“When you hear hoofbeats, think horses, not zebras”
That is a common medical school idiom: Doctors should consider the most likely possibility first when thinking of a diagnosis.
Here's my story where the hoofbeats turned out to be that of not horses, not zebras but that of a herd of water buffaloes. And man did I get trampled!
TL;DR
- Horses? - My 11-year old daughter has food poisoning. I take her to the pediatrician.
- Zebras? - No, she has appendicitis. I rush her to the hospital.
- Water buffaloes! - The pathology report: Appendiceal Neuroendocrine Tumor. More surgery in the offing.
- Trampled - Yet another surgery and Hurricane Beryl, all in a span of 4 days.
- A happy ending - Much to be thankful for.
Prologue
I have been divorced a few years now. I share custody of my 3 kids - my 14-year old son and my 11-year old twin daughters - with their mother. They alternate weeks living with me and their mother. I don't have family support in town and there's too much for a single parent to handle, even if I have the kids every alternate week. Blanca came to work for us when the twins were born - like many twins, they were born with some health issues - and I needed the help. She is someone I have trusted to take care of my kids for 11 years now.
Horses
Friday, January 26, 2024 : The kids are with their mother this week. I get a text from her that Eva vomited a few times. Most likely food poisoning. The strawberries are the prime suspect but she couldn't be sure.
Monday, January 29, 2024: It's my week with the kids. The kids come over (Mondays is transition day, that's how we set it up). Eva is still not feeling great. We take the dogs for a walk on Monday and Tuesday and she cannot walk fast because it hurts her tummy. A certain amount of post-retching discomfort is to be expected but this feels different. Pediatrician time.
Zebras
Wednesday, January 31, 2024: I pick Eva from school mid-morning to take her to the pediatrician, who takes not even 5 minutes to diagnose her with appendicitis. We are sent straight to the children's hospital. On the way, I call her mother. At radiology, she is diagnosed with perforated appendicitis and surgery is scheduled for the same day. All the while, she has been stoic and taken everything in stride. I make arrangements for my other daughter to go to after-school childcare, the dogs to be boarded for a few days. I know that I will need to stay overnight with her so I ask Blanca to stay overnight with the other kids.
As I am doing all this, Eva is being wheeled in to pre-op and that's when she finally breaks down. Her mother is able to get someone cover her shift and make it to the hospital, before surgery, to see her. The surgery goes well. The general surgeon sees 200 of these every year. No biggie for him.
I stay overnight at the hospital. Her mother and I work out a new schedule. The other kids go over to her so I can focus on Eva.
Thundering herd of water buffaloes
Friday, February 2, 2024: Eva makes great post-surgery progress. By Friday evening, the doctor on call is comfortable releasing her. We decide she needs to avoid going back-and-forth between my home and her mother's, so I drop her off at her mother's. I go to pick up the dogs from the boarding place before heading home. That's when I get a message from the hospital. Pathology report has been posted: Appendiceal Neuroendocrine Tumor (ANET). I have never felt so cold.
Who has time for grief?
Friday, February 2, 2024: I spend the evening calling my closest friends and howling on the phone for many hours. Patience of the saints must have descended upon them to have listened to me for so long. Another message from the hospital. Pediatric oncology appointment for the 19th.
Sunday February 18, 2024: It's time to tell Eva about what the next day's visit is all about. Yet again, she's stoic. Where does she get her strength and her calmness? I come from a family of anxious people.
Monday February 19, 2024: We meet the oncologist. He explains that ANETs are rare and rarer still in children. Almost all are discovered after appendectomies. <1 % of all appendectomies reveal ANETs. Good news was this one was well-differentiated G1 tumor. This is to say it is slow growing. Bad news was the pathology reported tumor cells close to where the appendix was "cut". Positive margins, it's called. He could not be sure there were no tumor cells on the other side of the cut. Then there was the perforation and the pus that was released. He advised surgery. She would lose part of her colon and part of her small intestines. The doctor asked Eva if she had any questions. "Will I have to miss summer camp?" she asked. The great worries of childhood!
Wednesday February 21, 2024: Post-op follow up with the general surgeon. He recommends a surgery plan. Since it's a slow-growth tumor, there's no rush. We decide to schedule surgery sometime after the school year is over.
Interlude
School is over. The girls attend camp. Surgery is scheduled for July 5th. I am not worried about the surgery. I am worried about the pathology report. Will they get everything or is there yet another shoe to drop? I arrange a hiking trip to Yosemite with my friend. It's not really about the hiking itself. Last time I came unglued when the pathology report blindsided me. This time I know that I should not be alone should I get bad news. Surgery is set for 6-days post-surgery.
Surgery (again)
Thursday July 4, 2024: The kids are with me this week. Happy Independence Day. It's prep day for Eva. Antibiotics. Colon cleanse (it's not pleasant). Anti-emetic for the nausea. A day spent on the can. Screw fireworks.
Friday July 5, 2024: Eva checks into the hospital. She is calm. That is until she changes into the hospital gown. She starts sobbing. By the time she is in pre-op, she is back to her stoic self. Her mother came soon afterwards. She is to stay at the hospital overnight with Eva on this day.
The surgery goes well and I head back home afterwards to the other kids. I am to return the next morning to stay with Eva for the next 48-hours.
Sunday, July 7, 2024: Eva makes better than expected progress and she is discharged early in the evening. This time I take her home.Meanwhile, Hurricane Beryl has been barreling our way and I am underprepared.
Rough Weather
Monday, July 8, 2024: Hurricane Beryl hits. The kids are to go over their mother's but the roads are impassable. The kids get to stay with me an extra day. We lose power later in the day. Eva's finally bummed: no more iPad.
Tuesday, July 9, 2024: The hurricane has passed. Still no power. It's beginning to get warm and uncomfortable without the AC. Their mother finally makes it through and picks them up. She has a whole house generator so I know the kids are better off there. I have a small generator and my internet is still up so I continue to work.
Thursday, July 11, 2024: Still no power. It's hot and humid already. It is too hot to sleep but I have to take the early flight out to Fresno, CA (that's base camp for the hike). I have a 6-hour layover at DFW. There I finally get the pathology report: no evidence of tumor cells. I finally exhaled after 5 months.
Gratitude
Saturday, July 13, 2024: We hike the Misty Trail to Vernal & Nevada Falls.
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A special thanks
I want to thank my boss at the time, whom I cannot name for reasons that will become clear soon. I want to thank him for his support during a trying time, for giving me the grace, time and space I needed to care for Eva, accompany her to her doctors' visits while juggling other parental duties. He is a man of faith and he was called to become a missionary by his church, in a part of the world that has been known to be hostile to missionaries. I cannot thank him enough.