Sunday, March 31, 2013

Grey's Anatomy Takes Kawasaki Disease To Heart

*** Caution! Spoiler alert! This post describes in great detail narrative from Grey's Anatomy, Episode 9x19, "Can't Fight This Feeling."  If you haven't watched this episode yet, and you don't want to know what happens, then stop reading.  Seriously.  Walk away from the post.  Do not pass go.  Do not collect 200 dollars.  You have been warned. ***

 
Watching Grey's.  Me: You're my Kawasaki baby.  Her: I'm your Kawasaki survivor. 

When I first found out that Grey’s Anatomy was going to be doing an episode featuring a child with Kawasaki Disease, excited doesn’t begin to cover what I felt.  I’m a huge Grey’s Anatomy fan; one of those over-the-top geeks who has seen every single episode more than 5 times, type of fan.  I also happen to be a Kawasaki Disease awareness advocate since my daughter has survived two different cases of KD.  This was like every holiday rolled into one.

Then I found out that Sarah Chalke, who would be guest-starring in the episode as the KD mom, initially brought the idea to Grey's creator Shonda Rhimes because Sarah's own son had been diagnosed with Kawasaki Disease two years prior, and she wanted to raise awareness for the sake of other parents and children.  After speaking at a KD fundraiser and hearing other KD parents' stories, Ms. Chalke said, "...I had never met anyone who had had it before. They were all so brave, and the experience galvanized me to feel like we have to do something; we have to do whatever we can to raise awareness for this rare thing that there is a treatment for but that is so often misdiagnosed."

Ms. Chalke seemed extremely committed to the fact that this was to help real-life parents.  When asked if she would play the mom in the episode, she said, "Thank you so much, I can't put into words how much it means to me that we're going to do this episode because it's going to raise awareness and it's going to save kids." I had very high hopes that this would be a great boost to the KD cause because I figured an actual KD mom wouldn’t agree to do something that didn’t show the reality of this disease.

Boy, was I right.  While watching the episode, aptly titled “Can’t Fight This Feeling,” I remember posting on Facebook that it was getting a little hard to watch.  Looking back on it, that wasn’t exactly true.  It was hard watching it without having an emotional reaction to it, and I did end up crying through most of the scenes with Sarah Chalke.  But the emotional reaction wasn’t exactly bad.  It was exhilarating.  I felt a weird sense of vindication watching it, like I wanted to scream at the TV, “YES! Exactly! That's what happened to us! That’s exactly what I said!”

The episode introduces us to Chalke's character, Casey, and her son, Parker, who has been sick with a fever above 103 for over a week and has been diagnosed with a virus.  But Casey has a strong feeling that it isn't a virus, and when Parker develops a rash, she brings him back to Grey + Sloan Memorial Hospital ER to be reevaluated.  His rapid strep test comes back positive, and Parker is again sent home with more medicine (antibiotics).  But Parker doesn't get any better, and Casey again brings him back to the ER, this time revealing that this is the 3rd medical establishment to try and bully her into thinking she's wrong to question their diagnosis.

No longer willing to back down, Casey voices her feelings loud and clear: "You either don't care about my son or you don't believe me.  Either way, you suck, and I want someone else.  FIND ME ANOTHER DOCTOR!"

Enter Dr. Meredith Grey.  After an insulting visit from a psychiatrist, Casey's pleas are finally heard by someone willing to listen to her.  Dr. Grey tells Casey she believes her and will admit Parker for more tests.  Even after further testing and a CAT scan show nothing new, she listens with an interested ear as Casey describes the different diseases that she has researched online that seem to fit Parker's symptoms - one of which is Kawasaki Disease.  Dr. Grey doesn't talk down to Casey when she explains why all of these diseases have been ruled out.  Casey does not stop pushing and insists there has to be something.  She knows her child and her gut is telling her this is not strep.  Dr. Grey, a mother herself, again runs more tests.

Still nothing; there's nothing surgical and labs all come back clean.  After exhausting all avenues, Dr. Grey is convinced it's strep and plans to discharge Parker.  Casey still doesn't give up.  She again tries to convince Dr. Grey that there is more going on than the labs show.  She pleads:
“I know I keep saying this and I know it’s crazy, I mean I can hear myself sounding crazy.  But this feeling won’t go away.  This feeling that there is something wrong with him.  And I know you’re telling me there is nothing wrong with him and that I should believe you because you’re a doctor and I’m just a waitress.  But how do I ignore this? How do I ignore my gut telling me that there is something seriously wrong with my son?"
Casey is so convincing that Dr. Grey wants to go over all the findings one last time with intern, Jo, before discharging Parker.  This takes long enough for updated labs to come in, which show that Parker's initial strep test is a false positive.  Meredith runs with this news, examines Parker one last time, finds conjunctivitis, and finally diagnoses Parker with Kawasaki Syndrome.  Parker is started on the standard treatment of IVIG.  Because Casey pushed so hard, and because Dr. Grey listened to her, Parker's IVIG was started within the 10 day window of fever onset, which greatly reduced his chances of further heart complications.

I think that most KD parents, like myself, were very happy with how the episode played out, but it is important to note that there were some disappointments.  Some thought it just wasn’t enough - not enough time devoted to the KD storyline, not enough specific information given about the disease.  I will say that from both medical and filmmaking standpoints, that while the medicine wasn’t spot on accurate, I think they did a pretty great job.

Some people were upset that the Kawasaki Disease storyline wasn't the main focus of the episode, but I thought it gave more suspense to Casey and Parker's plight.  It also added to the realism that abounded throughout the narrative.  Most urban ER's are brimming with emergencies and you have to make sure your child isn't lost in the shuffle.  Since Kawasaki Disease is so often misdiagnosed as a simple virus, your child can easily be overlooked in the sea of seemingly sicker patients.  Add to this the urgency involved in getting KD diagnosed and treated within the first ten days, and all of a sudden you're dealing with a ticking time bomb that only seems audible to your own ears.

It also sounds like some people wanted a classic presentation of KD, where all of the tell-tale symptoms (Swollen lymph nodes in neck, rash, red eyes, hands, feet, lips, and tongue) were present and diagnostic testing turned out the predictable high platelet count and SED rate so typically seen with Kawasaki Disease.  I think it is important to remember that this isn’t an educational special on PBS, it is a hit television series on a major network.  Hit television shows rely on ratings - ratings rely on drama - and a classic presentation of Kawasaki Disease in which all the symptoms are present, making it a pretty quick and easy diagnosis, does not drama make.

This is why I believe Grey’s Anatomy chose an a-typical/incomplete presentation of Kawasaki Disease.  Not only did it give the storyline more drama, it gave a more realistic view of the disease, in my opinion.  If they had presented a classic case of KD that was easily diagnosed by the doctors, I know that I would not have been the only one throwing my arms up at the TV and questioning, “Seriously? That’s not what it’s like at all! That was way too easy!”

Grey’s Anatomy’s depiction of Kawasaki Disease was so chillingly real, I can pretty much make side-by-side comparisons with my child's own KD story.  I literally heard my words coming out of Sarah Chalke’s mouth.  What seems to be as common to Kawasaki Disease as chapped lips or strawberry tongue, is the amount of convincing parents have to do to prove their child has more than just a virus.

One can find many instances of standard KD awareness information throughout the episode.  Dr. Grey does mention the symptoms of strawberry tongue, peeling skin, and red eyes as symptoms of Kawasaki Disease.  The absence of these symptoms in this case is a major reason why Dr. Grey doesn’t initially suspect KD.  Later in the episode, conjunctivitis is recognized, evidencing that many KD symptoms take a long time to appear.  They also stress how important it is to start IVIG within the first 10 days of fever onset to lower the risk of permanent heart damage.

What the writers of Grey’s Anatomy executed beautifully, was the sheer will and determination it so often takes on the part of the parent, to get their child diagnosed with Kawasaki Disease.  Only 19 out of 100,000 American kids will get Kawasaki Disease.  It often presents with symptoms that suggest a plethora of other illnesses.  There is no diagnostic test you can give specifically for Kawasaki Disease.  Many of the secondary symptoms of KD rely heavily on the parents’ shoulders to identify.  No doctor is going to know that a child is having personality changes without the parent telling them.

After showing Casey her son's echocardiogram, Dr. Grey shows her a slip of paper that Casey had given her earlier.  A slip of paper with her son's diagnosis of Kawasaki Disease written on it.  Meredith tells Casey:

“Do you remember this? Parker has Kawasaki Disease.  You fought for your son.  You didn’t give up.  You saved his life today.  You were right.”
There are other points that show just how seriously Shonda Rhimes and company took this issue.  We got Meredith Grey as our doctor.  The doctor the show is named after, THE doc of Grey’s Anatomy, was the one to take on Kawasaki Disease.  We also got very strong references in both the opening and closing scenes. 

In the opening scene, Meredith knows her daughter is up even without hearing her.  She just knew.  In voice-over, she tells us that to cut out an aneurysm (ironic example), you’ll need “confidence, an eleven blade, and some really good instincts.”  It may not require a scalpel, but I can say from personal experience that being a KD parent takes a whole lot of confidence and good instincts.

In the closing scene, Meredith checks on Parker and finds him sitting up and coloring.  Casey mouths the words “thank you,” and holds up a picture Parker has drawn.  Parker is already on his way back to being himself, as evidenced by the relief swimming in Casey’s eyes.  Dr. Grey’s voice-over confirms what every KD parent learns the hard way: “Try as you might, you can’t ignore your instincts.”

Meredith has decided to go the extra mile in an effort to protect her daughter’s health by getting both her daughter’s and her genes mapped.  “I wanna be able to fight for my kid...” Then in voice-over: “It’s like they say, always follow your intuition.”  Every single time I’m giving a mom advice on KD, I mention intuition.  Every.  Single.  Time.  In lieu of an actual diagnostic tool, it seriously seems like the most important tool in diagnosing Kawasaki Disease.  Someone is going to tell you no.  It’s just going to happen.  And you have to have the strength to listen to your intuition that is screaming at you - YES!

That’s only the second to last line in the episode, though.  Ever appreciative of music’s power, this episode of Grey’s ends with a song lyric.  I haven’t been able to locate the details of the song yet, but from what I can tell the lyric is “that I wasn’t alone.”  For me, this is not only apropos for KD families, but for the entire KD community as a whole.  I hear it from KD parents all the time - how lonely it is.  It is so important to remember that you are not alone.  Other KD parents know exactly how you feel and what you are going through, and we are here to help.

So much has changed and grown, even since my daughter’s first bout with Kawasaki Disease.  There now abounds a wealth of information in the form of websites, blogs, message boards, and social media sites for people looking for information on Kawasaki Disease.  Sarah Chalke tweeted during the episode that she kept going back to the Kawasaki Disease Foundation website as a source when her son was sick.  No one knows how scary Kawasaki Disease is more than a parent who has seen it in their child's face and no one is ready and willing to help more than a KD parent.  I am forever grateful and proud to call myself a member of this community.

I’m also grateful for a TV show that has brought such positive attention to a cause dear to my heart.  Thank you to Sarah Chalke, Shonda Rhimes, and everyone involved in the making of Grey’s Anatomy.  I can’t fight this feeling that Grey’s just saved the lives of countless kids.





5 comments:

  1. Hey, The song is called "the storm" by the airborne toxic event

    ReplyDelete
  2. We in Australia just watched this episode and I too cried my way through it. It bought back so many emotions of how alone I felt & what a struggle I had convincing doctors that something was seriously wrong with my son.
    Also, don't forget that giving antibiotics can mask the symptoms and therefore make KD even harder to diagnose because all of the "classic symptoms" may not be evident.
    We are our Children's Advocates.

    ReplyDelete
    Replies
    1. You are right, my daughter received antibiotics needlessly both times. That alone feeling is a huge reason I do what I do for KD awareness. We can't stop kids from getting KD (maybe some day!) but we can help parents not feel so alone. Thanks so much for your comment.

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