I left the hospital at about 2:15 today, after drafting up my discharge summary for the sepsis baby. Have discussed matters of weekends with my resident. He says "How about you make up the time during the week?" I said "How about I take an extra evening call a week?" We agreed. I get to spend Saturday and Sunday at home. Yay.
The most interesting thing that happened today - besides everyone thinking my pig is too cute - was the update on the kid I mentioned yesterday.
Seems around about 6:30, the father decided it was time for him and child to leave. The doctors felt at the time that the child was not stable enough to be discharged. It was explained to the father in plain terms that with his child's condition what it was, there was a very real possibility of him going into respiratory failure and dying if he were to be taken home. Please note: this child was a drop in his oxygen sats away from being intubated. We wouldn't have sent him home even if his parents promised to call 911 at the very first change. What the father did next sealed matters, though. His response to this explanation? "I don't care. We can't fucking afford to be here." Some discussion ensued, during which the father became belligerent. At one point he stated that even if all the the child needed to be discharged was followup meds at home - he wouldn't get them. Things got bad enough that Security was called in. Security escorted the father to the door. And sometime in there, he was overheard saying he was going to come back with a gun. Security was reluctantly convinced not to file a CHINS (Child In Need of Services) report on this kid.
Now it becomes a simple fact: We cannot legally or ethically return a child to a dangerous environment. And the father's words, followed by the child's mother's pleas, have raised the question in our minds of whether discharging him would do precisely that. So now instead of being willing to send him home as soon as he's stable - even if he's still sounding like he could use observation - we'll keep him here, because there is significant doubt in our minds as to whether his father would "afford" to call an ambulance in the possible event that this child occluded his airway and turned blue. That's how concerned he seems to be about money.
Mom, after Dad was escorted out by Security, began pleading with us to release the child. She's convinced that if we keep the kid, the father will divorce her, and her wifely green card will be null and void, and she'll be deported back to Russia. It sounds like a threat she's heard before. And she begged because "you don't know what he's capable of." This woman looks, acts, and sounds like someone who's completely under her husband's thumb. She acts and sounds like someone who's been abused. But we can't prove it, and we can't file a suspicion report on an adult.
The resident there overnight was worried, the nurses were unnerved, and everyone's trying to figure out what to do with this kid. Meanwhile, his X-rays from today show an airway the size of a paper straw and his mother is still trying to get us to send him home. When I left, he was going to have an ENT consultation and we were still wondering whether the parents' attitude would qualify us to file a 310 report with Child Protection Services. There's neglect and/or abuse implicit in withholding necessary medical services from this kid. Is it enough?
Will find out Monday after talking with S, the social worker. I told her I was going to want to know what transpired. Damn right I'm going to want to know.
But for now...I'm going to pack up and go home, where my Angel is waiting for to spend the weekend with me.