Parents Use Telemedicine to Get Daughter Life-Saving Care

Paying it forward: Physician’s mother was saved as a child by the same procedure


Dr. Akharouf’s Story
From left: Robbie, Phoebe (8), Sara and Keturah (10)


With stay-at-home orders in mind, many people are reluctant to venture out, even for needed health care. One family, however, learned firsthand that virtual visits—a new offering to keep medical appointments safe during COVID-19—are not only more convenient, but can also save lives.

On a Wednesday night this past April, 8-year-old Phoebe complained of not feeling well. She began throwing up. Her parents, Sara and Robbie, initially thought it might be her lactose intolerance acting up, thanks to recent quarantine dinners of pizza and ravioli.

“But every hour she kept vomiting,” her mother, Sara, said. “And I thought, Oh wow, she's really got something.”

Sara stayed up with Phoebe through the night, posted near the bathroom. After a brief lull in early morning, they tried having Phoebe drink water, but the vomiting became worse and she began complaining of side pain. At 9:40, they decided to call PacMed.

PacMed Nurse Valentina heard the symptoms and, with extra stay-at-home precautions in place, immediately scheduled Phoebe for a 10 AM virtual visit. The family had never used the Zoom platform in MyChart (PacMed’s patient portal), so Medical Assistant Nyeelah called first and walked them through the technology. By 10:05, they were seeing the doctor, virtually.

“I'm glad they called and had the visit with us,” said Dr. Nawal Alkharouf, one of PacMed’s newest primary care physicians. “The alternative would have been a perforated appendix.”

Through the Zoom app on their computer, Dr. Alkharouf performed an initial assessment, including guiding the parents through a physical exam and asking clarifying questions to rule out similar conditions. “I tried to get her to do a jump test,” said Dr. Alkharouf, “to get up and just jump, but she couldn't even get up. Just going from a laying to a sitting position was very difficult for her and she complained of pain. I could see on the camera that she was really guarding her right side.”

Based on the exam, Dr. Alkharouf suspected appendicitis, but there were a few atypical symptoms as well. With the added risks associated with exposure during COVID-19, the doctor wanted to be sure before sending them to the emergency room. So, she prescribed anti-nausea medicine, which the family picked up immediately. The doctor called them back 90 minutes later.

Phoebe was still vomiting, even on the medication, so once again, Dr. Alkharouf led them through a physical examination, with the parents’ assistance.

“She said, ‘Okay, you're going to be my hands,’” related the mother, Sara. As Robbie held the camera up close to see Phoebe’s reactions, Sara performed the exam just as the doctor would have in the office, pressing down gently across Phoebe’s stomach to find the source of the pain.

They both noticed that Phoebe’s pain was more pronounced now on her right side—where the appendix is located—so they decided to bring her in to Seattle Children’s Hospital. After informing the hospital of Phoebe’s condition, Dr. Alkharouf called the parents back with details on the hospital’s COVID-19 visitor policy, as well as its valet service so Phoebe wouldn’t have to walk far.

After a wait (the hospital had to test Phoebe for COVID-19 before admitting her), she was cleared for laparoscopic surgery for her appendix later that night. When Dr. Alkharouf called the family in the hospital to follow up the next morning, Phoebe was already feeling better, keeping liquids down and enjoying Jell-O.

Looking back on the experience, Sara reflected, “The part I liked was using the camera like I did with the doctor. Phoebe could barely move, so if I had to go into the doctor to get it diagnosed, that would have been—torture for her.

“So, having her just lay on my bed and the doctor talking to us, just like we were sitting in front of her—that was really cool.”

Exactly 75 years earlier, another little girl was threatened by appendicitis, and a doctor took similarly innovative action at the time to save her life.

That little girl was Dr. Alkharouf’s mother.

It was in India, in 1945, before the country had partitioned into Pakistan, when the five-year-old began vomiting with abdominal pain and a fever. Her mother (Dr. Alkharouf’s grandmother) became very worried.

The only local hospital was British and was designated to treat only British military families in India. Still, the child’s uncle knew the hospital was their best hope. Against the odds, he biked to the hospital to plead with a doctor in person, saying she was only five and would die if they didn’t help her.

While it was against policy, the doctor was kind and agreed to visit the family in their home. After his examination, his face became grim. He told the family that the situation was dire, and she needed surgery right away. The family would later learn that the previous week, three British children had presented at the hospital with similar symptoms, indications of appendicitis. Sadly, all had died.

Immediately, they transported the young girl to the military base and operated—discovering that her appendix had already perforated. Nevertheless, they were able to perform a successful appendectomy. She became known around the hospital as “the miracle child.”

The hospital had a courtyard with a pond. During the girl’s recovery, the doctor would sit with her by the water. He taught her the ABC’s—her first exposure to English.

Rejuvenated and inspired by her introduction to this new world, that young girl grew up healthy and went into medicine herself. She became a family practice provider, married and started a family of her own. Her daughter, Nawal, would grow up and also become a physician, join PacMed—and save the life of young Phoebe the same way her mother had been saved.

“Seeing Phoebe made me remember my mom,” said Dr. Alkharouf. “I feel like it’s paying it forward, you know. Because if no one had saved my mom’s life, I wouldn’t be here. Not only that—they also inspired her and encouraged her; she became a doctor because of it. There’s a lot one person can do—sometimes we don’t realize our effect. Our words matter, our actions matter. They change lives, and we don’t always realize that.”

A few weeks after Phoebe’s surgery, PacMed called the family to check in. Phoebe was back to her normal self, facing the challenges of childhood these days. “Yeah she's pretty active,” said Sara. “She keeps trying to do her math right now and she's distracted, so I told her to run up and down the stairs, and move around.”

We shared the story of Dr. Alkharouf’s mother with Sara.

“That is very cool,” she said. “Since the surgery, we keep saying, Wow! We are just so thankful for medical care. Because if we didn't have it”—she paused—“that would be awful.

“That would be terrible, just being in that much pain, and being able to do nothing about it. But the medical teams get it handled so quick these days, and help your child get out of pain.

“Yeah, it’s pretty awesome.”


You can schedule a virtual or in-person visit with PacMed by visiting pacmed.org/schedule, or by calling 1.888.472.2633.

Dr. Nawal Alkharouf provides care as a pediatrician out of PacMed’s Canyon Park clinic in Bothell.

Dr. Akharouf
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Read more about Nawal W. Alkharouf, MS, MD, FAAP, or call for an appointment: 425-412-7200.

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