Tuesday, December 30, 2014

Just for fun

Two nights ago after a weekend of worrying about Princess Bear (PB) I called the Dr.'s exchange.  Most of the time they try to get you to take the child into the ER.  I explained that an ER trip wasn't necessary but a Dr's appointment was.  Our Dr. is a wonderful Dr. and it's often tough to get an emergency appoint.  The nurse I talked to agreed that PB could wait until morning and made an appointment for her.  Unfortunately her regular pediatrician is on vacation until next week.  The nerve! :)  So we went with our back up pediatrician Dr. S.  PB has met Dr. S on several occasions when she couldn't get into her regular pediatrician but whatever she needed to be seen for warranted more than a nurse practitioner.  When her regular pediatrician retires Dr. S will take over PB's care.  So there we were for our 10:30am appointment.  Of course we didn't actually see the Dr. until around 11am.  She was concerned about a couple of things.  She heard wheezing in both of PB's lungs.  PB's been fighting the same ick that I had before Thanksgiving, my mom had in Florida and my dad has now.  The Dr. had put her on antibiotics and cough medicine the week before.  Dr. S was worried that the medicine wasn't working and perhaps switching would be the best plan of action.  She also agreed that with PB being sooooo lethargic for the past 24 hours and it getting worse it seemed like the illness was triggering her Gilberts Syndrome (basically causes bilirubin to build up in the liver).  She didn't want to overreact but thought that admitting PB for 23 hours to the hospital so she could receive IV antibiotics as well as a lot of IV fluids to help flush the excess bilirubin would be a good idea.  She explained everything to me before I left.  I did as if I could stop at home before going to the hospital so I could feed the cat and get some clothes for PB and myself.  She said no that she really wanted to get fluids started as soon as possible.  She said that after I got PB  registered and on the Peds floor I could run home.

So I called my mom to let her know we were incoming (She works at the hospital as a secretary in Pastoral Care).  I text my sister and gave my dad a quick call.  Then it was time to call Mason as we were driving so he could do his pep talk telling me that everything was going to be fine.  We got to the hospital and the fun started.  Oh, first I must say that this area is being particularly hard hit by the flu.  So I get to admitting and give them PBs name.  They hand me a pager and tell me to wait for a regististry agent.  That was a 20 minute wait.  PB is falling asleep on me in the waiting area.  My kiddo is 5'6" and change and weighs 130 pounds and she's curled up on my lap sleeping.  Finally the person calls me back to register her.  PB is a frequent flyer there.  It's were she gets her OT and PT and any and all tests she needs.  First the person tries telling me she can't find her in the computer.  Wrong answer!  Try again!  Then she hits something on the keyboard and papers as in at least 30 of them come flying out of her printer.  She's screaming at it to stop and hitting the power button to no avail.  Honestly at that point I should have taken my child and run for the hills!  I think she has things under control and I try to relax.  Next she literally starts hitting her keyboard and saying I didn't mean to do that!  I'm going to have to call them to fix that.  Oh shit!  I was wondering if perhaps I should have stopped for a mini bottle of wine or something.  She sends me back to the waiting area with PB where every other sick person in the world is waiting to get admitted.  She tells me that someone from Peds will be there to get us soon.  I ask if I can just take her up to the floor since we're more than familiar with it.  Nope.  Access denied.  Once again this would have been a good time to have cut my loses and run.  So there I am in the waiting area holding PB who seems to be disintegrating before my eyes.  35 minutes later someone from transport shows up.  They load PB into a wheelchair and we're off.  Whoa buddy!  You missed a turn!  We need those elevators to get up to peds!   The guy looks at me and tells me that peds is filled.  Actually overflowing.  There is a child using the procedure room as a regular room and they are taking us to a peds overflow floor.  Yeah right!  They took us into the bowels of hell!  Seriously!  Ground floor in the old part of the hospital.  It's a mixed floor of.....everything!

I'm still trying to keep calm at this point.  They take us to a room that PB is apparently going to be sharing with another little girl.  Whoa!  Kids are never supposed to have to share rooms.  Sick kids don't generally do well trying to share spaces and bathrooms.  Kids just don't hold somethings well, know what I mean?  OK, fine we can deal with this.  I hope.  I get PB in bed and comfy and the nurse says I have to come down the hall with her to answer questions.  Seriously?  You can't find a laptop or tablet to bring in the room?  I'm now supposed to leave my kid in a room with strangers by herself.  Yeah I know I'm overprotective.  Shoot me.  She doesn't feel well and I can tel she doesn't want me to leave.  The nurse says there is no other option but she'll be as fast as possible.  She starts asking all this health history questions.  Then we get to questions about MRSA.  Has PB ever had MRSA?  Why yes she has!  She's also been on antibiotics in the past 30 days.  This triggers flags that she has to be tested for MRSA colonization.  Frankly the only time I've ever wanted to to be colonized.....it would have bought her a private room!  So of course....no colonization.  Yes I realize it's a good thing but frankly she spends enough time in hospitals that I can't worry over nasal MRSA colonization.  Plus the private room would have been a huge help.  I ask how soon they're going to start an IV.  Not until the residents have seen her and talked to the hospitalist.  Then they'll start it or wait for the hospitalist to come in.  OK....this child is dehydrated so regardless of what the blood work shows shouldn't y'all be starting fluids?  That one falls on completely deaf ears.  Before we left the Dr's office they emla cream (numbing cream) on a couple of spots so it would be easier on PB when they drew labs and put in an IV.  The down side is that they have to use something with a pretty strong adhesive to get the emla cream to stay put.  PB and I are both allergic to adhesive so we try to use as little as possible.  I explain this to the nurse who gets that she'll have to use paper tape to secure the IV and she seems cool with this.  They also ask me what I want to do.  There is an order for labs but not an IV yet.  They can leave the emla cream on for awhile until the IV order comes in.  Last time we did this she had blisters everywhere the bandage had been.  I almost beg them to just place the IV port and not hook it up.  They can't do that without orders.  So I tell them to do the blood draw and we'll hope for the best with starting the IV.  At that point in time I'm just pissed and ask how long it will take the residents or hospitalist to get there.  Of course no one has any idea.

My mom clocked out and made her way to PB's room.  I catch her up on everything.  Everyone and their brother is pushing PB to drink.  Please remember that this kid has a SERIOUS hacking cough.  She tries to drink and almost vomits.  Fun times I tell you.  She goes to the bathroom and the nurse tells me "Yep!  She sure is dehydrated!".  Ok.  Can you please call the residents and relay that info and see if we can get IV fluids started.  No dice.  Then the visitors from my mom's department start coming in.  Most of this people have known PB since she was born.  Whenever PB is in the ER or admitted she has a non stop flow of visitors.  The up side to all the visitors is that it keeps her busy.  The nurse had told me that the MSRA testing takes about 30 minutes so I go to hunt her down and find out that the test was negative.  Then I start asking about when the residents or the hospitalist will be there.  I flat out ask how I can contact the hospitalist directly.  Remember when the admitting Dr. didn't even want me to stop at home first?  So here we are and she's been there for almost 2 hours and no IV has been started.  I'm sure the nurses were ready to kill me.  Ask me if I cared?  I'm out at the desk every 15 minutes asking for news on the residents or the hospitalist.

 Finally 3 hours after we've been in the room the residents show up.  They say that her lungs sound fine but perhaps it's because during one of her coughing fits she could have cleared whatever was making the wheezing sound.  I ask them when they are starting an IV since even if PB doesn't need IV antibiotics she still needs fluids for the dehydration and the potential bilirubin build up.  They say that the hospitalist doesn't want to start an IV until he has the blood work results.  I think the nurses were completely expecting me to flip out and frankly I was damn close.  I start asking if there is any down side to starting IV fluids.  We know the kiddo is dehydrated so if nothing else it will help with that.  Nope.  The hospitalist wants to see how she does with her own fluid intake.  At this point I demand to speak to the hospitalist and they tell me this isn't possible.  So I start calling the pediatricians office but it's gotten late enough that I can't get anyone there to intervene.

Then I try ordering dinner for PB and myself.   Now PBs allergies have been on file forever.  She's allergic to oranges and eggs.  As in she can't eat straight egg but can have things made with eggs in it.  This has never been a problem in the past.  PB decided she wanted applesauce, fresh pineapple, a blueberry muffin and french toast with juice and hot tea.  They proceed to tell me that she can't have any citrus or anything with egg in it.  So basically the kid would have been having applesauce, juice and tea.  Oh hell no.  They want to watch her food and fluid intake but they're making it impossible to order foods?  This mama was ready to start hurting people.  I explain that she just can't have oranges or things like scrambled eggs.  Nope.  The nurse as to remove all mention of allergies.  Since my mom knows most of the people that work in that office during the day she says screw it and goes down there to try to explain things to them because I couldn't even find her nurse.  I finally find the nurse and she does what the dietary people tell her to do and once again I try to order PBs dinner.  Once again they say no.  The nurse does some additional change, my mom had also found someone she knew and we finally got dinner ordered.  That was at 4:30pm.  Remember that time. 

My mom tells me to go home and pack some stuff and feed my cat.  I got back to the hospital about 5:35pm.  I get back to PBs room and my mom announces that they won't be bringing her dinner until 7pm.  This is after oh dear hospitalist says he wants to see how PB does with her food and fluid intake.  The kiddo hadn't eaten since that morning but no worries.  My mom was just going to go to the cafeteria and buy her dinner from there.  Nope.  Gotta have a dietitian approved meal.  Really????  My mom goes home for the night and one of my best friends and her daughter came to visit.  Maria and I have been friends since we were in first grade together circa 1979.  PB is sandwiched between Maria's 2 kids and they've been buddies their whole life.  I was so glad that PB had a distraction!  Actually I was damn thankful for the company.  The girls started doing their nails and having fun while Maria and I chatted.  About 20 minutes into their visit PB tells me that she has to go to the bathroom and wants me to come with her.  OK skip this part if you're queasy.  She had major diarrhea and it was evil.  I spent enough time working in daycare to know that when something smells like that it's not a good thing.  Enough of that.

Dinner finally comes and PB managed to eat the applesauce, some pineapple and some of her muffin.  This kid can usually eat most adults under the table.  She does drink 6 ounces of juice so woot woot!  She then laid back and feel asleep with company there.  Something that she would normally never ever do.  I'm getting a bit worried at that point.  Maria and Emily went home and I waited for the residents to come back.  At this point this is still no IV in place yet.  PB had several more bouts of diarrhea.  I ask the nurse how this will play into her already being dehydrated. I also ask for some pepto or something to help her.  Nope.  Residents see no need.

By 8:45pm it's very clear that they aren't going to start an IV or new antibiotics.  So why in the bloody hell is my child even in the damn hospital?  They are doing absolutely nothing to help with the issues she can in with nor the ones she's developing.  Ok.  We'll try a new approach.  In the past when PB was dehydrated but no severely so they let me monitor her at home.  How much is she taking in versus how much is she peeing out.  It's not fun but its easy and I can do it at home without her being exposed to G-d only knows what in the hospital.  So I ask if I can take her home since they are obviously not going to do anything to actually help her.  The nurse calls the residents and they turn down that request.  At that point I was almost tempted to call PBs vacationing pediatrician at his home.  Something I've not done often but he's told me to do it when I feel it's needed.  I ask the nurse what would happen if I just said fuck it and took PB home.  Apparently in the lovely state of Illinois that means a police report will be filed against you.   SERIOUSLY?!!!???  SERIOUSLY?!!!??

I called my mom and updated her and she said to just hang tight.  She reminded me that the nurse said the hospitalist usually comes in around 6am.  Because really that's when you want to wake up sick kids and their parents.  After a bad nights sleep from getting up every 4 hours so vitals can be taken.  PB had started taking in an ok amount of fluids and for awhile the urine concentration came down to a place that wasn't considered  dehydrated!  Whoohoo!  Let's throw a party!  In the mean time she had several blisters pop up where emla cream and bandage had been applied.  So I ask the nurse if we can get some neosporin and something like benedryl cream because she was really itchy.  Nurse calls residents and residents say "Nope.  Not needed.".  I'm so proud of myself for not actually decking someone at that point in time.

PB took a nap for a little while and when she woke up she was very thirsty.  You'd think a good sign.  She went to the bathroom and again the urine concentration was back to being considered dehydrated.  We're having fun now kids!  I take PB for a walk to where all the snacks and drinks for patients are at.  She didn't want to eat but agreed to try some hot chocolate and soda (I know!  What a freaking combination!).  During our walk a nurse heard PB coughing.  She didn't see us.  She turned back around and asked if it was PB coughing.  Yep.  She couldn't believe that it was so bad.  I mentioned that they weren't letting PB have her prescription cough medicine; just over the counter stuff.  The nurse just started shaking her head.  We go back to the room and she did drink the soda.  The little girl on the other side of the room who was about 3 years old is still going strong with the TV blaring and playing with her toys.  Around 1 am I ask the nurse if its ok to turn off the TV.  She looks on the other side of the curtain and tells me that the parents are watching it so it has to stay on.  Now I understand if the kids are up the TV being on but frankly I thought it was damn rude that both kids were sleeping and they kept the TV on.  The nurse came in for vitals at 4am and I once again asked if it was ok to turn off the TV and this time she did.

My mom came in at 6:10am to wake me up to get ready to deal with the hospitalist.  I'd pretty much decided that I'd ask for another blood draw and if all of PB's liver numbers including bilirubin were fine I was going to take her home.  At 8:20am the resident comes in and starts asking questions.  I ask him about a blood draw and he says they see no reason for that.  He does say that they are on the fence about whether PB should be released or observed for another 23 hour admit.  Yeah buddy- let me answer that for you.  I'm taking my kid home TODAY!  The idiot hospitalist didn't show up until 9:30am and grants me permission to take PB home.  I didn't talk to him other than say I was taking her home.  If I would have tried dealing with the man I probably would have reamed him a new a$$hole. 

PB's release paperwork finally came through around 11am.  She has spent most of the day sleeping and coughing.  I know she's not eating or drinking enough but I'll be damned if I take her back to the hospital.  We have a follow up with the nurse practitioner at the pediatricians office tomorrow.  I'll be looking into how to file a complaint since this hospitalist followed NONE of the admitting orders.  I'm just praying that the next time PB is in the hospital a different hospitalist is on call.

So that was my last day and a half.  Hope yours was much much better than ours!

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