Pete’s out of town this week doing some Rambo Doctor thing in Texas. Advanced Traumatic Life Support? Maybe? (Supportive Wife of the Year Award). Something where they play mass casualty doctors with rubber M16s.
You can tell how much I really care about it, right?
So of course, as per usual, Charlotte got sick about 24 hours after he left. It started with a runny nose and a cough. It progressed to a fever. Then nasty secretions from the trach. Then came along an oxygen requirement.
So, lucky for us, our pediatrics office has 7 day a week appointments. Even Sunday afternoon. We made an appointment. We arrived at the appointment at 2:30. We saw the pediatrician at 4:00. This was after the triage nurse had recorded her vital signs, with a Respiratory Rate of 56 (normal for CA is 30), oxygen saturation of 88% (normal for CA is 98%), Heart Rate of 170 (normal for CA is 130s) and temp of 101 (normal for CA is 97.6). We still haven’t gotten any oxygen for her, and Caleb is literally bouncing off the wall. During our wait (the office staff was super awesome by the way) I asked if we should go ahead and go to Radiology to get a chest Xray, since it was inveitable and we were waiting anyway. The doctor wanted to see her first.
Finally we go back to see the doctor and he declares that he hates computers and he needs to see a chest X-ray. He listens to her, says she has some nasty crackles and sends us up to Radiology. We get a chest film and head back to clinic. The doctor goes back to see the film and then comes into the exam room and asks me to come too at the film. I put Charlotte back in the stroller, load up all our stuff, and drag Caleb to a room three doors down. We crowd into his office, and he shows me the film. I’ve looked at Charlotte’s X-rays before, but let’s remember, I’m not a radiologist. Looks like a chest X-ray to me!
Her belly was super distended with air, and her diaphragm was compressed, creating about 1/3 of the lung volume she should have had. This is where the appointment begins to fall apart.
“This is an inpatient problem, so I’m not really sure how to help her outpatient.”
What? He then spends the next 30 minutes discussing all the things that are wrong: possible consolidation, although it’s hard to tell because of the compressed lung space. But due to her recent Pseudomanal Pneumonia, you guessed it, “That’s an inpatient problem, not something we take care of outpatient.” I suggested maybe contacting the ID doctor, who consulted on her last pneumonia. He called, and was told to put Charlotte on Cipro. He then told me to call the ID doctor in the morning. (Would you like to give me his contact information? No? Oh, OK, I’ll communicate telepathically.) What about her distended belly? His suggestion, frequent rectal dilation (not going to happen), since, you know, the real solution to this problem is an inpatient solution. He’s getting ready to send us home, despite his frequent, “I can’t take care of this as an outpatient” comments. Really reassuring.
It’s 5:00 and he still hasn’t even addressed Charlotte’s oxygen saturations. He’s walking out of the office and I stop and ask him, “So, what should we do about her saturation levels? I can give her oxygen on the vent, but I don’t have a way to give her O2 off the vent.”
Use Nasal Cannula.
Now, I know that maybe if you weren’t familiar with trachs, this might make sense. But the first thing you learn when you have a trach is that a person breathes through the path of least resistance. Seriously, open your mouth and try to breathe through your nose. Can’t do it, unless you block off your airway, right? Same thing with the trach. So I can go ahead and put a nasal cannula on, but it’s not going to do anything if she’s not breathing through her nose.
I point out this slight problem, and he declares, “That’s an inpatient issue, I’m not sure how to take care of it outpatient. Call the ID doc tomorrow. Thanks!” And walks out the door.
And that’s how I spent my Sunday.
Ultimately, Charlotte was admitted through the residents (they stuck their neck out for me, and deserve a big hug). She’s doing much better now, and we’re home.
And never, ever seeing that doctor again.