Friday, July 27, 2012

A brief interupption on Tomas' biology; in which I make the resident doctor wake the attending at 11:00pm

On Monday Tomas went in to his pediatrician for his routine lab work. I got a phone call later that day telling me his potassium was really low and they wanted repeat lab work the next day. On Tuesday I took him back and get a phone call a few hours later saying his values were still really low and he needed to be admitted.
I hang up the phone and push my "Admission: red alert" button. Lights flash, sirens blare. Childcare for the girls instantly appears, bags fly out completely packed from secret compartments in the walls, gas tanks fill up automatically, TPN bags and feeding pumps magically and compactly fling themselves into their respective backpacks then march in line along with everything else to settle themselves nicley in the trunk of the car.
A girl can dream can't she?
Anywho - a friend was able to keep the girls until Mike got home from work, and I not so magically or effortlessly did the rest. Get to ER...blah,blah, folder code 2 (code 1 is not breathing or bleeding to death and the red folder is for kids with issues)....just once couldn't we be a green folder code 4 maybe? Instant triage, reverse pressure room, labs, IV, bradycardia, stat EKG, blah, blah, blah. Potassium through an IV really burns and and so do I later when I find out they could have run it in with his TPN through the central line and have him not feel a thing.
Get moved upstairs at 2 in the morning, get a lesson on blood alkalinity and urine alkalinity and potassium and bicarbs and dear God when did I fall asleep and why is it already 6 am and someone else is trying to talk to me?
Wednesday was spent trying to stabilize him, but in true Tomas fashion he made them work for it. After two IV boluses and 1 G tube dose of potassium his levels are pretty close to normal so he is left alone. Now to figure out what happened. Could be this or this or that. I love this game, it follows me around like a shadow. A black death bringing, life sucking, spirit quelching shadow, but hey, at least I know how to play. GI says this, nephro says that, and eventually we have a plan for discharge and for maintenance and a way to keep him stable at home, but no idea what the hell happened in the first place.
Thursday morning comes and we are ready to leave. New TPN formula is sent to home insfusion and set to be delivered that afternoon. Appts. are made with pediatrician to check labs next day, new scripts are written, GI writes discharge orders and bags are packed. Not so, says nephrology. his urine PH was too high on Tuesday and Wednesday and we need to re-check it to make sure it is better before he can go home. Ok, get a urine bag on him and wait, and wait, and wait, because umm....I've said this 100 times - he hardly pees when the TPN isn't running. Finally, he did pee, urine gets sent off and @ 9pm the resident comes in.
Happy faced, because isn't it great that we get to go home, "Mrs. Hernandez, I'm just finalizing your son's paperwork and then you can go."
Me - "What about his urinalysis that we've been waiting on all day."
"It came back a little high, but nephro said he could go."
"What's a little high?"
"Well, what was it on Tuesday and yesterday."
"Also 9"

I have to stop here because she said that with the most serious and professional of faces. Like it made perfect sense. Like somehow the passage of 8 hours made a value of 9 go from being enough to keep my son in the hospital to being and acceptable value with which to go home.

"I don't understand how that can be since the whole reason we've hung out here all day was to make sure the urine ph was going down."
"Well, we talked to nephrology and the senior resident said it was ok for Tomas to go so I'll go get your paperwork."
"Why don't you go get your senior resident instead."

To be continued...have to take Tomas to pedi for labwork. I LOVE THIS GAME!

1 comment:

  1. This is why I hate the resident game! Such a joke! So I take it you are home? Ha Ha!