Pneumonia in the Time of an Antibiotic Shortage
My 4 year old couldn't breathe. And the medicine was gone.
I was a mother the first time I pressed my open hand against someone’s skin to feel for a fever. My baby’s cry woke me up in that middle time, when it seems like the night is looping to avoid the dawn. It was a new cry, the one I’d come to recognize as her sick cry. I leaned over the side of crib, covered her little forehead with my palm. Her skin was just on the side of too warm, like the heat from an open proofing drawer.
I found the thermometer I’d been given at my baby shower just a few months before. Drew it across the skin above her eyebrows, a gesture of divination. Her fever was 100.2 degrees. She wailed while we rocked her. I ground my teeth, watching out the window for morning light, like my vigil could pull in the morning.
She cried while the doctor examined her. It was an infection. Her body was heating up to create a hostile environment for the bacteria in her body. If she was older, he’d recommend letting the fever do its work. But she was just a few months old, so fevers could be more dangerous than helpful. She hiccuped tears while a nurse gave her Tylenol.
The nurse showed me how to slowly push the liquid into her mouth, holding the syringe dropper angled into her cheek so she didn’t spit the pink liquid out. She bleated and gulped while I picked up her prescription for Amoxicillin. While I loaded her back into the car, I cried too.
I’d just turned 25. I was struggling to contextualize my new life as a mother. It wasn’t composed of the neat narrative arcs I’d grown up watching on TGIF - brightly lit scenes of family accord with the occasional Very Special Episode. Instead, it was a sprawling, gnarling, catching thing. An old growth forest with danger lurking in the shadows.
Mother narratives are as old as stories, but my motherhood has always felt primeval. I suppose it makes some sense. After all, I was present at the earliest stages of my own motherhood. Still, it’s exhausting to live in a Mothertext. Often, I just want to know what the plot is driving at. There are no new stories, not really. The same themes repeat over and over across space and time and people.
I first found Thompson's Motif-Index of Folk-literature when I was in my twenties. It's an incomplete index of narrative elements that repeat across folktales. I used to read through it the way I scroll through Twitter.1 It's been years since I owned a physical copy of it, but I can see the pages in my head. And when I’ve felt the familiar outline of a motif in my life, I’ve grabbed at it.2 I add them to the collection of found objects that help me understand the story of my own life. Sacred Oak, Salt of Hospitality, Wisdom Learned from Children, Identification By Token. Often, it must be said, I find myself grasping at nothing.
When we got home, I tried to give my baby the antibiotic the way the nurse showed me. She choked on a wail, spit up a string of medicine and saliva. I cried again, while I pushed it back into her mouth with my finger. She stopped crying a few hours later. I stayed up again that night, feeling her forehead and listening to her breath. Like my vigil could prove we were both deserving of healing. The next morning, she was the right-warm. The antibiotics worked.
Since then, I’ve understood my motherhood as a kind of escort mission with a series of side quests. A lot of those quests have started in that middle looping space. There have been years when it seemed my right hand existed just to feel for fevers.
Some of them still smolder in the center of my palm. It feels silly to admit this, but it’s true. Sometimes, I press my left forefinger into my right palm, expecting to feel heat against my fingertip. But of course, I never do. Long life is in Wisdom’s right hand. The memory of pyronegnic thermal energy is in my right hand. We are not the same.
My right hand only holds on to the fevers that burn beyond their borders.
Fate of Parents Revealed in a Dream
In 2014, my dad’s leukemia returned. A week after he was admitted to the hospital, I put my hand across his forehead. His skin felt hot enough to crack my metacarpals and evaporate their yellow marrow. Hospital Acquired Non-ventilator Pneumonia. He was admitted into the ICU. I stayed awake during the night when I wasn’t with him, like my vigil could prevent his spirit from slipping from his body. The antibiotics had too little support from his depleted immune system. He went into septic shock and died a few days later.
Resuscitation by touching the Tree of Life’s branches.
Early on a Saturday morning last June, after a grinding bout of Covid, my thirteen year old stumbled into my bedroom. She’d thrown up and her heart was racing. I cupped my hand against her cheek, warmth radiated down my radial artery. A quick drive to the hospital. Pneumonia. The x-ray of her lungs looked like a tree, the leaves in her right lung were tight and heavy. I wanted to reach into her and help each leaf unfurl. It was ridiculous to me that I could not shake her branches until the heaviness was gone. And then she went into compensatory septic shock. I watched the antibiotics drip into her IV, like my vigil could make sure this healing draught worked, this time. (Read about that experience and what it means within the context of the Dobbs decision.)
I can still feel both those fevers sometimes. I stretch my fingers to help the heat dissipate.
Last month, after a bout of RSV, my four year old woke up in the middle of the night, gasping. I put my open hand against her forehead and then her cheek and then her forehead again. She was smoldering. While I walked around the house looking for the thermometer, I tried to shake the embers out of my hand.
For the rest of the night she was incandescent. As her elevated particles crashed into one another, she talked brightly about: the inside of black holes. Is there something hiding in them? Her favorite bunny slippers They are soft enough to sleep in but not too soft to walk in! The way her lungs felt. It feels like a google of trolls are pushing on me! Fevers always make my kids talk like they’ve just woken up to the world. The next day she was diagnosed with pneumonia. The leaves in her right lung were tight and heavy.
The Greek word for fever, pyrexia, comes from the word for fire. The Romans had a goddess of fever, Febris. She was meant to protect them from fevers. What mother hasn’t felt like making an offering at her altar as her child’s temperature climbed? An ancient Persian doctor, Akhawaynī, wrote that fevers were symptoms, not diseases. He said they often accompanied illnesses like pneumonia.3 This wasn’t comforting. Before germ theory was developed, infectious diseases presenting fevers killed nearly 50% of all people before the age of fifteen.4 Pneumonia was a particularly pernicious killer.
A 19th century understanding of communicable disease helped slow the spread of viral and bacterial disease. And then, the discovery of antibiotics made death from infection relatively rare. We’ve always been very careful about only using antibiotics when we really needed them. And each time I’ve marveled. The amoxicillin that I pressed into my baby’s mouth came from a strain of penicillin grown from a moldy cantaloupe in the 1940s5. An enchanted fruit that stops death. If that isn’t the stuff of folklore, what is?
Preservation of life during world calamity.
After the doctor diagnosed Brontë, she paused, “There’s an antibiotic shortage. The hospital has made a list of antibiotics that will work if you can’t find amoxicillin. We’ll start at the top of the list and work our way down.” The shortage has many causes. Like an early, aggressive RSV season that’s led to more infections. And the fact that our government leaves production of public goods like amoxicillin in the invisible hand of the market.
The World Health Organization reports that, “pneumonia is the single largest infectious cause of death in children worldwide.” Too few children have access to antibiotics and treatment. For parent who’s never seen pneumonia before, it would be easy to think, “Well, if she’s not better in a couple days, I’ll take her to the doctor.” But I’ve seen what happens when the infection spreads from the lungs to the bloodstream. I’ve tried to resuscitate the dead by shouting. It doesn’t work. I left the doctor’s office a little shocked. They were sending me home with an increasingly sick child and no promise of antibiotic. It felt like a test, not reality.
Quest for draught of healing.
The list wasn’t big enough. The New York Times recently reported that only the amoxicillin suspension is difficult to find. That is probably true in many places. It was not true in Denver. I spent hours on the phone trying to find a powder or suspension antibiotic that could treat the infection branching through my daughter’s lungs. When each antibiotic got crossed off the list, I had to call the doctor’s office and request a new prescription.
They were overwhelmed with other parents calling. I got an answering service half the time. When I called one CVS, the pharmacist clucked while he scrolled on the computer, “I am not seeing any antibiotic that can treat pneumonia within 50 miles of here. It will be interesting to see what the doctor’s office comes up with.” I told him I didn’t find it interesting at all.
When I posted to Instagram about the shortage, one woman sent me screenshots of a Facebook group where moms were sharing tips on how to find a pharmacy that still had antibiotics. Some of them had been looking for multiple days. Three people sent me instructions on how to use the antibiotics you can get for fish at pet stores. All three had to use them when they were uninsured and could not afford prescriptions for infections.6
An hour before my doctor’s office closed, I found an antibiotic on the list at a Walmart. The pharmacist told me it was the last they had in stock, and there wasn’t much left. I called my doctor’s office on the way to the store and left another message with the answering service. For the next forty minutes, I paced past Black Friday endcaps while I tried to get my daughter’s prescription transferred one last time.
When I felt the fevers in my hand, I picked something up to replace the heat - a gallon of milk, a toy, Bluey pajamas size 4T. Unfortunately, it’s never been hard for me to hold two things at once.
Riley stayed home and held Brontë while I made all the calls and did all the pacing. What about the parents who have no one to hold their sick children while they search for medicine? Or the mother who is out of sick days and cannot call out of work? Who has to try to find the medicine tomorrow, when there’s more time? What about her child? How is this the system we’ve come up with?
A nurse finally answered my call. I started talking quickly, repeating the medicine and dosage I needed. We’d already wasted too much time. She told me to calm down. I bit the side of my cheek and then said, “Oh I am so sorry, you know how crazy moms can be.” I wanted her to want to help me. I needed her to push through the prescription before the office closed, before someone else filled their prescription with the last dose, before the pharmacy closed, before the infection moved from the tree to the streams around it.
I cried when the pharmacist handed me the little white bag with two little bottles of pink healing potion. Because I know. I know that fairy tales exist to explain the darkness, not eradicate it. I know that for every motif I’ve held onto, there is another one waiting to grab me back and send me tumbling into thickets that won’t let go. I know. Okay? I know.
Hero returning with berries sent back to bring tree.
And now, for a few recommendations, a few more words and a few more pictures.
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