Today was the fourth day of surgery and instead of getting better, the morning has deteriorated into one of those great ideas gone wrong situations. The pre-op team was supposed to leave at 6:30 and the rest at 6:45, but the whole operating room team - nurses and techs and the Child Life group who help the kids get through surgery, do pre-op teaching, comfort parents, etc felt they should go early too. As you might imagine, it was impossible for that many people to get on the bus on time. We ended up leaving at 6:40, just late enough to get stuck in the morning traffic. The second bus left at 6:45 so we had about 5 minutes to prep the first group for the OR before the surgeons arrived on the ward to do their rounds. I have to go around with them as they all have things to say about what they want added or subtracted from the standard discharge orders. I have all the discharge orders pre-written and ready to sign, an usually they're fine. However, there are always a few that need to be revamped. All of them must be signed before I can return to the pre-op patients because the kids need to leave so beds can be stripped and re-made for the next round of patients. This morning, because we were late, I didn't get back to the pre-op kids until just after 8:00, and Rosa, the nursing director had sent the kids to the playroom and the mothers to the parent dining room for breakfast. Rosa is wonderful in almost every way, and she didn't get to be director of nursing by being wishy washy. Breakfast for the parents is at 8:00, and is not delayed just because the doctors get behind.
So, enough griping. The parents got fed, the kids got prepped and my blood pressure gradually came down. You'll notice from the photos that all the kids wear caps to the OR. These have long ribbons on them and the parents like to wrap these around the child's neck and tie them in a knot. I find myself shuddering a lot and occasionally sneaking the knot open as I pretend to soothingly pat a child's head. I'll organize the photos when I'm not so rushed, but two kids in particular stand out. One is a child with a cleft lip and lobster claw deformities of the hands and feet. He also has very sparse hair on his head. He's 7 months old and has a 4 year old brother with the same syndrome. The hair gets thicker as they get older. You can probably pick him out by the hair. He has a very lovely result. The other one will have to wait until tomorrow as I still don't have photos. He's about seven and his front top four teeth stick out so far he can't close his mouth. One of the plastic surgeons is also a maxillofacial surgeon and he fractured the maxilla and moved it back and wired it in place. He and the plastic surgeon then closed the lip. The result is phenomenal, but the child is having a slow recovery. We've been using stronger pain medications and today he was sitting up and even playing a bit after spending the first 24 hours after surgery alternately crying and being knocked out by pain meds. I hope to get a post-op followup tomorrow.
A couple of babies have plastic tubes in their nostrils acting as splints to maintain a rounded position as the cartilage heals. The tubes can be removed for cleaning, and the babies don't seem to mind them. You'll see some in the photos. There were some cancellations due to illness, so tomorrow might be the last day of surgery with Friday morning's patients moved to tomorrow. We'll see.
This was a very difficult day for me. Mid morning I was called emergently up to the dental clinic by a student and technician who were seeing a baby for an obturator recheck appointment. They said the baby was blue and breathing fast. When I got there, I found a very blue baby with and oxygen level of 61(normal around 98-100,) and a very rapid heart rate. As I examined her, she laughed and smiled and grabbed at my stethoscope, trying to eat the tubing like most one year olds do. After a bit it was clear that this was the baby I had seen at screening, the one with only one ventricle. The mother confirmed this saying that the cardiologist had told her there was nothing they could do for her baby. The mother is quite young and was there with her own mother as well. After reassuring the dental student and technician and talking with the mother a bit and making sure she would see the nutritionist this week, I went back to the ward. For some reason, seeing this little girl was just devastating for me today. Any big children's hospital could choose to take her on and swallow the cost of her heart transplant, the only thing that could save her. It won't happen because the business people don't think in terms of one baby. They think in terms of actual dollars and would add it up and it would be prohibitive. Also, they would think of it being a precedent, the flood of people who would hear about it and send them lists of needy kids, and on and on. Actually, a hospital could do it with the doctors and staff donating their time and then just not counting all the little beans. It wouldn't affect the budget or bottom line at all. Or, one of the many extremely wealthy people in the US or other well off countries could easily foot a bill for this child. Or some big donor could do it with some stashed stock options.
I know it's not realistic to think this way and there are tragedies playing out all over the world. I'm also aware that this little girl is just one of thousands in the same state of terrible health and that one can't help them all. The thing is, someone could help this one child, but it won't happen because that's the way things are. Someone or some institution could quietly save her life without turning the deed into a media circus and therefore initiating an avalanche of calls for help. It won't happen because no one who could help has a vested interest in helping.
So, that's my rant for today. Tomorrow I'll be upbeat!
So, enough griping. The parents got fed, the kids got prepped and my blood pressure gradually came down. You'll notice from the photos that all the kids wear caps to the OR. These have long ribbons on them and the parents like to wrap these around the child's neck and tie them in a knot. I find myself shuddering a lot and occasionally sneaking the knot open as I pretend to soothingly pat a child's head. I'll organize the photos when I'm not so rushed, but two kids in particular stand out. One is a child with a cleft lip and lobster claw deformities of the hands and feet. He also has very sparse hair on his head. He's 7 months old and has a 4 year old brother with the same syndrome. The hair gets thicker as they get older. You can probably pick him out by the hair. He has a very lovely result. The other one will have to wait until tomorrow as I still don't have photos. He's about seven and his front top four teeth stick out so far he can't close his mouth. One of the plastic surgeons is also a maxillofacial surgeon and he fractured the maxilla and moved it back and wired it in place. He and the plastic surgeon then closed the lip. The result is phenomenal, but the child is having a slow recovery. We've been using stronger pain medications and today he was sitting up and even playing a bit after spending the first 24 hours after surgery alternately crying and being knocked out by pain meds. I hope to get a post-op followup tomorrow.
A couple of babies have plastic tubes in their nostrils acting as splints to maintain a rounded position as the cartilage heals. The tubes can be removed for cleaning, and the babies don't seem to mind them. You'll see some in the photos. There were some cancellations due to illness, so tomorrow might be the last day of surgery with Friday morning's patients moved to tomorrow. We'll see.
This was a very difficult day for me. Mid morning I was called emergently up to the dental clinic by a student and technician who were seeing a baby for an obturator recheck appointment. They said the baby was blue and breathing fast. When I got there, I found a very blue baby with and oxygen level of 61(normal around 98-100,) and a very rapid heart rate. As I examined her, she laughed and smiled and grabbed at my stethoscope, trying to eat the tubing like most one year olds do. After a bit it was clear that this was the baby I had seen at screening, the one with only one ventricle. The mother confirmed this saying that the cardiologist had told her there was nothing they could do for her baby. The mother is quite young and was there with her own mother as well. After reassuring the dental student and technician and talking with the mother a bit and making sure she would see the nutritionist this week, I went back to the ward. For some reason, seeing this little girl was just devastating for me today. Any big children's hospital could choose to take her on and swallow the cost of her heart transplant, the only thing that could save her. It won't happen because the business people don't think in terms of one baby. They think in terms of actual dollars and would add it up and it would be prohibitive. Also, they would think of it being a precedent, the flood of people who would hear about it and send them lists of needy kids, and on and on. Actually, a hospital could do it with the doctors and staff donating their time and then just not counting all the little beans. It wouldn't affect the budget or bottom line at all. Or, one of the many extremely wealthy people in the US or other well off countries could easily foot a bill for this child. Or some big donor could do it with some stashed stock options.
I know it's not realistic to think this way and there are tragedies playing out all over the world. I'm also aware that this little girl is just one of thousands in the same state of terrible health and that one can't help them all. The thing is, someone could help this one child, but it won't happen because that's the way things are. Someone or some institution could quietly save her life without turning the deed into a media circus and therefore initiating an avalanche of calls for help. It won't happen because no one who could help has a vested interest in helping.
So, that's my rant for today. Tomorrow I'll be upbeat!
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