below his armpits, except for a hygiene opening in the groin area. We have to lift him up and tuck a diaper into the edges of the groin opening. The surgeon recommended reclining him so that urine and waste doesn’t go up his back and seep into the cast. She said that because a child has to go under anesthesia to apply this type of cast, she will not replace a cast just because it’s stinky (adding that she doesn’t have to smell it and the kids kind of become nose blind anyway, so it’s a sort of penance for lazy parenting). The nurse recommended lining the diaper with ABD pads as another moisture-absorbing layer to prevent leaks and so far that is working like a charm. The surgeon told us that the best way to minimize the risk is changing his diaper by the clock every two hours while we are awake. Obviously, he can’t have a traditional bath, so she also recommended that we take baby wipes and rub down as far as we can reach into the cast through the openings once a day to clean him.

I think maybe the hardest moment of this entire experience, so far, was when they called me back to see him in recovery, and the first thing he did was reach out to me, but I couldn’t pick him up. I truly felt like I was failing him. The nurse did adjust him so that I could lie down next to him, and then he fell asleep while they continued to monitor him. After being intubated, and already being hoarse, he was making a somewhat croupy/wheezy sound, so they gave him a breathing treatment. When they got him settled back in his pediatric room, I called Jordan to meet me at the hospital with Alice, so we could trade off for a bit. I hadn’t been home since we left for the park, so I was still covered in sunscreen and dried sweat, and wearing a tank top and shorts!

Alice, bless her little heart, cooperated so I was able to take a quick shower and nap before my sister Sarah arrived! My angel of a sister offered to come for a few days to take over infant duty, so that Jordan and I could both be at the hospital and focus our attention on Malcolm. She took a cab from the airport, and when she walked through the door I immediately bombarded her with instructions for Alice and then left her high and dry to go back to the hospital ;). Fortunately, Malcolm slept almost the entire time I was gone and was just waking up to eat a little dinner as I walked in the room.

 Alice crashed on Aunt Sarah's shoulder after a bottle.

The second night was a slight improvement. He still startled frequently, but I think he was still groggy enough from the anesthesia that he fell back to sleep faster. I was also able to lie in the bed with him now that he was in the cast rather than the plaster splint, so each time he startled I would run my fingers through his hair or hold his hand, which also seemed to help him relax. The only trouble we ran into is the croupy wheezing seemed to come back in his sleep. The nurse brought a pediatrician in to examine him, and they decided to administer an oral steroid, which seemed to do the trick.

 Project Linus gifted Malcolm this precious blanket!

The physical therapist came to see us in the morning and instruct us on how best to manage him. He’s already doing a great job of moving his uninjured leg and wiggling the foot of his injured leg, but if we notice that he’s not moving enough, we’ll need to bend it for him. She talked to us about lifting him, changing his position frequently to avoid pressure ulcers, particularly on his heels, checking his skin around the openings of the cast for irritation, and positioning him in a wagon for transport. She said she obviously can’t do a full evaluation of him in the cast, but when it is removed we will be following up with outpatient appointments to work on regaining mobility (we’ve been warned that walking may not happen for a few months after the cast is removed even).

The biggest hurdle from being discharged from the hospital was obtaining a special car seat approved for use with hip spica casts from social services. We were very relieved to find out that they were able to track one down, and it would not delay him starting his recovery at home. The social worker who delivered the car seat and instructed us on its use was amazing! He was so upbeat, knowledgeable, and clearly deals with this all the time! There are two different types of spica restraint: the car seat, and a harness. The car seat is preferable, but all spica casts are different and they don’t all fit. We were thrilled that Malcolm fit in it like a glove. The only drawback was the positioning of his injured leg did not allow for rear-facing, which would’ve been even more ideal, but the surgeon had already said that we shouldn’t be driving other than to doctors’ appointments, so he won’t be out often as it is. The social worker helped Jordan install the car seat, the nurse brought in a wagon for us to load him in, and we were out of that joint!

When we walked in the door of the house, I was immediately overwhelmed again! My sister-of-the-year had gone to the grocery store, cooked dinner, cleaned our kitchen, done two loads of laundry, made our bed, made a precious “welcome home” sign, AND taken perfect care of our almost-four-month old. I was already emotional and just broke down in tears thanking her.

After we unloaded the car, and got Malcolm temporarily settled in his bedroom, Sarah, Alice, and I ran a few errands to stock up for the long haul. We started at Buy Buy Baby to get some Size 3 diapers and overnights, which fit better in the cast. The nurse had also recommended covering the outside of the cast with a cloth diaper or diaper cover, so we picked some up, but unfortunately they’re just too small. If someone with sewing proclivities (I know, I know, I sew, but definitely don’t have time) is inclined to create some sort of snap-on or Velcro large diaper cover I would owe you one big, huge, giant, favor – and I’d be willing to pay too! We also picked up a travel magna-doodle, which has been a huge hit during our first full day home.

 

Here's Malcolm, clutching his magna-doodle in his sleep. 

Next stop was Bed, Bath, and Beyond, where I don’t think I’ve ever spent so much money on pillows! We moved our futon mattress up from the basement onto the living room floor, so he can watch TV, and we bought wedge pillows we tucked under a fitted sheet to create an incline. We also purchased an armchair-style pillow, and two memory foam contour pillows, which have been great to support his legs. We dropped off his prescription at Walgreens on the way home, where we also picked up the ABD pads.

 Here he is, settled into his living room spot!

He figured out that he can use the cast as a road for his cars.

 

In addition to his baby wipe bath last night, Jordan held Malcolm over a shallow bucket so that I could wash his hair, face, and arms properly. Malcolm cannot be left unattended in this cast, so Jordan took couch duty last night so that I could try and rest in our bed upstairs, since I bore the brunt of the sleeplessness the first two nights. His night was good, but not great. He continues to spasm and wake himself every two to three hours, and it was after midnight that he fell asleep at all. The spasms have continued to be a problem this afternoon. I read on a hip spica cast forum that some orthopaedists will prescribe something to help with the muscle spasms, so I went ahead and e-mailed ours to see if she has any suggestions. Our biggest prayer request currently is that we can get these spasms under control so that Malcolm can sleep more soundly. Rest is so important to healing and he’s hardly getting any!

 This was after his first bath.

 Alice and her favorite Aunt Sarah! The night I got home, she didn't want me to rock her to sleep, she wanted her auntie!

Our sweet friend, Amanda, was Malcolm's first visitor tonight when she delivered dinner for us and a cool sound book and car for him! 

So if you’ve read this far, you must really love us ;). We’re trying to look on the bright side and take things an hour at a time! We have been able to find a few blessings in this already! I’m so glad that Alice is SUCH an easy baby! She’s been sleeping through the night for quite some time and is generally entertained as long as someone is in the room and talking. There is still the challenge of nursing her every 2-3 hours during the day, and now changing Malcolm’s diaper and position every 2 hours, but it could be much worse.

Thank goodness I am a part-time-work-from-home/full-time-stay-at-home mom! I don’t know how you would do this otherwise without hiring a full time nurse or taking a major FMLA hit! I am thankful that we have great medical insurance, so that this injury is not going to bankrupt us. I am thankful that my husband works for a progressive, compassionate company, that hasn’t questioned his using sick days to tend to his injured child. I am thankful for our HUGE support network that has reached out with truly staggering offers to help and prayers. I am thankful for my parents who arranged for Sarah to come help me and for delivery of a spica chair, which will greatly improve Malcolm’s quality of life the next six weeks! I am thankful for my brother-in-law, Ryan, my Aunt Angie, my youngest sister Molly, Jordan’s parents and step-parents, all of whom are taking shifts to help me while Malcolm has his cast on. I’m thankful to my Aunt Karen, Grandma, and amazing family friend Jane, who have all offered to fill in if needed! And maybe the biggest gift in all of this is that Malcolm will fully recover, and probably have no memory of it! It is strange to think that something that happened in an instant will have consequences for 2+ years, particularly when he’s only two years old, but this is not a cancer diagnosis and the doctors have assured us it will not even affect his development!