Sepsis, Overwhelming Fear, Victory

I got a clinic call last Sunday asking if I would be willing to see Zac that morning at our home.  Zac is a 9 year old x-patriot boy.  2 days prior a boil like spot had painfully started at the entrance to his right nostril.  Sunday morning he had awoken with swelling down to his lip and swelling under his eyes.  I was concerned even before they arrived, knowing that there was a potential for infection to spread to the brain, because of the region this was in.  I knew that we needed to treat it aggressively and quickly.  When he arrived, I was surprised and alarmed at the swelling.  However, I was somewhat relieved that the pustule had come to a head and it was draining.  We decided to start him on Keflex 250 mg 3 X a day and to continue using an antihistamine.  I really expected that within 24 hours the swelling would be significantly better.  I wanted to add in a second antibiotic, but had no idea which one.  I felt so frustrated with my lack of knowledge.
The next morning I sent Zac’s Mom a text and was quite alarmed when she said that the swelling was worse.  Now clear up into his eyelids.  We agreed that they would come to the clinic where more nurses would be working at the lunch hour.  In the meantime, I second guessed the antibiotic and followed another nurses advice and switched him to erythromycin.  I also sent Dr. Di (our furloughing Dr.) an email.  I caught Karin (our furloughing nurse) on Facebook and discussed the case with her.  At noon three of us nurses assessed Zac.  Now his swelling had filled out his whole face.  He was miserable.  We all decided to put him on a steroid taper.  YIKES!
I could not shake his condition.  That evening Dr. Di had responded to my email and told me to read about periorbital sepsis and if indicated give 3 doses of Rocephin intramuscularly and to not do steroids.  I started reading, but the symptoms didn’t quite line up.  I felt very concerned and not confident in what should be done.  Then I remembered Dr. Brenda.  She normally lives far in the interior, but currently she was in town.  Dr. Brenda quickly called me back and discussed the case with me.  She encouraged us to start the injections.  Change back to the Keflex.  Finish the steroid (not that it was indicated, but to finish what we had started).  I felt so relieved to have sound advice.  I let Zac’s parents know and they drove to the clinic.  Fortunately our school nurse (Ben) was willing to give the shot at 10 p.m..
By the next morning, Zac was much improved.  Now an Australian Dr. was suggesting that we add in Flagyl.  I was concerned about putting a 45 kilo kid on yet another drug.  So I wrote the infectious disease Dr. in the States (who I talked with when Mark fell on the mountain and we were working with his wound healing).  10 or more emails went between us over the next 12 hours as he wrote me paragraphs of advice and council.  5 injections needed.  Stop the Keflex until done with the infections and then start to mop up what the injections didn’t cover.  STOP THE STEROID. : )  Finally, I now felt very confident in our treatment plan.  In wound care, I love autonomy and independence.  In medical conditions that I don’t know enough about, I LOVE FOLLOWING DR’s ORDERS!!!!! : )
There was one big problem with our treatment plan.  Zac had an overwhelming fear of injections.  This was not just a small little whimper fear, but a very real fear.  The moment it was time for the shot, there was tears and out of control terror.  Day #3, it was my turn to give the injection.  30 minutes of crying, screaming and fussing….before the injection was given.  I don’t make light of Zac’s fear.  Because for him, this was very real.  We probably could have stopped the injections on day #3, but we knew that cavernous sinus thrombosis was a possibility.  So Zac’s parents and us nurses decided together, that 5 injections would result in the best outcome.  We had to put Zac’s fear out of our minds.  But not for long!!!!  The next morning, Michelle (school nurse) had emailed the family an article of how to deal with fear of shots.
That afternoon, Zac walked into the clinic for injection number 4.  Asked Michelle to count to 3.  There were no tears, or fuss, or temper tantrum.  Zac’s mom texted me to let me know this amazing victory.  I asked what had happened.  She responded, “Zac’s says that God gave him comfort.  An awesome testimony from our 9 year old boy”.  Injection #5, same result.  I saw Zac in the school parking lot right after his last shot.  His face was all normal again.  He radiated happiness and success.  I felt so proud of him and this fantastic outcome.  Not only healed from the sepsis, but also healed from fear.
I asked his parents if I could blog this story.  Because what happens at the clinic, stays at the clinic. : )  They did give permission.  I asked how Zac came to overcome his fear.  This is what his Mom wrote me, “We didn’t get to read Michelle’s email until after he had the needle.  But what I did do was talk to him frankly about the dangers of not having the needle.  We were giving it to him out of love.   Not to hurt him.  He burst into tears when I told him.  From there he came to me with a plan.  He was going to be brave.  He wanted me to hold his leg so he wouldn’t kick anyone, and he was going to count to 3 then be given it.”
I don’t think this story will end here.  I have a feeling that Zac will be able to help others overcome fears.  He has learned an amazing lesson at age 9.  I have learned so much from Zac.  About sepsis, about antibiotics, about steroids, about being brave and having a plan to face fears and allowing God to give comfort in situations that seem awful. 
I am so thankful, that despite my “nursing errors” that God held Zac carefully and brought much good out of this story.