Horses and Zebras

I had cause to take Birdy to Urgent Care recently where I received quite the dressing down from the triage nurse who responded to my assertion that it was "exacerbation of asthma" by telling me that Birdy had a temperature and therefore it was probably only a minor chest infection, adding for good measure, "Just because she's got asthma doesn't mean you have to give her the inhaler every time she coughs."

I had followed Birdy's asthma plan to the letter that day, and the subsequent delay in treatment due to her being classed as not very urgent meant that by the time she was seen her SATs were 88. If you don't know what that means, suffice it to say that it's not good. She was admitted to hospital and eventually put on oxygen.

Apparently, the phrase "When you hear hoof beats, think horses, not zebras" was coined by a medical professor in the late 1940s. The idea is that medics ought to consider the most obvious and likely causes of symptoms before looking at unusual illnesses and rare diseases. It makes complete sense.

Unless you live in the savanna.

In the savanna there are an awful lot of zebras. There aren't many horses. I'm pretty sure that people living in the savanna learn to expect zebras when they hear hoof beats.

At our house, we live in the savanna much of the time. Zebras are not at all unusual, and because we are exposed to them a lot, we have learned to expect them, and to quickly tell the difference between them and horses.

When I hear hoof beats, I know to keep an eye out for zebras. When Birdy does that particular cough, and her throat strains with every breath, I know to take her to hospital and say "exacerbation of asthma". It's not just a mild cough, it's zebras. When she starts to go a little red around her mouth, I ready the anti-histamine and epipen in case a severe allergic reaction is kicking off. Zebras.

Knowing that your children have been exposed to alcohol and drugs in the womb, have been neglected as infants and experienced all the myriad of other early losses, traumas and stressors common to so many looked after and adopted children . . . well, it makes you expect zebras.

With OB, the zebras are sneakier than with Birdy. They are often disguised as horses. Really naughty horses. Really anxious horses. Really oppositional horses. Really angry horses. But nonetheless, they are still zebras.


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