On March 10, a month and a half into an ordeal that had zapped most of the life out of her 4-year-old body, Ava Lewis was scheduled for another checkup with her former pediatric surgeon. Instead, she was in the operating room at WakeMed having her appendix, which had burst a month and a half earlier, removed.
“I don’t think she would have made it to April,” Ava’s mom, Jamie, said of the date set by their first pediatric surgeon to remove Ava’s appendix.
The Lewis family’s nightmare began Jan. 18 when Ava developed a fever and began vomiting. A few days later, Ava was suffering from diarrhea and stomach pain, and had lost 10 percent of her body weight.
Two trips to the pediatrician resulted in a visit to a local hospital, where Ava was diagnosed with a possible kidney infection. When Lewis described Ava’s symptoms to her anatomy professor at UNC Wilmington, “the first thing he said was ‘appendicitis.’ Sure enough,” added Lewis, ”a CAT scan showed a ruptured appendix with a 3.8-diameter abscess.” Ava was put on antibiotics, stayed in the hospital for two weeks and then was released.
“But she wasn’t her bubbly self,” said Lewis. “She was still in pain.”
And she didn’t seem to be getting better. Frustrated and upset, Lewis went back to her professor who made a few calls and connected her with Dr. J. David Hoover of WakeMed Physician Practices - Pediatric Surgery.
Up to this point, Lewis said most of her insight into what was going on with Ava was gleaned from research on her iPhone and Google. She would look up things the doctors had said but hadn’t taken the time to explain.
“Dr. Hoover, on the other hand, listened to me describe Ava’s situation and told me what was going on. He couldn’t really say very much without seeing her,” explained Lewis, “But he was very reassuring and professional.”
When another three weeks passed and Ava’s condition failed to improve, Lewis’ professor suggested she call Dr. Hoover and seek a formal second opinion.
“When I called his office back I got an assistant who knew exactly who I was and asked how my daughter was doing, if she’d had her surgery yet,” recalled Lewis. “I couldn’t believe she remembered us.”
Dr. Hoover was in surgery at the time, but he called Lewis shortly after leaving the operating room. He told Lewis to come up the next day, and he would work her in.
Over a month into her illness, Ava had become wary of doctor visits. She didn’t feel good, said Lewis, and all the poking and prodding didn’t help. She’d also gotten to the point where she would tell the doctor or nurse she felt fine when she really didn’t, just to avoid another needle. Yet here they were, Ava, Jamie and dad Mike, driving to Raleigh to see yet another doctor.
“Every time another doctor or nurse would come in, we’d tell her, ‘They just want you to feel better, Ava,” said Lewis. However, they didn’t have to explain that about Dr. Hoover; the two hit it off immediately.
“He was great with her,” said Lewis. “She wasn’t scared. He was very genuine, very down to earth. She felt she was in a safe place.”
And Lewis didn’t have to rely on her iPhone to interpret Dr. Hoover.
Immediately after examining Ava he suspected fecolith, or little, hard stool stones. "He said they were common in 30 percent of appendicitis ruptures. No one had mentioned that before.”
Dr. Hoover put Ava back on antibiotics — she had been taken off of them by her previous medical team, who thought the antibiotics had been making Ava sick. Whereas her previous surgery date was early April, Dr. Hoover didn’t want to wait any longer than he had to. He allowed two weeks for the antibiotics to work, then scheduled Ava for surgery on March 10.
“As it was, we ended up going to the emergency room the night before because she was vomiting again,” explained Lewis.
Ava’s surgery went well. Three days later she was scheduled to be released, but Dr. Hoover wanted one last look to make sure she was ready. He didn’t like the fact that she wasn’t eating much and that she hadn’t had a bowel movement since surgery. He told the Lewises that he wanted to keep her another night. Good thing because that night, Ava had to go back on an IV and morphine. Ava perked up the next day and was released.
“The whole experience at WakeMed was wonderful,” said Lewis. “When we first got there, the nurse walked in to introduce herself and told us, ‘Anytime anyone comes in that door they should be telling you who they are and what they’re doing.'”
Lewis also appreciated the fact that everyone — the doctors and the nurses — were on the same page.
“It was very relaxing for me and my husband,” explained Lewis. “I felt like I could be the parent. I didn't have to question everything that was being said. I could focus on my child.”
Two weeks after being released from WakeMed, Ava was showing signs of feeling better. A key moment for Lewis happened a couple of weeks later when Ava, free of the pain that had afflicted her for nearly three months, allowed her parents to do the one thing they’d been aching to do all along.
“She let us touch her,” said Lewis, and she knew she had her Ava back.