The moment the cannula infiltrated, time split in two.
In one world, I was an American pediatric emergency medicine physician.
In the other, I was Leela’s mother, holding my 11-month-old daughter in a Scottish resuscitation bay as she writhed and screamed, the flesh of her foot burning from the inside.
I had tried to prevent this. We had moved from New York City to Edinburgh three weeks earlier. When Leela developed a prolonged febrile seizure — a common fever-related seizure in young children — we took her to the emergency department. The seizure persisted despite initial treatment, and the medical team prepared to administer an anti-epileptic medication called phenytoin. This alarmed me. Pediatricians learn early in training that phenytoin is highly toxic to tissue if it leaks from an IV — a complication known as an extravasation injury that can cause severe tissue necrosis and, in rare cases, limb loss. The risk is particularly concerning in infants and during active seizures, when IV access can be difficult to maintain.
I explained gently, then more firmly, that in the United States, fosphenytoin is preferred by nearly all pediatric emergency departments for status epilepticus because it is safer. I wasn’t trying to interfere; I wanted to trust the team caring for my daughter. This was a prolonged febrile seizure in an otherwise healthy child at a tertiary children’s hospital. It was routine.
