“Being in the ER was less dramatic than you see in movies or on television,” says Madden GraffBell, a 14-year-old freshman, who found herself at NMC’s Emergency Department this past February. 

“You don’t see that scary side,” she says, “Everyone was supportive and friendly.” 

Experiencing acute abdominal pain while at school, Madden was evaluated by the school’s nurse. “She did a leg-drop test and had me stand on my tip toes,” says Madden. 

The ‘tip toe test,’ called the Markle sign, refers to pain elicited when the patient drops from standing on their toes to their heels with a jarring landing. If abdominal pain is localized as the heels strike the ground, Markle sign is positive, indicating inflammation of, or near, the appendix.  

“I had to hold my hands over my stomach,” Madden says of the pain, “I needed to lean over onto the table, and couldn’t sit up straight.”  

Madden’s mother was called when the school’s nurse suggested Madden be taken to NMC’s Urgent Care for her abdominal pain. Arriving at NMC around 3 pm, things moved quickly. 

“We were triaged immediately, they flagged us through” says Jess Graff, Madden’s mother. “They were very nice to us and kept things calm, as they whisked us off to the ED.”  

Madden was again tested by lying on her back, lifting her right leg against the resistance of the physician’s hand, an assessment known as the Psoas sign. This motion causes friction of the psoas muscle over the inflamed appendix, presenting pain. Bloodwork and an ultrasound confirmed an infected appendix. 

“One thing that really stood out in the ED, was that every staff member addressed Madden equally as the patient. They didn’t just speak to me as the parent, which helped give Madden ownership over her own body,” Jess says. 

“They gave me options, instead of just talking to my mom, they talked to me. Because it was my choice, they gave me the options,” says Madden.  

“When someone has acute appendicitis, we use as much information as possible from the patient’s history, vital signs, blood work and imaging results and always taking in the patient’s preferences for their own goals of care to help create a plan together that is best for the patient,” says Anna Royer, MD, FACS, who met with Madden in the ED. 

“When someone is sick and we are trying to determine the best approach to helping them feel well, it is important that they have as much participation in their care as they would like,” says Dr. Royer. 

“While each patient is different, it is my responsibility to help fill in the details; and some people like to know as many details as we are able to provide,” she says. 

“Dr. Royer was phenomenal,” says Jess. “She had great skill in speaking to both Madden and I, in a comprehensive way that wasn’t speaking down to us. She made the medical options palatable without needing a medical background.” 

Dr. Royer explained both the use of pharmaceuticals to treat the infected appendix, as well as the process of surgically removing it.  

“As a surgical community, we have learned that not all appendicitis needs to be managed with surgery. Sometimes patients are too sick to have surgery and sometimes there is too much infection for surgery,” says Dr. Royer. 

Due to Madden’s youthful age, the downside of treating her with medication would be a possible recurrence or future necrosis of her appendix. 

“I was reluctant for my child to have surgery with no prior issues,” says Jess. “Yet, the staff honored our questions and concerns, walking us through the options.” 

With time and space to organize their thoughts, Jess says they reached out to Madden’s father to discuss with him.  

“We were there for many hours,” says Jess. “Having our own space made it comfier as we waited. It was a clean and refreshed environment, with a lot of privacy.” 

Only thirteen at the time of her emergency, it would not be Madden’s first surgery. Just eight months prior, the teen had had eight teeth extracted under anesthesia. 

“I knew what going under felt like,” she says, “I wasn’t that nervous except knowing they would have tools inside of me. Otherwise, I wasn’t that scared.”  

Jess recalls her daughter texting her friends from the ED to tell them what was happening. “I kept thinking ‘she’s this healthy 13-year-old,’ yet there she was being prepared for surgery.” 

Later that evening, Dr. Royer performed a successful appendectomy, with Madden being released that same night to recuperate at home.  

“We left the hospital about 11 pm,” Jess recalls, “Only to encounter a very heavy snowstorm on our way out to Fletcher.” They made it home slowly but safely, following a very strenuous day. 

“My recovery was quicker than you’d think,” says Madden. “I had surgery on Tuesday and was back to school on Friday. It hurt my abs the first few days and it was hard to sit up.”   

Her mother says that other than missing a few days of school and taking a break from PE classes, Madden recovered quickly and was back to her regular physical routine. 

“I run cross country and track, but my main thing is cheerleading. I love sports and spending time with my friends,” says Madden.   

“I really enjoy caring for young adults,” says Dr. Royer. “They have the ability to communicate what they are experiencing and also give new perspectives. They are often quite brave.” 

Managing emergent surgical problems from the ED every fourth day, on average, Dr. Royer says that all general surgical concerns from the ED go to her when she is on-call. She reminds us that the needs of the ED are always fluctuating, based upon situations that may arise. 

“Unfortunately, in emergency situations we don’t always know all of the details, so we need the trust of those we are caring for to help get them better,” says Dr. Royer. 

“Being sick can be such a challenging time. It is hard because even just moving from a chair to a stretcher can feel impossible. It is hard to focus and often everyone is asking a lot of questions,” she says. 

“It can be helpful to remember that everyone is there to help you and cares,” says Dr. Royer. “Don’t feel shy to speak up with questions or concerns – we will help guide you on next steps the best we can.” 

Even before her appendectomy, Madden had referred to NMC as ‘her hospital,’ according to her mother. “She was born there, as a breech baby about 10 minutes after we arrived at the hospital,” says Jess. 

“If I’m hurt or something isn’t right, I know they will take care of me and do what’s right for me,” says Madden. “I have friends whose parents work there, everyone is nice. For everything that ever happens, that’s where we go.” 

Living in Franklin County and working at CVOEO in St. Albans, Jess says she recognizes the importance of having a reliable community hospital. 

“It feels like a neighborhood hospital to us, a safe space. Even in new spaces like the remodeled ER, it still feels familiar because we have friends who have worked there for so long,” she says. 

“Everyone who works there seems to also be contributing to the community, not just to the hospital,” Jess says, “That really means a lot.”  

 

Story by: Sarah Parsons West 

Courtesy Photo: Jess Graff/Madden GraffBell 

Photo Caption:  

“Madden GraffBell, 14, underwent a successful appendectomy at NMC last February.  Madden, now a freshman at BFA Fairfax, leads an active lifestyle including cheerleading and competitive running.”