September 12th, 2003

Nescafe rabbit

How did it get to be midnight again?

Have been goofing off all afternoon. Bought a few presents for Angel. Didn't get started on studying until 9. Didn't get all that far. Now it's time to go to bed, and I haven't gotten you an update on today, O Best Beloved. And today...was interesting. I'll recap the highlight of my day, which was choosing the other new patient who came in overnight to cover, and leaving the kid with croup for the residents.

En bref: If your child comes in with croup, and the doctors are concerned enough about it (croup can be very mild, or occasionally a kid will come in with what sounds like impending respiratory failure) to recommend he stay for observation...listen to them. If you happen to be at the Hoosier Healthwise hospital, which gets all kinds of funding to help pay for hospital stays when patients cannot...listen to the financial counsellor. If you happen to be currently going through a bankruptcy, and are completely broke, and have no insurance (except your wife's, which kicks in on the 15th of September - whereas today is the 11th), please consider that the doctors are not saying "we would like to watch your kid just to be on the safe side." Please consider that the doctors are saying "your child's breathing is so close to total collapse that we don't feel like we can responsibly allow him to leave this hospital." Please consider that we are afraid, given the degree and intractibility of your child's stridor, that he might suddenly go into respiratory failure and die.
Isn't that just a teeny tiny bit more important to you than your fucking bankruptcy and the fucking hospital bill?

Don't you think, O Best Beloved, that any rational parent, when told by a doctor - several doctors - that their child is not stable enough to leave the hospital, would then say "okay, we'll do what it takes and worry about the bills later."? The father of A apparently disagrees, as he was threatening to leave at 10 AM when we did morning rounds, before the hospital could "suck one more fucking dollar from me." When it was explained to him that his room billing went from midnight to midnight, he informed us that he was leaving, no matter what condition his child was in, at 11:30. That was as long as he was going to let us keep his kid. Because they couldn't afford this, and the hospital wasn't doing anything to help his kid (observing, pulse ox, and two overnight neb treatments with epinephrine back to back apparently don't count, because we didn't do more treatments or something) and we were just keeping the kid here to make more money.
I am speechless. We've explained to him multiple times that his kid isn't in a stable or safe condition. We want him here, where we can have him intubated and breathing 100% oxygen inside of the two or three minutes it would take to get him in the car. Where, should his airway close off as it is obviously threatening to do, he can get the help he needs. We want him in the hospital because it's the best place for him to be. We're fucking doctors. We want to do the best fucking thing for our patients.

JL called S, the social worker, and they discussed our options. It's going to be up to R, the first year post-MD - the intern on call tonight - to deal with the situation. To decide whether he thinks that this kid is going to have to stay regardless of his parents' wishes. Because since A is 18 months old, witholding necessary medical treatment from him can be qualified as abuse. And we can call security and have Dad escorted out, and file a report with CPS against the family, and we can make goddamned certain that A stays here, if we think that his situation hasn't improved enough for him to be safe going home. But we have to be certain that that's medically necessary. What a nightmare.

Is your child's life not worth more than money? Do you not understand? What gives?
I'll leave the rest for another time, as Angel forgot to bug me for bed at 11 and it is now after midnight, and I have to be up at 5:30. Good night.
  • Current Mood
    angry angry
Nescafe rabbit

I have a new rule for you...

...when the senior resident is on call, you get to go home early on Fridays.

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.
  • Current Mood
    confused confused