Hand, Foot and Mouth Disease (HFMD) – it’s the one disease that every parent fears as it spreads like wildfire, taking down everyone in its wake; not just children, but parents too. Yet somehow, despite working in the paediatric emergency department for years and seeing numerous children with HFMD on a daily basis, not once have I contracted this dreaded disease from my patients.
The truth is that it’s relatively easy for a doctor who’s gloved and masked with an infinite supply of antiseptic wipes to keep the causative viruses at bay since they spread through close personal contact and contaminated objects. However, that’s not the case for young children who play in close quarters with little protection from viruses, and this is how my daughter who goes to kindergarten, became the Typhoid Mary in our household. (Yes, I know that it isn’t the right name but HFMD Marion doesn’t really have the same ring.)
I remember that morning when the school administrator called to inform me that Marion had oral ulcers clearly. I was attending a meeting at an embassy in my capacity as President of the Association of Women Doctors (Singapore). Suddenly, I had to switch hats and play my role as a mother instead, organising for Marion to be sent home immediately but not before Baby Marcel was sent out of the house to stay with my in-laws. I was particularly worried about Marcel because while older children who have HFMD can be persuaded to take some soup or candy, babies often cry and refuse everything and this results in dehydration and low sugar levels. So off to my in-laws he went.
I then had to wear my professional hat and complete my meeting before rushing home to check in on poor Marion. In those hours, I felt a wave of empathy for all those working parents who come to see me with their kids covered in spots previously. I never fully appreciated all the care and coordination that goes on behind the scenes when HFMD strike the family until it happened to me.
When I arrived home and examined her myself, I noted that she had ulcers at the back of her throat but no rash over her hands or feet, nor did she have any other viral symptoms such as fever, cough, runny nose, diarrhoea or vomiting. Regardless, I drew an imaginary line across the house and told her elder brother Mark that for now, he would have to stay at one end of the house because I didn’t want to risk him missing primary school if he fell ill. I told Marion that she was to play at the other end, where she would reign as Princess Dragon Marion and defend her land against Tiger Mark. My attempt at Chinese Zodiac gamification worked wonders because Marion didn’t feel psychologically scarred at social isolation at all. In fact, she rather enjoyed border patrol duties, particularly as Mark would leave paintings and notes for her, mostly enquiring after his garden which lay in her territory.
After about three days, Marion developed red blotchy spots over her face, arms, hands, knees, shins and feet. Despite her disfiguring illness, she remained in high spirits and continued to give her brother the sitrep on his garden while he crouched by the imaginary line and politely said nothing of her speckled appearance. And so my crouching tiger and hidden dragon remained until about 14 days later when her rash and scabs finally cleared up and she was released from her pleasant prison of toys, snacks and Netflix. Baby Marcel returned home and all was right with the world.
Little was I to know that that wasn’t the end of HFMD’s reign in our household. Four days after she returned to school, Marion was sent home yet again with ulcers in her mouth. I could scarcely believe it even though I knew the incubation period could be as short as two days. Once more, the baby was sent out of the house but it was too late – Marcel developed mouth ulcers in the days following.
Over the next five days, Marion developed only a sparse pinpoint rash over her hands but her mouth was full of painful ulcers. Her appetite dropped tremendously and she had fever, vomiting and bouts of severe abdominal pain, leading me to wonder if I was making a mistake by keeping her home instead of rushing her to the hospital. Then as quickly as the illness escalated, it went away, in stark contrast to her first bout. Clearly, this was a completely different virus, one of many strains that can cause HFMD.
Three days later, I woke with a terrible pain in my mouth. As the week went on, I developed a mouthful of excruciatingly painful ulcers, a horrible itchy rash over my arms and legs and the worst abdominal pain I have ever experienced, and this is taking into account my three experiences with childbirth. It was a nightmare but in a role reversal, Marion took great care of me. She gave me massages, put on comedic performances and helped me organise my scarves so that my room, ironically now my own prison, wouldn’t be such a mess.
Baby Marcel and I recovered in about a week and since then I don’t take good health for granted anymore. Although none of us needed to be hospitalised for this viral illness, HFMD turned our lives upside down for the better part of the month. Never again, will I say to a parent of a patient not to worry if they ‘just’ have a virus.
This story is a part of a series of columns by Dr Jade Kua (left), documenting her life with her legendary six Ms. The paediatric emergency specialist is also the programme director of DARE which stands for Dispatcher Assisted first REsponder. It is a community project that aims to educate the general public on how to save the lives of cardiac arrest victims by teaching them basic resuscitation. Follow her on Instagram @drjadekua.
Also read: Dr Jade’s previous column, Adding A Splash Of Colour