Jocelyn’s Adventure, Part I

It all started Wednesday night, when, at 6 p.m., my 4-year-old Jocelyn told me she was “tired and ready for bed.”  We had a meeting to attend as a family, and I thought she probably just didn’t want to go.  We went to our meeting and the kids went to bed late, about 10 p.m. Jocelyn was grumpy and refused to brush her teeth.  I really didn’t think anything of it; after all, she was two hours late for bed.

At 7:30 Thursday morning, I awakened the kids (they were still in bed), and J immediately started complaining about abdominal pain.  She was pointing to her right lower quadrant, rolling around with her knees to her chin, and refused food and drink.  She had a 99.8 degree temp.  It was a textbook presentation of appendicitis.  Tom was just about to leave with the family car, and we quickly decided that he would stay home with Shannon (two years old) while I, the medical person, would take her to the ER.  I have little faith in traditional hospitals in the area to care for the needs of a child, so I decided to drive through rush hour traffic to the medical center in Houston, to Texas Children’s.  As an ER nurse, I have transferred many patients there, but I had never had a need to visit myself.  By some miracle, I did not get lost, and we left the car at valet parking and quickly walked into the ER.  We were taken into triage even before I completed my paperwork, another miracle if you know anything about the overcrowded state of Houston hospitals.

The nurse questioned J about her pain and took vital signs, and of course her symptoms had evaporated.  The nurse recorded no fever.  J said her pain was a 2 on a 1-10 scale, and she had a smile on her face.  I thought, “I have brought her here for nothing.  I feel like such an idiot.”  I was sure they would stick us back in a crowded waiting room somewhere, but they got us a room right away.

Children’s is a teaching hospital, so we saw one of the residents first.  Then the attending ER doctor (translation: the one with experience) came in.  Both times, J said she had pain, but only when they pressed on her belly.  We were whisked to ultrasound, and when we returned, they ordered a urine and CBC (blood test).  Thankfully, I had the presence of mind to ask for a cup when J needed to pee earlier in our visit, so I was able to obtain a clean catch urine, a much happier alternative to a catheterization. (read: trauma to the nth degree.)

As soon as J heard “blood test,” she freaked.  Of course.  What kid likes to get a shot?  Almost immediately, a cheerful girl from the Child Life team appeared.  She dispensed stickers and bubbles and lots of distractions while the nurse prepared to start J’s IV.  I saw the vein the nurse selected and said to myself, “It’s going to blow.” It blew, but she got her blood test.

The nurse informed me that a CBC takes an hour.  In the small community hospitals where I have worked, a CBC takes 15 minutes, but Children’s has about 100 times more patients than any of my old hospitals.  To give you an idea of the size of the place, it has at least 4 towers that I could see, and each tower was about 30 stories tall.  Each one of those stories could hold 50 patient rooms.  Another comparison will give you an idea of their size: a community ER may have 10 Fast Track beds and 15 or 20 regular beds.  This hospital has 15 or 20 departments within the ER.  There’s a reason they are #4 in the nation.  They are really, really good at what they do.

An hour passed.  The ER resident came in & told me that the labs and ultrasound were “basically normal.”  He said they wanted to keep J overnight for 23-hour observation.  As a nurse, I have a little knowledge of the way insurance and billing work, and I told him he needed to either admit us or let us go home, because most insurance companies will not cover 23-hour observation beyond a small percentage.  Since we are saving up for a second car, I knew that the simple act of placing J in observation could wipe out both our emergency fund and our car savings. I told the ER doc the same thing when he came in to check J again.  He listened thoughtfully. “Well,” he said, “I have very low suspicion.  Everything is very borderline, and she has very few symptoms.” He had J jump up and give him a high five, which she executed well.  “I don’t have a problem with letting you go home.” I prepared mentally for discharge and food.  J had not eaten anything since 6 p.m. the night before, and she was getting very cranky.

When the nurse returned to check vital signs again, I asked if J could have a drink or some food. “Sure,” she said, then returned a minute later. “The doctor just wants surgery to clear her for discharge, and then we can feed her.” More waiting occurred.  Two surgical residents appeared, rather nervous and apparently lacking confidence.  One held a surgical consent, and one sheepishly offered, “It’s surgery’s opinion that we should operate just to be safe.” Whaaaaaaat?!?  I just told my child we could go get waffles,and now you want to take her to the OR? As an ER nurse, I have an inherent distrust of residents.  They may be very nice people, but they are not always right.  I stood my ground. “She’s asymptomatic except for a very faint tenderness.  She has no fever, no change in her coloring, and she is playing happily in bed.  I do not support the idea of performing major surgery on a child who is not sick.”

I don’t think those residents were ready for that kind of response.  They backpedaled and couldn’t find the words they needed.  Then the ER attending came in, and they had a very spirited discussion about the fate of my child.  I thought it was interesting to watch.  I have seen this kind of thing happen in the past, but it’s usually not in front of the patient.  At the conclusion of the debate, the ER doctor demurred, “OK, I will keep her until the surgical attending [translation: the surgeon with all the instincts and experience] can come and see her.” I agreed to this plan, and the three doctors left the room.

Another hour passed.  The nurse poked her head in and informed me that the surgeon was tied up in a very complicated case, and she was sorry about or wait.  She offered crayons and books.  I sighed and thought, “I hope it doesn’t take too long.” J was resigned, lying quietly in bed, only occasionally complaining of hunger or boredom. It would be two more hours before we saw the surgical attending.  I spent most of that time wondering if she really did have appendicitis or not, and how badly this was going to hurt our finances.  I agonized over the possibility of sending her to surgery without cause, and I also worried about taking her home. What if she ruptured and I missed it?  Three hours spent worrying in a sterile, quiet ER room is not good for the soul.

(To be continued)

 

 

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