As 4-year-old Elianna Grace sat in the back seat of the SUV, battling her second fever in three days, her mum flashed back to the coughing and vomiting fit the preschooler had the previous weekend — and to a niggling fear about the girl's sudden illness.
Elianna had spent April 14 playing in her grandparents' pool in Bradenton, Florida. She blew a geyser of water at family members with a pool noodle. One of them tried to spray her back, but Elianna was already inhaling and got a mouth full of water.
The preschooler coughed, vomited and retched for the next few minutes, her mother, Lacey Grace, told The Washington Post, trying to expel a lung- and a stomachful of chlorinated water.
But half an hour later, Elianna was happily splashing in the pool. The next day, she seemed fine on a shopping trip with her mum. The crisis seemed averted.
On Monday the girl's preschool called her parents. Elianna had a fever. She'd have to go home and, per the facility's policy, stay out at least 24 hours. Elianna spent a day with her mother at the family's business, colouring quietly in a corner. On Wednesday, she was back at preschool with no ill effects.
But the preschool called again that afternoon. The fever was back.
This time, her mother took her straight to Urgent Care, but even then, Lacey Grace worried she was overreacting. She and her husband have two daughters — 4 and nearly 2. Fevered trips to the doctor are not unusual.
"There are so many times I have taken my kid to the doctor, saying I'm being a worried parent, and they say it's a viral thing, give it a few days," Grace told The Post.
But she had read about Frankie Delgado Jr., who died last summer under similar circumstances. Frankie, also 4, inhaled a large amount of water while splashing at the Texas City Dike with his family.
His family worried the symptoms that manifested a few days later were "dry drowning," an imprecise term to describe water trapped in the respiratory system that can ultimately make it difficult for a person to breathe. But experts say it may have been a bacterial infection.
Whatever the cause, the outcome was tragic: an otherwise healthy child, dead in a matter of days.
"I never would have correlated that fever to the pool incident if I hadn't read that story about Frankie," Grace said. "I was like, this is not going to happen to Elianna."
Grace noticed worrying signs as she looked at her overheated daughter on the way to Urgent Care. The girl was shivering. And there were purple spots on the girl's skin as she was getting X-rayed.
"The doctor came out and said 'You have to find the nearest emergency room,' " she recalled, in recounting the incident to The Post. " 'You need to pick the closest one. Just go.' "
At the more-advanced facility, doctors gave Elianna's worried parents the prognosis: Their daughter had an uncommon but severe bacterial infection in her lungs and was struggling to get enough oxygen into her bloodstream. It all started with the water she'd breathed in at the pool.
The doctors said there was nothing they could do to remove the fluid — that had to happen on its own. At the moment, they had to fight the infection and the inflammation it was causing.
More X-rays followed. And every five minutes, it seemed, someone in a white coat was holding a stethoscope to Elianna's chest.
The scariest moment happened sometime between Wednesday night and Thursday morning. Mother and daughter were snuggled in Elianna's hospital bed when doctors and nurses rushed in. Elianna's oxygen level had dipped to dangerous levels, according to a monitor clipped to her toe.
Grace said the monitor's warning was the only sign that something was wrong with the child sleeping in her arms.
Her doctors "were saying things like 'This is why she's here. Thank God you brought her in. This is why you're here. Nothing's going to happen to her with all these resources here.' "
They were right, Grace said. Two days later, after a round of a strong antibiotic, the 4-year-old was able to breathe without an oxygen mask, her mother said. She stopped wheezing when she exhaled.
Elianna took an abbreviated trip to the park on Monday, and has an appointment for what her mum hopes will be her last X-ray on Wednesday.
Initial news reports widely deemed Elianna's case "dry drowning" or "secondary drowning," even though her parents say doctors told her the girl was fighting a secondary infection. A GoFundMe page that friends started to help the Graces pay for hospital costs details the full cause: chemical pneumonitis, aspiration pneumonia and perihilar edema.
Similar questions — a "dry drowning diagnosis" versus a quickly spreading bacterial infection — came up in Frankie's case.
He and his family members went to the dike on Memorial Day weekend last year, and the 4-year-old splashed in the knee-deep water. Shortly after they got home, he started vomiting and had diarrhoea.
On June 3, the boy told his parents that his shoulders hurt and laid down for a nap.
"Out of nowhere, he just woke up," Frankie Delgado Jr. told Houston's ABC affiliate KTRK. "He said 'ahhh,' he took his last breath — and I didn't know what to do no more."
"I walked in. I could see him lying there; they were still working on him," his mother, Tara Delgado, told CBS affiliate KHOU. "I'm screaming, 'Let me just touch my baby! Maybe he needs his mama's touch.' "
Family members (and reporters who talked to them) initially attributed his death to dry drowning, although others said his symptoms seemed similar to a bacterial infection.
Recently, doctors have shied away from the terms "dry drowning" and "secondary drowning," preferring to specify the circumstances of someone's death to improve resuscitation treatments.
In dry drowning, a person's larynx closes in an attempt to stop water from seeping into the respiratory system, according to the Cleveland Clinic. But air can't get through, either, depriving the body of oxygen.
In secondary drowning, water is trapped in the respiratory system. It causes the lungs to spasm, making it difficult for a person to catch a breath. The lungs can also get irritated and fill with fluid.
Even if her daughter wasn't a victim of "dry drowning," the situation was still petrifying, Grace said. One day, her 4-year-old was fine, colouring on what appeared to be an unnecessary sick day from preschool. Twenty-four hours later, doctors were telling her she couldn't breathe without an oxygen mask.
But those doctors might not have been there in time, Grace said, if she hadn't read Frankie Delgado's story, horrified. Now, the story of her daughter's sudden sickness is forever linked to Frankie's.
So with her daughter on the mend, she reached out to Frankie's mother, Tara Delgado, and other family members, to express her gratitude.
Grace heard back this week.
"Frankie's sister has reached out to me," Grace told The Post, relaying the message the woman sent:
"Something with your story is making us cry. We miss Frankie every day. We do everything we can to get his story out there to prevent this from happening. We're glad to see it's making a difference."