Friday, June 28, 2013

How to be blacklisted from the ER

Have a mental breakdown over the pros and cons of infant ibuprofen and infant Tylenol.

Granted, there's more to it than that, but I'm sure in the eyes of the ER staff, that's exactly what it looked like.

You know how things can silently and quickly build up until all of a sudden you find yourself a sniveling mess of a person over what is sometimes a triviality?  That was me last night. 

Hello, I'd like to introduce myself.  I'm the mom who brings her sick child in as a last ditch effort to find someone who can help.  I'd also like to let you know that this is our third medical consultation in three days.  I've been to Meijer/Walgreens 3 times now to find something that offers relief, once at 1:30 a.m.  I'm tired.  I haven't eaten anything for about 7 hours now, and at the glacial pace that this is going, the food outlook isn't good for the immediate future.  I'm beyond worried that I can't control my daughter's fever.  In fact, I gave her ibuprofen, and it went up; I gave her Tylenol 3 hours after the ibuprofen and it still went up.  The medical staff at our doctor's walk-in clinic sent me to the ER because they don't have anything else to offer me, which scares me.  She has had full-body (including face) hives for three days now, and each day has been worse than the day before.  She is swollen and itchy and burning up and only wants to snuggle but doesn't want to be touched or moved.  I'm going to go a bit nutty on you, and no one is going to see it coming.  I know that your job is very stressful and very difficult.  I will not be making it any easier tonight.  Please, bear with me.

Neither Ben nor I had ever really seen anyone with hives before, so when Audrey started getting angry red bumps covering her legs and arms, we thought she had bug bites all over.  To me, hives are something that you hear about, shake your head, mutter "Oh, that must be horrible!" while thinking "Wow, glad I don't have those..." and continue to listen to the person's litany of medical problems.  They go hand in hand with shingles in my medical understanding: I don't (now read that as "didn't") know what they are other than a skin problem, and they're not fun (i.e. people make them out to be torturous). 

What has caused Audrey's hives has been the million dollar question that is still unanswered, though speculation is rampant.  And my frustrations thus reached a breaking point when confined for 3 hours to exam room 4 purgatory with a feverish, hurting 12-month old, I felt that they were glossed over for the sake of only addressing the fever.  Yes, please help me with the fever, but please, PLEASE help me control the hives! 

Everything in my mom-turned-doctor understanding is that you must be judicious with ibuprofen and Tylenol.  There are warnings on the boxes.  The doctor that we consulted the day before (whom we have seen before and have a trust-understanding with) specifically instructs me to be judicious with the OTC meds.  The pharmacist whom I consulted about the whole ibuprofen/Tylenol quagmire that I felt mired in and upon whose advice I ultimately took Audrey back for her third medical consultation specifically warned me about dosage and advised me not to stack both on top of each other because medical understanding has changed. 

I understand that our fundamental understanding of medicine is something rather chimerical at best and hazy at worst.  And my fear came to a head when the medical voices that I consulted were not in agreement.  What does a parent do at this point?  Perhaps I should have thrown caution to the wind and spent the 100K+ for my own medical education (I jest).  But when a doctor says "Use infant Tylenol" but the box of infant Tylenol doesn't even allude to any sort of dosage for any child less than 2 years old, even though it's labeled "infant," what is a parent to think? 

I'll say it: you don't know what to trust and you think of meds that are generally considered as innocuous as ibuprofen and Tylenol as potentially dangerous and that which must be monitored carefully.  So when the innocent nurse's aide came into our exam room brandishing not just ibuprofen or Tylenol but both together and in a HUGE dosage, I flipped.  The box says 1.75 mL for her age/weight.  When I called the doctor's office today, he said 3.75 mL for her weight if only over 100.5.  And when the nurse's aide comes in with a syringe full of ibuprofen at 5 mL (we never got as far as the Tylenol because, yes, I freaked), my tears runneth over and my normally modulated voice (really, I'm pretty good at being calm and non-accusational with medical staff) turned into something better resembling a harpie.  That's probably why the ER staff whole up in a area that is completely shut off from everything.

Ultimately, I'm glad I fought back to the extent that by this point, it had been so long since we were first seen that Audrey's temp had lowered and she didn't need both dosages of meds.  And in hindsight, I shouldn't have chosen this hospital to take her as I quickly remembered that it functions on a metric system, which is essentially a different language in my right-brained mind.  Yet when pressed repeatedly about why I should follow these high dosages and what in my mind is a very aggressive use of meds, even if they are OTC, I never received an answer other than "We know what we're doing because we work in a hospital.  I'm a doctor, so you should trust what I say."  No, I don't because frankly, we're on a first date here, and you're distracted by the cute girls across the room who are demanding your attention (to wit, the two people who were brought in on gurneys prior to his consult with us).  They acknowledged that I'm getting conflicting information but then turned around and said "But, really, you should trust what we say and not what you heard elsewhere."  Red alert to a scared mama's mind.

All of this is not to say that I blame the hospital or the staff for what turned out to be a lousy experience.  It was what it was, and it could have happened in any medical office by this point.  As a teacher, you come to understand that the crazy parents are crazy out of fear for their child's well-being and a fierce love and sense of protection.  As a parent, you understand that the teacher (or in this case medical staff) has a job to do and sees your child as one of many that pass through their doors, understanding that the child is special but also knowing that you only have to much to give to this one case, especially one who isn't bleeding.  (I did dwell on the irony of my weeping into Audrey's baby soft hair as we paced in the hallway of the not-as-much-of-an-emergency side of the ER as we watched two people who I'm guessing were in a car accident and probably were bleeding being wheeled in on stretchers.) 

Once our life gets back on a more even keel (I started the week taking Abby to the dentist for a 2-hour cavity fix, which is, of course, also a fun adventure), medically speaking, I'm going to write a thank-you-for-helping-us-even-though-I-pulled-a-nutter note and make some cookies and take them in for the ER staff.  They were making choices that they thought were right.  And though I don't fully agree with them, I understand their intent, and I thank them for that.  Regardless, I'm still going to drive across town to our familiar hospital next time.  (Please, let there not be a next time.)


Mariah said...

I'm betting that you had been using the concentrated infant Tylenol and they were using the new, non-concentrated kind. They recenty changed it so all children's Tylenol must be non-concentrated, so that's why it's 5 mL instead of 1.6-or-whatever mL. It is so scary to have a sick baby. Davis had a 103+ fever for four days at Thanksgiving - fun, fun, fun. I hope Audrey is feeling much better soon. If you need to reschedule our toy party so you can stay home and snuggle her all weekend, we can do that!

Amy said...

She's improved today--hallelujah! Her fever topped out at 101.8 & Tylenol took it down quickly. I didn't know that there was a concentrated/non-concentrated thing happening. You'd think that the hospital staff could have articulated what you did. For me, this is how I'm earning my parenting gray hairs, I guess.

Crystal said...

Ah-Ha! The parenting gray hairs are the best part. :) Sick babies aren't fun and hives are the worst. Ick.