Sunday, January 24, 2010

Sometimes the Right Choice is the Hardest One to Make

Having a child like Liam who has the needs that he has sometimes leaves me questioning my Mommy instincts. I know I'm a good mom for him, but I don't always know what is the best choice in certain circumstances. This week has been a long and trying week, and my instincts have been tested to the extreme. I am proud to say that I think I did all the right things.

For the past week (almost two weeks as I write this), Liam has had a little cold with a yucky cough. I've had a hard time trying to keep his sats up, particularly when he first woke up. I was already a little out of my comfort zone since we've switched pediatricians with the departure of our favorite Dr. M. I don't know Dr. K very well, but I do know that it's clear he's been doing his research on Liam's case. I'm grateful for that. During the week, we had seen Dr. K. about three times. He instructed me on how to deep suction Liam's nose when he's congested. He can't have decongestant meds, so that was really our only choice. When his nose is clear, he can breathe through his canula, which is really important. He also taught me how to do CPT for him to loosen all the mucus. I hated torturing Liam with the suction, but it was working to help keeps his sats up.

Wednesday when Liam woke up, nothing I did would keep his numbers high. He'd had a rough night Tuesday night waking up coughing until he vomited and then just collapsing asleep when his coughing fits were over. He was clearly exhausted from all the coughing. I knew something wasn't right and that I needed to get more help for him than what I could do at home. I called Dr. K's office, but 2:15 pm was the earliest Liam could be seen and I knew he was struggling. I also contacted our pulmonologist's office and consulted with the nurse. She suggested that Liam really needed help as soon as possible. I agreed, and we headed in the direction of the Children's ER. It's a little over an hour's drive, but would land him in the care of the best dr's for him. At least that's what I was told would happen.

I arrived just after noon, and went in. They saw that he had his O2 with him, so he went to the front of the line. The nurse checked his sats, and he was at 92%, which isn't quite high enough. She had us wait a little longer before taking him back because he needed to be in his own room away from other kids who could make him sicker. She explained that he had his own oxygen and other kids didn't so he could wait longer. Okay, but now he's waiting in a room full of really sick kids and not satting high enough. Whatever. I could see that the ER was packed and was willing to wait for him to have the private space.

Finally he got to his little ER room, they gave him one breathing treatment to bring up his sats and took his history. He was seeing a resident doctor, who I think might have just recently hit puberty, but was sure she knew all the right answers for Liam. This is the exact information I gave them:
-He has had a cough with his sats all over the place for the last week.
-The pediatrician has him taking breathing treatments every two hours with CPT about every four hours.
-His ear is draining huge amounts of green thick discharge. This is new and wasn't there the day before. He is Deaf, and his ears need to be protected.
-He is just recovering from C-Diff, and has missed the last two doses of the medicine for it because we've been so focused on the breathing issues. He needs the next dose asap because we're just now having normal poop after six weeks of not having that.
-His pulmonologist was going to call ahead to let you know he's here and what to do with him since his lung disease is rare and needs to be treated a little bit differently than others.

The response the "doctor" gave me was the following:
-Yep, his ear is draining. Interesting.
-We all have C-Diff in our intestines, and your pediatrician may have jumped the gun a little bit in giving you those meds.
-The pulmonologist wants him admitted, so he's on a list to get a bed.

After the dr. left, Liam was taken for a chest X-Ray and tested for a variety of viruses. I explained that Dr. K. had already done both of those things on Monday, and that all were clear. They wanted to check again anyway. Okay. Fine. Check again. When he returned from the X-Ray, he received one breathing treatment and 30 minutes of IV fluids. It was noted that, at that point, he was well hydrated, so I have no idea why the fluids. But, okay. I can just suck it up and deal with all of this until he gets to his own room where the pulmonologist can take charge of his care.

Liam went to sleep during the breathing treatment and stayed that way for a long time. In total, he slept about four and a half hours. During that time, his nurse informed me that he'd have to go to a "holding annex" to wait for a room. I picked up my sleeping baby, who didn't even bat an eye and slept through the whole move, and followed her to the annex. It was one big room full of children with confirmed illnesses all divided by little curtains. There was one sink in the room. It happened to be in Liam's little curtain area. Great. Now everyone is rinsing their puke buckets in my child's area.

I was starting to get really nervous about this situation because I know how easily Liam gets sick, and how much damage it does to him. I spoke with the nurse and explained the situation and that he really couldn't be with all these kids. Why take him from a private space to one full of very sick children??? She called in the same very young doctor we'd seen, and explained the situation. Since the doctor was there, I again mentioned the C-Diff issue and that he really really needed that med. "He has C-Diff? Well, he should be in isolation then". Great!! Whatever gets him isolated I am happy to go with. They STILL didn't get him the meds for his C-Diff, though, and it's a drug to be taken every six hours. By this point, he'd missed a good four doses and the clock was still ticking.

The very sweet nurse tried to get him into an isolation room, but none were available. No matter. I was told he'd be on the top of the list to get a bed when one came open. Okay. Fine. I will wait a little longer.

Strangely, all the kids around him got into rooms. Go figure. I was livid. One of them was sent to the pulmonology unit where Liam REALLY needed to be!!! I was hopping mad, and brought it to the new nurse's attention. (There had been a shift change during this whole time). She said, "You're right, but that child went to a two bed room." Okay, I get that, but then at least he was only sharing with ONE other child. Liam was in a space that was starting to fill up again with up to twelve other children. I was willing to take my chances.

By this point, I was just in tears and beside myself. I was questioning my decision to bring him, worrying sick about the C-Diff issues, and it felt like I wasn't even thinking straight anymore. The on-call pulmonologist came in to see him. We'd met him before during our long summer stay. He was kind, but doesn't know Liam's case. He wanted him to have inhaled steroids. Fine. Whatever. This guy always wants to give steroids.

I waited another couple of hours, still begging for him to get out of that situation. Nothing. Finally around ten, the charge nurse came in and said, " I think we have a plan for him until he gets a room." My response? "No. We're done here. We are going home. Please page the pulmonologist and tell him we're leaving. I don't want anything to do with the little resident. She is full of it, and won't listen to my concerns. We are leaving. Now. Please make arrangements."

I couldn't believe I'd just done it. I was so angry, though, and hurt that they'd acknowledged a need for my precious baby to get medical help, but then denied him what he needed. My head was spinning. I knew that, if anything happened to him that night, I'd live with a horrible guilt for life. But I also knew that staying any longer was like a death sentence in terms of what diseases he was picking up sitting there.

The nurse called the doctor and came back to ask me if they had gotten a chance to note his sats while he was sleeping. ARE YOU KIDDING ME?!?!?! The child slept for FOUR AND A HALF HOURS!!! How did you NOT know this?!? How did you not notice him so out of it that he slept through the entire transfer from ER bed to holding annex hell??? That was enough for me. I took him and left.

I sobbed all the way home. I was just beside myself with worry and anger and frustration and the whole thing. It was the worst feeling ever. I called Jo on my way home, and she talked to me the whole hour plus drive.

The next morning, we went directly to Dr. K's office. I told him the whole story through tears. He was so compassionate and understanding...and pretty sure I needed a nap. Really? The three restless hours of sleep I'd gotten wasn't enough? Hmmm...

I pointed out that, in the ELEVEN HOURS that I was there, Liam had received:
-One breathing treatment
-One 30 minute IV fluid treatment for nothing
-One inhalation of steroids through an aerochamber.

He validated my decision and said that, if Liam is ever in that much trouble again, I don't need an appointment. I can just bring him in. If he is there, he will see him and take care of him and not let him suffer anymore.

We checked his sats and listened to him. He was doing better. The problem? He'd begun throwing up that morning and wasn't wanting to eat. My worst fear was rearing its ugly head. C-Diff was coming back in full force. Dr. K and I decided to watch it during the day with the understanding that I could bring him back at any time if I had concerns about the C-Diff. He also gave me some drops for his ears, BOTH of which were now infected and oozing.

Liam played well, took a long nap, but still refused to eat. Then the diarrhea started. I took him back to Dr. K's office where we determined that he needed to be admitted for IV fluids. Gaaaah! I was so angry. This whole part could have been avoided if they would have just listened to me at Children's in the first place.

The irony? Liam's pulmo called me and asked why he wasn't at the hospital when she went to see him. I told her what happened, the whole story, and that I'd gone down there trusting that he would be taken care of and fully prepared to stay through the weekend if I had to. She told me she'd called ahead and told them the following instructions for Liam:
-Regular breathing treatments with CPT
-Listen to the mother. She knows what she is talking about and will only bring him if something is really wrong.
-Keep him away from other sick children.
-Admit him to his own room.

I think we have a plan now. When Liam is really struggling, Dr. K will see him and consult with our pulmo. Depending on what he needs, we will decide if he needs to be admitted here or at Children's. If it's Children's, he will be directly admitted to his own bed. I feel better about that.

So, now that you've read through this loooooooong post, you see why Mommy instincts are sometimes so hard to read. It seemed to be against all logic for me to take him from the hospital that could help him, but I did it anyway because my gut told me it was the best choice. I'm so glad I did. I am proud to report that he seems to be on the road to if we can just get him to leave his oxygen on....


  1. Yikes, yikes, and more yikes. :hugs:

  2. Oh my goodness- I can't imagine your frustration! You definitely did the right thing- the ER staff was bungling the whole thing and were exposing him to lots of germs (while not taking care of his most urgent needs, which was to get a private room and wait for the pulmonologist)! The new plan sounds like a much better one- that way you have access to a private room without all the exposure to diseases with the little guy. I hope his C. Diff disappears soon and his ears clear up (and his sats stabilize). What a whirlwind of frustration!

  3. You did everything right! I'm glad you wrote this all out...what an ordeal.....