Midway through the second trimester of my pregnancy, we went on a family trip to Philadelphia. While it may not sound as glorious as a tropical vacation, I’d lived in Philly for years after college, and it still feels like home to me. It’s a great little city with many kid-centric activities to entertain my 5-year-old stepdaughter, and wonderful old friends welcomed us into their home for a long weekend. We had a fantastic getaway, but just hours before departure on the last day, things suddenly went south. While killing time at the playground before a museum meetup, Lili landed off-balance dismounting from the monkey bars and fell. Jeff and I both saw her elbow hyperextend and bend backwards, and knew it was not good. Supremely brave, or shell-shocked (or both), she barely cried. Instead, she cradled her broken wing across her midsection and stood stone-still, eyes closed, complexion suddenly more vanilla than its usual mocha frappe.

I called Anna to update her that we had to forego our playdate in favor of an x-ray, and asked where the closest urgent care clinic was. “Why would you go to urgent care when you’re a mile from CHOP, Karen?” she asked, clearly a seasoned local parent. I’d forgotten we were a stone’s throw from Children’s Hospital of Philadelphia, the best in the country. My sister also worked as a pediatrician in their emergency department. So off we went, Lili whimpering quietly in her booster seat in back, her father and I in worried silence up front.

From the moment we arrived, CHOP was amazing, independent of family connections – my sister was not in the ER or even the country at the time of our visit. We waited for under a minute before being ushered into an exam room, had pain meds on board (pediatric nasal med spray is genius!!!) and a diagnosis of a supracondylar fracture of the humerus in under an hour. “Monkey bars or trampoline?” the radiologist asked, as he showed us the break on her x-ray films. That was the first I’d ever heard of this injury, but the doctors told us that it was the single most common fracture in children between the ages of 5 and 8. He informed us she’d need a surgical repair with external pins, the sooner the better. Jeff and I briefly freaked out, then conferred, called Lili’s mother and grandparents, and talked over the specialist’s recommendation.

Early in this adventure, I came to the heartbreaking realization that regardless of whether or not I had medical training, a sister on staff, or parents in the field, the decision-making components of Lili’s medical treatment were not going to be offered up to me by the hospital because I am stepmommy, not biomommy. Being a stepparent had never before felt inadequate, but it threw me for a huge loop in this context. Pregnancy on its easiest day made me feel highly emotional and overwhelmed, so trying to gracefully handle things I couldn’t control was even more of a struggle. Lili got hurt on our watch, so I wanted to help make her better. For the first part of our hospital stay, I was able to calmly assume my role as support staff. Jeff has always been careful to run things by me, which took the edge off of the helpless feeling. It was also not lost on me that the statistics spit out by both my parents and the pediatric orthopedist were the same: CHOP did thousands of repairs of this type of fracture every year, more than any hospital in the country. They were better than good, and I didn’t need to get involved. Caregivers and family were all on the same team.

Sometime that afternoon, the nurse zipped in, rubbed numbing cream on Lili’s elbow and wrist, and then covered them in saran wrap. Knowing where we were headed, I began to feel queasy. Lil is not a kid who rolls into the doctor’s office and plays happily in the waiting room before she gets a booster shot. She is unfunctionally, viscerally terrified. Some years earlier, her mother and I met for the first time at the Ear, Nose, and Throat doc’s office after 2 year old Lili shoved a few things up her nose at Mommy’s house. That day, the two of us (using every last bit of strength) were not enough to hold her still for the exam. Sitting next to her in the Emergency Room bay at CHOP, the scene from the ENT’s office played out in my head and I started to sweat, knowing an IV placement attempt was imminent.

I tried stalling, and asked the nurse if we could wait to put in a line in until her mom arrived. She was now on her way down from Westchester, it would only take a few hours to get to Philly. The nurse was very kind, but explained that since Lil was going to be a surgical patient, they couldn’t feed her or give her anything to drink, so we needed to get an IV going so she could stay hydrated and have meds without extra pokes to keep her comfortable in the next few hours. Fair enough.

A few minutes later, a CHOP Child Life team member appeared with an IPad and some cheerful rhetoric. We’ll call him Mr. Happy, and I despised him immediately. He was very saccharine sweet and struck me as disingenuous. What’s worse – he had come to assist in a painful procedure. Mr. Happy smiled brightly and told Lili she was allowed to yell, but she wasn’t allowed to move. Frightened, she immediately started screaming and flopping around, trying to get away. Mr. Happy promptly chastised Lili for moving, while the nurse asked a tearful Jeff if he could help by holding his daughter still.

That was the end of stepmommy sitting quietly on the sidelines. I suggested Jeff go for a little walk in the hallway (he had started to get emotional, and I did not want to further terrify Lili), and once he was safely outside, I turned to Mr. Happy. He could hold the IPad, I told him, but he needed to stop talking to Lili. He tried to counter with “Now, Honey, I know you’re upset right now” but I was having none of it. My name was not Honey, I hissed, and he needed to Shut Up. Lili’s eyes widened, because Karen does not usually talk like that. I assured her that she did not have to shut up. Just Mr. Happy. The poor kid felt too lousy to appreciate the fact that she had been granted full immunity from prosecution. At that point, she could have demanded a herd of miniature horses and I would have produced them.

Next, I addressed the nurse. He had, I said, *one* shot at getting the IV placed. While he was kind, he was also wielding a needle that was about to poke a petrified little kid who, despite narcotic pain medication, was still making painful groaning noises. “Ma’am, it can be very difficult to find a vein in a small arm,” he said. That did not impress me. This was a center of medical excellence, I advised him. I expected he could get the job done on the first try, and if not, he could step into the hallway with Jeff (and Mr. Happy. I would have loved for him to GTFO as well), and I would put in her IV.

“Oh, I’m not sure that’s allowed,” chirped Mr. Happy.

“OUT OF MY FACE!!” I shouted.

Mr. Happy retreated a few steps. The nurse and I then faced off. I softened for a moment and asked him if I was making him nervous, since I wouldn’t want to make it tougher for him to get the job done. He shook his head, winked at me, and placed the IV on the first try. A total rock star, that nurse. It happened so fast that Lili was surprised, and waved her non-IV hand up in the air, whacking Mr. Happy, who had started to creep back over, squarely in the face. I could have high-fived her for that, but sadly she didn’t have any free hands left.

After that hiccup, things moved along speedily. We got a room upstairs with a super sweet nurse, and Lili fell asleep watching cartoons. Lindsey (Mama) arrived with favorite stuffie Polar Bear, and I located some My Little Ponies in the gift shop to keep him company.

On the way back up, I passed the coffee cart and got us all reinforcements. We made it through the rest of the night without much fanfare, but in the morning the great divide opened up again.

Lili was rolled out of her room to OR prep just after dawn. We all hustled along behind her moving bed. At the entrance to the surgical prep room, the nurse held up her hand. “Only the parents beyond this point.” We are the parents, Jeff explained. “2 person maximum,” said the nurse. My eyes welled up, because I knew what that meant. Jeff looked at me helplessly, and Lili, who was already anxious and unsure about what was happening, saw my face and started to cry.

I gave her a thumbs-up and told Jeff and Lindsey that I’d grab some lunch for them, then meet them in the family waiting room. Once they were safely behind the big SURGICAL SUITE doors, I retreated to the ladies room, locked myself in a stall, and called my mother. On the floor in the stall next to mine, I could see a pair of shiny red heels, and I wanted so to hard to keep it under control until they clicked their way out of the bathroom. But I couldn’t. The last 24 hours spilled out in garbled wails and sobs into my cell phone. From under the stall door where I’d seen the red heels, a well-manicured hand appeared holding a wad of tissues. For some reason, this only made me cry harder.

My mother did her best to be soothing for a few minutes, after which my phone battery died and I proceeded to the family waiting room to meet up with Jeff and Lindsey. We sat and stared at what looked like a flight tracking screen for about 45 endless minutes until it read “Recovery Room” next to Lili’s patient number. The surgeon had already warned us that once again only 2 parents could be in the recovery room. Jeff was kind enough to let me take a turn, so Lindsey and I waited next to her bed until she woke up from anesthesia.

A few minutes after she opened her eyes, she looked up at us over Polar Bear’s head and this conversation ensued:

Lindsey: How do you feel, Lilibear?
Lili: I’m great, but I can’t give you a thumbs up because I can’t find my hands.
Lindsey: Try not to move. How does your arm feel?
Lili: It doesn’t hurt at all! Nothing hurts.
Lili to the nurse: Do you want to take my blood pressure?
Lili to Lindsey: They do it on my leg and it feels weird but not bad-weird.
Lindsey (to me): She’s stoned, right?
Me and the nurse (in unison): Yes.

By that afternoon, she had regained her wits (and plenty of fight for anyone who dared try to examine her). We busted her out of the hospital by dinnertime, and headed home to recuperate. She sported a fabulously decorated Wonder Woman cast the following weekend at her 6th birthday, and became adept at writing with her left hand in the weeks her right was immobilized. We fussed over her, dressed her in chic, cast-friendly sleeveless knit shawls, and reviewed the hospital weekend both in our heads and with each other. Although we are often told that children are amazingly resilient, both Jeff and I worried that she might be traumatized from the horror of what she experienced.

Truthfully, I have not yet completely recovered from the events of that weekend. Seeing a sweet child in pain was agonizing, and not being allowed to be present for every opportunity to comfort that child was also acutely painful, in a different way. Lili is still afraid of doctor visits, but is now old enough to speak with us about it, and somehow has managed not just to cooperate, but appear enthusiastic about dentist appointments (?!). Just the other day, she and I were talking about her baby brother’s first trip to the hospital, and I asked her if she still had any questions or concerns from her weekend at Children’s.

“Did it really happen?” she asked, “because I don’t remember any of it.”