12 February 2014

Warning: Whining Ahead

We had our first child-related trip to the ER last night. The label "Emergency Room" would imply the situation was an emergency, but it's incredible how often a person has to go to the hospital for something completely not a crisis. That was us and the entire pediatric ER waiting room last night: a whole bunch of families who did not look or act like they were having a catastrophe and needed immediate attention. I did everything possible to avoid the hospital and its $200 copay, but in the end, that's where we found ourselves.

So Abigail had been constipated for a few days and had barely eaten. She'd vomited once the day before and it was clearly related to the constipation. Since she eats a primarily dairy-based diet, she gets constipated often, but I usually just increase her fluid intake, give her extra fruit, and she clears up within 24 hours. Not a big deal. After open-heart surgery, it takes a lot to rattle me about Abigail's health. But she was rejecting fluids yesterday. And if there is one substance Abigail will gleefully consume, it's beverages. She loves water - warm or cold, milk, non-dairy milk, smoothies, and juice. And by yesterday evening, she'd had only 8oz of fluid, despite my myriad of attempts. She had one wet diaper all day and it was not even half full. She was short-tempered, clingy, and sleeping more than usual. My mommy-gut was starting to alert me: This has never happened before. And how can you get ahead of constipation when your kid won't drink? I was nervous to let her go another night without consulting her doctor.

I called the pediatrician (well, the triage nurse on staff) and described all our symptoms, to which she admitted that Abigail did sound dehydrated and they weren't equipped to do a saline solution there. She advised that we head to the ER. After some discussion, she recommended a pediatric urgent care clinic that wasn't too far from the hospital (which is only 25 minutes from our apartment) that we could try first to avoid a hospital visit. She warned that young, non-verbal kids can go from bad to worse really quickly, so it was best to take action.

It was about 5pm in the evening, I'd just gotten home from picking up Matt from work and was about to start dinner. Of course it was one of those days when I'd barely had lunch and there was little food in the cupboards as I need to go grocery shopping. Everyone knows emergency rooms are incredibly slow, but I wasn't expecting anything too drastic, I mean, we just needed a saline IV. I packed a bag with some books, snacks, and water bottles, and all three of us drove to urgent care.

The nurse at urgent care didn't even admit us - she heard about the lack of wet diapers, the behavior change (clingy and grouchy), and sent us to the ER. She told us that the pediatric urgent care clinic didn't do IVs in little ones. The pediatric clinic doesn't poke little kids. I still haven't wrapped my mind around that one.

So shortly before 6pm, we found ourselves standing in a long line to enter a metal detector at a hospital emergency room. Yes, you heard that right: a metal detector. I checked three times to make sure we had entered the correct door. It looked like an airport security terminal. There were a few security guards milling around, an x-ray device to see inside bags and purses, and we had to empty our pockets into little plastic bins. Matt and I were in shock at the bottle-necked entrance to an emergency room. Eventually we got through the line, the two check-in stations, and found seats in the pediatric ER waiting room. Where we waited. For hours. All because Abigail was approaching dehydration.

The room was crowded and as kids' bedtimes ticked by and bored adults got sick of staring at exuberantly painted walls, everyone started getting a bit testy. The vast majority of people in that waiting room could have been sitting around anywhere. A three-week-old sound asleep in his mother's arms as she messed around on her phone. A teenage couple getting into a spat while their young daughter toddled around the waiting room chewing on a teether. A school-age boy shouting at his dad in Spanish over something he didn't get at the store. Very few patients looked as though they were having an emergency, including us.

Abigail was signing "eat," but refusing the snacks I brought, signing "water," but refusing to drink, signing for toys I didn't bring, fighting exhaustion, and trying desperately to walk around the waiting room. Matt and I passed her back and forth between us for about two hours. When a tech finally appeared and called Abigail's name, Matt and I literally cheered.

Things finally started going our way once we got back to our room: an attentive nurse showed up promptly, a friendly physician's assistant with a good bedside manner discussed possibilities. An order was put in for an x-ray to determine the severity of the constipation and we were left in our quiet room.

Then the nurse stopped by to offer us some juice to get Abigail drinking. She needed a urine sample, she explained.

"A urine sample? From a dehydrated toddler?"

I explained that I had brought water, a juice box, and some snacks, but that Abigail wasn't having it.

"Well, we have apple, grape, water, and milk," she offered. "Would she like it in a sippy cup?"

WTF? I thought. Like I haven't been trying this all. freaking. day? If I could get her to drink, I WOULDN'T BE HERE RIGHT NOW.

I selected apple juice just to get her to leave.

The nurse returned quickly and stood over my shoulder to see if Abigail would drink it. Abigail took a small sip and pushed the cup away.

"Do you want more juice?" She asked loudly. "More juice?" Abigail signed "more" because she heard the word "more" being emphasized, which got the nurse all excited. But I knew better. I kept offering the juice, Abigail kept refusing. The nurse finally left us.

And we waited. And waited. Abigail was getting irritable again. Matt and I played every game we could concoct in our hungry, tired, irritable states and got Abigail to drink three more ounces of apple juice.

Finally a guy popped his head into our room. He was probably in high school, wearing a bright red polo with khakis and carrying a clipboard. I was positive he was the tech who was going to lead us to the x-ray until I spotted the word "volunteer" on the back of the clipboard.

"Can I get you anything?" He asked with an expression that begged us to reply in the negative.

I asked if he could get us an ETA on the x-ray, which he thankfully did, although the response was, "there are people ahead of you, it could be a while." The nurse did tell us that if we wanted to wait up in the x-ray area on a bench, we might be able to get in faster. We excitedly agreed. As we followed her down the winding hallways, we passed empty x-ray room after empty x-ray room. There were people in hospital beds in the hallway waiting outside of lit, empty x-ray rooms for their turn to have an x-ray. On my way to the bathroom, I found yet another hallway of empty x-ray rooms.

The hallway was cold, the bench was uncomfortable, and Abigail was so freakin' done with life at that point. She oscillated between slap-happy giggles and angry outbursts with breakneck speed. My blood sugar was crazy low, my back hurt, and I was so tired I was starting to get nauseous. Matt was not in much better shape. I don't know how long we waited in that beige hallway, but finally someone called for Abigail and we got a perfect x-ray after the first try.

"How long will it take to read the x-ray?" I asked the technician in a voice slightly-higher pitched than normal. I was terrified of the response.
"Usually it takes 45 minutes to an hour, but we're really busy today," he responded apologetically.

We were back in our room by about 10:20pm, found some Olympics on television, and tried to settle in. The nurse popped in every once in a while to try to get Abigail to eat some crackers or drink some more juice, which was irritating me in the extreme. I am her mother, the person she is closest to in the world, and I can't get her to eat or drink, why would a complete stranger have better luck? And most importantly, if she would eat and drink, I WOULDN'T HAVE COME TO THE E-FREAKING-R! And I was right: the nurse's obnoxious persistence got her nowhere. We also checked periodically to see if Abigail had a wet diaper they could run a test on, but she was perpetually completely dry.

It was almost 11pm when I finally lost it. Between the dizziness, lightheadedness, and exhaustion, I felt like I was drunk. Turning my head quickly, lifting Abigail, watching the slow-motion replays on TV, all sent my head spinning. It was almost FOUR hours after Abigail's bedtime, she'd barely eaten in two days, and she didn't feel good. Matt was starving, exhausted, and just as angry as I was. In hushed voices we went over our case with one another. We had done everything possible to try to avoid a trip to the ER: we spent two days working through solutions at home, we contacted the pediatrician, we went to urgent care. We were talking about a non-crisis, border-line case of dehydration, but apparently the only place in all of America that can handle such an event is an emergency room.

I paged the nurse and asked if we could get started on the [damn] saline solution while we waited for the [f-ing] x-ray results. (Words in brackets means they only thought and not spoken). A few minutes later, she popped into our room, "Why do you want to start her on an IV?" she asked.

It took every last ounce of strength I didn't know I had to keep my temper under control. I explained our logic:

-We're here on concerns of dehydration
-The pediatrician said she'd need a saline bag, and we could only do that at an ER
-The urgent care clinic said she'd need a saline bag, and we could only do that at an ER
-Why not start the saline bag now while we wait for x-ray results? You know, speed things up a bit.

The nurse detected my anger and paged the physician's assistant. It turns out they never wanted to do a saline solution because Abigail was acting mostly normal. Her lack of lethargy was an indication that her dehydration was not very severe. Apparently IVs are more "invasive" and they like to approach things "conservatively" and not traumatize young kids by poking them unless it's necessary.

I laughed. I honest-to-goodness laughed. A bitter, sarcastic laugh that came out before I could stop it. I couldn't look the nurse or the PA in the face at this point, I definitely would have yelled. I explained that Abigail gets poked a lot. Between the twice-yearly blood work, any in-between blood work a specialist wants, and the vaccines...she doesn't usually even cry about it. An IV wouldn't traumatize her. I explained that it was FOUR HOURS past Abigail's bedtime and we had accomplished nothing that I couldn't have done on my own at home.

As we were talking, Abigail's x-ray results came back (Coincidence? Who knows) indicating that she had mild to moderate constipation and no blockages about which to be concerned. He recommended that we keep trying bits of food and fluid with Abigail.

He assured us that if we had to come back, they wouldn't repeat these tests and would start her on an IV quickly.

Oh, joy.

He said a bunch more things, most of which seemed unimportant and I kept inserting the question, "So we can just go home and keep an eye on her?" every time he paused. There was a 0% chance we were going to spend more time in that exam room waiting for Abigail to pee.

As soon as the doctor left the room to get our discharge paperwork in order, Matt started packing things up and offered me my coat. I had to laugh again, this time a sad laugh. Discharge paperwork never arrives quickly.

It was midnight by the time we arrived home. We had left the apartment SEVEN hours earlier because Abigail was ALMOST dehydrated. And we arrived back home in the SAME CONDITION that caused us to go out in the first place. Sans a $200 copay.

Abigail fell asleep within moments of her head touching her crib. Matt and I scarfed some Taco Bell and hit the sack just as fast.

But wouldn't you know it? I had insomnia. I could barely stay sleeping for more than an hour at a time and it would take forever to fall back asleep. And when the alarm went off in the morning, I realized I had a nasty headcold. To make matters even worse, Abigail did not sleep in this morning, waking up at her usual 6:30am. I'm completely exhausted, Abigail's a total (still not-eating or drinking) grouch, and there is still no food in the cupboards. I have zero expectations for today. Matt has been checking in from work almost hourly and has assured me that he can get things in order and be home quickly on a moment's notice. He just may have to. In the meantime, I've been Googling "why ERs are so slow," and apparently it's a national epidemic. From now on, I think we'll be waiting to head into an ER until it's actually a catastrophic, crisis emergency.


Anonymous said...

What? I thought our dear Commander in Chief had fixed all of this?!

The security checkpoints are exceedingly alarming.

What a mess. I'm sorry you've been through all this. Have you ever tried suppositories ...I think they're glycerine sticks or something like that and you can insert them yourself. According to Dr Sears you should be able to get them at the pharmacy.

Just a thought. I sure hope your day improves! TB

Anonymous said...

PS you have every right to WHINE over this one!

Anonymous said...

Also, we have constipation/hemerrhoid issues in our house, so I put ground flax in everything I bake, as well as yoghurt and smoothies. Ground flax helps keep things regular. I wonder, too, if you can put magnesium powder in her drinks, which is natural and has a laxative effect. "Natural Calm" is the brand I use during pregnancy.

Anonymous said...

Part of the reason ERs are so slow is that everyone who has a catastrophic emergency gets seen first. Did you go to Ingham? They're notoriously slow, and for no obvious reason. I know where I work they have a "fast track" program to try and speed through people that could potentially be in and out quickly.

There is definitely a gap in available care between urgent care and emergency, especially for kids. I'm sorry you guys had such a crappy night. Hope Abigail (and you!) are feeling better soon.


Cam Wollner said...

Ugh. You absolutely do have every reason to complain because that sounds horrible.

If you can get anything at all down her the thing that helps us the most is Magnesium. I give Mae 250mg normally with 1/2 a child's probiotic (although she is much heavier than Abigail) and that usually works really quickly (our record was 8 days without going, although she was at least drinking which is how we lasted that long). That's not all that helpful though since if you could get anything into her you wouldn't be facing this so really I'm just rambling hoping something I say might be a tiny bit helpful!

Anyways, we'll be praying for you guys and hoping you don't end up back there?

Anonymous said...

You are all in my thoughts and prayers. Please keep us all posted on how she's doing!

Anonymous said...

You are all in my thoughts and prayers. Please keep us all posted on how she's doing!