On December 21, our teenage daughters were visiting the Distillery District in Toronto with family friends, with plans to stay overnight. Back home in Midland, Ontario, about two hours north of the big city, my husband and I were enjoying a tranquil, cozy evening. Then the phone rang. It was our 16-year-old, Hannah: “Um, we have kind of an emergency here. Cayley ate something with nuts in it. Should she have the EpiPen?”
I sat bolt upright, my thoughts racing to all the training we had done over the years for this moment; Cayley, a 19-year-old university student, had never needed to use her auto-injector before. From the pitch in Hannah’s voice, I could tell that she was struggling to stay calm for Cayley’s sake. My older daughter had always, always, always informed wait staff of her peanut allergy. What on Earth had happened?
The Distillery District’s Christmas Market was teeming with shoppers. Cayley and her boyfriend Mark were to meet Hannah and our family friends at one of the district’s restaurants but, coming from a busy mall, they had run late. By the time the pair arrived at the bustling restaurant, they were starving. Our family friends, including Hannah’s friend Paige and her mother Cindy, had already ordered appetizers.
Cayley eyed Paige’s dish – crab fritters – and asked if she could have one while she waited for her food. Cayley used to babysit Paige and they always thought they had similar food allergies. Cayley had reacted severely to peanuts when she was a toddler and had skin-tested positive to several tree nuts. Paige appears to have a peanut allergy identified through skin testing, but her only severe reactions have been to soy and legumes. Hannah reminded her sister to check with the server, but since Paige was happily eating the crab fritters, Cayley assumed they were safe. After swallowing the fritter, she realized she was wrong.
Immediately the roof of her mouth and her throat started itching – and Cayley was struck with a sense of dread. She picked up the menu and pointed to the crab fritters, which had a very clear “sauce contains nuts/peanuts” symbol. The servers then confirmed that the dish contained peanut. Cindy gave Cayley a Benadryl, while Hannah suggested going to the restroom to assess the situation. Once there, Cayley began to feel swelling in her throat, like something was stuck there, and was moments away from a full-blown panic attack. Hannah had to ask her sister multiple times if her auto-injector was in her purse; it was. That’s when our phone rang.
From the restroom, I could hear Cindy in the background, talking reassuringly to my kids. She said something about Benadryl that I couldn’t quite make out. My own panic ratcheted up a notch because I had recently read the tragic story of Oakley Debbs, the Florida 11-year-old who had a seemingly mild reaction to nuts in a cake, took Benadryl and died hours later, quite possibly because he didn’t get epinephrine right away. I knew that in anaphylaxis, the speed of receiving epinephrine has made a difference between life or death in other cases as well. To me it was plain: Cayley had eaten peanut, she was having a reaction to it, and she needed the auto-injector as soon as possible.
As my husband and I were semi-yelling instructions: “Yes, she needs the EpiPen for sure! Put it into the largest part of her thigh! Yes, through the jeans! Hold it and count to 10 so all of it gets injected.”*
Cayley was getting ready to inject herself, but lost her nerve. Hannah placed her hands on Cayley’s shoulders and said, “Look at me. Focus on me. Look at my eyes,” while Cindy calmly took hold of the device. She had never needed to inject Paige, so this was a first for everyone. I heard Cayley cry out as the device was injected and Cindy counting to 10. It felt like an out-of-body experience; I could picture it like I was there, but couldn’t touch anything, or help in any way.
Meantime, Mark had advised the restaurant staff, and they called the paramedics. Minutes after her injection, Cayley was taken by ambulance to a hospital, accompanied by her boyfriend. I tried to comfort Hannah, who had become distraught as the paramedics attended to her sister. I told her how she did everything right, but we were obviously both affected by the strain: when Cindy took the phone to speak to me, I broke down. She comforted me as I blubbered out my thanks to her.
After four hours hooked up to an IV and heart monitor at the hospital, Mark texted that Cayley was deemed healthy enough to leave. Later, she would say she almost instantly felt better after the injection. She got a new auto-injector prescription, one for four days of prednisone, plus a new outlook on how an anaphylactic reaction is handled. It was also a big reminder of how one can easily be prevented simply by never letting down your guard.
That first injection took the fear of the unknown away; Cayley confessed to me later that she imagined the auto-injector’s needle as much longer than it turned out to be, and that’s why she lost her nerve. So I suggest you practice on fruit with an expired auto-injector to show your children the actual size of the sharp. My daughter also learned to never rely on what someone else is eating as a sign that it’s safe, even if they have had the same allergies – as they may have outgrown them. Always check with the restaurant staff. The manager was excellent; Hannah said the staff handled the situation “10 out of 10.”
I’d like to say a heartfelt thank you to Merrill and Robert Debbs, for having the courage to come forward and speak about your Oakley’s tragedy. Your warning to others about the importance of using epinephrine promptly was certainly heard by us and Cindy’s family as well.
And lastly, happy belated December 21st birthdays to both Paige and Mark; it may not have been the intended celebration, but it was an evening none of us will forget any time soon!
M. Carolyn Black is a freelance writer based in Midland, Ontario.
*Updated manufacturer’s advice is that holding the EpiPen in place for 3 seconds is sufficient to receive the epinephrine medication.