Sunday, January 6, 2008

Adventures in the Children's Hospital: Part 1

As soon as the ambulance carrying Little A arrived at the Big City Children's Hospital, people scoff at her IV. The tube attached to her scalp threads through a small plastic medicine cup with the bottom punched out. The cup supports and protects the line. A wad of tape attaches the line and cup to Little A's head. It looks like a fez created by McGyver. Little A is one tiny car short of a baby Shriner.

"Did we do that?" people ask multiple times in the emergency department. The tone of voice is always disdainful, whether the person asking is an X-ray tech, orderly, or a nurse. Obviously they do better work here than in the last hospital. I feel sheepish every time someone asks about the IV fez, because it reminds me that this is all my fault.

I'd considered leaving Tahoe in the early morning Sunday when Little A looked so lethargic, but instead DH persuaded me to wait a few more hours to see if she improved before we packed it in. She didn't have a fever, he pointed out. Nor was she wheezing like she had been a few days before when her cold got worse. The albuterol treatments and prednisone we'd started a few days before must be working. So I went sledding with Big A, while DH watched Little A nap. When I came back from sledding I was even more alarmed at what shape Little A was in. She appeared more semi-conscious than napping. She grunted when she breathed. Watching her, my stomach quivered like I was in free fall. I insisted we go home immediately. Not in a nice, rational manner, either -- I yelled at DH in front of our vacation housemates and then threw everything we owned into bags willy nilly before rushing away.

That uncomfortable scene at the rental house was made even uglier by how pointless it was. We hurried, but did so too late. We did not leave in time to prevent Little A from spiking a high fever while traveling through the mountain pass. I watched as her breathing became more shallow and labored. Finally she stopped responding to my voice and hardly moved when I pinched her. That's when we called 911 from the highway in search of the nearest emergency care center (which I'll call Podunk ER). Thankfully it was only a few miles away. She needed oxygen and fluids and a wide variety of drugs immediately. Only then, after many hours in the Podunk ER, was she in any condition to go by ambulance to the Bay Area Children's Hospital where she eventually spent five days for treatment of pnuemonia.

The scalp IV jokes also bother me because truly, that is my fault. I am the person who asked for it. Podunk hospital nurses blew three veins in Little A's extremities and meanwhile her heart rate, breathing, and oxygen saturation were looking poor, and still they just kept poking at invisible veins in the arms and legs without seeming to notice that forty minutes had passed without making any progress on the IV. Little A cried but had no tears. She was so dehydrated. I felt on the verge of having my own stroke as I watched everyone around the gurney. Given her hair-challanged state, Little A's scalp veins stuck out like big, juicy apples on an otherwise barren tree. I said, "Can you put a line in on her head, like they do in a NICU?"

Two of the nurses immediately said they don't usually do that. But another nurse steps forward and said, "This baby has waited long enough already. Let's do it."

Nurse Mike was the one person in the Podunk ER who seemed to be trying to make my baby better, as opposed to just monitoring her as she got sicker. He placed the scalp IV on the first try. He gave Little A fluids and drugs to help her breathing, administered ibuprofen and aceteminophen for the fever (rather than idly mention she could use some Tylenol without bothering to get the meds, like 3 other nurses did). So I felt even worse when the Big-City Children's Hospital staff maligned Nurse Mike's IV. Sure, the rest of the other ER experience had been mock-worthy, but not him.

The irony is that over the next few days I am the one (privately) scoffing at the Children's Hospital staff when it comes to IVs, because although her fez occludes after eight hours and needs replacement, damned if the hot shots at the big children-only facility can get another vein. Even the hospital expert on "tough sticks" can't do it. My child has ten unsuccessful needle sticks in her arms and legs over two days before they give up. Thanks to the scalp IV, Little A was stabilized enough to continue her recovery by receiving fluids and medication by mouth or injection. So to me, Nurse Mike is a real hero. His IV sure was ugly, but it did what it needed to do.

Thankfully, aside from IV drama, the nurses and doctors turn out to be great at Children's Hospital. While unpleasant or painful things transpire (blood tests, Xrays, antibiotic shots, breathing treatments, etc.) everyone is respectful and sympathetic about the wailing and flailing that occurrs on the patient's part. Considering we stay for five days and deal with dozens of nurses and doctors, the fact that I never run up against an obvious asshole is pretty amazing consistency of care.

By contrast, there is no such uniformity in anything related to the parents of the children that surround us in the hospital. On one side of our room is a three year old girl with a difficult-to-control lung infection. The father is soft-spoken, dotes on his child, and spends each night at her bedside. Each morning the mother arrives with perfectly styled long blonde hair, wearing expensive knits and stylish high-heel boots. She appears to be early in the second trimester of a pregnancy. She's gorgeous, but constantly loses her shit. She yells savagely at the anesthesiologist when an MRI gets rescheduled. She snits at the doctor for not having test results available immediately after the test. She complains to the food service people for bringing dinner trays to other patients in the room who are allowed to eat when her child is NPO. When in her presence, her daughter's mood reflect her mother's, so the child screams twice as much as she does when she is around her father. I theoretically sympathize with the woman and all her frustrations, because having your child in the hospital when you are pregnant has got to suck buckets. But she is so unpleasant and huffy that in reality, I mostly just think she's a spoiled bitch.

In the bed across from the daughter of the spoiled bitch is a three year old boy. His mother sits with him a few hours each day but heads out at night for work and taking care of the rest of the children. The boy's mother speaks good English, but her husband and child mostly speak Spanish. The boy has pneumonia. The father stays with him at night and most of the day, too. When they take out the child's IV the father seems oblivious to the fact that the boy must drink a lot of fluids. The boy goes seven hours without drinking a drop, and when the nurses realize this, there is a mad dash to cajole the child into drinking a lot of fluid immediately, lest they be required to reinsert the IV. Nor does the father bat an eyelash when his son lies on his belly on the hospital floor and plays with the garbage can reserved for soiled linens. The father also fails to notice when his son scoots out from under the curtain separating his "room" from Little A's. The boy grabs at a pile of dirty diapers waiting to be taken away by the nurses (for weighing, then disposal). DH attempts to get around the crib and grab the boy just as the child's mother arrives for a visit and screams "DON'T TOUCH THAT!"

I suspect the boy would recover faster if he were completely unsupervised, rather than watched over by his father.


meg said...

This sounds so scary. I'm glad you're all back home now. Take care.

thrice said...

OMG, I'm crying. I'm so sorry that little A, big A, ou and dh had to go through that. How scary and how fast the pneumonia took over.

You are my hero for thinking of the fez IV. WhatEVer works.