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117 5 ChildrenwithHighFevers Case Stories Daisy’s Story Daisy Fang was a six-month-old girl who was brought by her young parents to their primary care physician with a fever of 103°F. The chart indicated that the mother had made few prenatal visits and had a normal delivery. Daisy had been to the clinic for three well-child checks but had not received any immunizations, since her parents did not want her to receive them until she was older. The child had had a fever for three days but had no other symptoms of sickness such as runny nose, sneezing, coughing, difficulty breathing, vomiting, diarrhea, or rash. No one else at home had been sick. Her parents had given her Tylenol, placed a Thai medicine on her temples, wrapped her in a blanket, stopped frying foods, and kept her inside. Still her fever persisted and she became sicker. She was sleeping more and not waking up to drink, cry, or play, so the parents brought her to the clinic. Concerned about a bacterial meningitis or a bacterial infection in the bloodstream, the doctor recommended—in simple English,since no interpreter was present—hospitalization , blood cultures, urine culture, lumbar puncture, and intravenous antibiotics . The baby’s parents were smiling as they listened intently to the doctor. The father asked a few questions about the tests, called his parents, and then agreed to the work-up, stating he was concerned that Daisy was very sick and needed the doctor’s help. The septic evaluation was done quickly. By the time the grandparents arrived, the baby was in the hospital’s intensive care unit, receiving intravenous fluids, antibiotics, and oxygen.The test results were consistent with a bacterial meningitis,which required fourteen days of intravenous antibiotics. Afraid that the child would not get better because there was no rash on her skin, the grandparents told the parents that the child needed the traditional healing rituals of khawv koob. The parents asked the nurses whether they could do the healing ceremony in the hospital; the doctor agreed to allow the ritual but refused to let the healer burn incense because of the oxygen Daisy was receiving. The grandparents became angry, but the parents remained quiet and did not challenge the doctor’s authority. Daisy remained feverish, lethargic, and weak for the next two days. Ultimately, she suffered a cardiac arrest. Immediately, the doctors attempted to resuscitate her and 118 Children’s Health her family rushed to the bedside. The nurses told them to wait in the waiting room, but the primary care physician allowed them to stay and tried to explain what was being done to save their daughter. The doctors’ efforts were futile. Once they stopped trying to resuscitate Daisy,the family gathered around her,crying and wailing in grief. After the infant died, the primary doctor heard the nurses and doctors say that if Daisy had had her immunizations, she would have lived. At the Christian funeral, the same doctor heard two elderly people tell the parents that if Daisy had had the khawv koob, she would have lived. Neng’s Story Neng Song was a three-month-old boy whose young parents brought him along to the mother’s prenatal visit and asked the doctors for a medicine to reduce his fever because he had a cold. The infant was fussy but consolable, with a fever of 103°F., and a normal physical exam. The doctors were concerned about a possible life-threatening bacterial meningitis or bacterial infection in the blood. With a Hmong medical assistant acting as interpreter, the doctors told the parents they needed to draw blood, get a urine specimen with a catheter, and do a lumbar puncture to identify whether he had bacteria in the blood, urine, or spinal fluid. The parents were shocked at the doctors’ evaluation, since the infant had only a cold, and refused the recommended interventions because they feared they would be harmful to their infant. The doctors tried to explain and convince the parents of the need to treat their child aggressively, since the feverish infant without an obvious cause for infection was at risk of dying from meningitis or bacteremia. The parents refused and wanted to take their son home. The doctors called a security guard to take the family to the emergency room while they obtained a police hold and started to get a court order to do their septic work-up and treatment. The parents telephoned their...

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