Saturday, October 24, 2015

You're Not A Good Anesthesiologist

Chantelle has quite the personality and often speaks what she is thinking. During her last surgery she had a new anesthesiologist and did not think she was good because she all business and did not have any good jokes to make her giggle.

As she was in IRC and in the process of being put under with the laughing gas first, Bug is used to the anesthesiologist telling her jokes to help her giggle and take good deep breaths. Well this anesthesiologist was business and this step was not as important to her. This step is an important part of the routine that Bug has become used to, and skipping this step is unacceptable, as was pointed out.

Bug- You're not a good anesthesiologist!
Dr.- Oh really why is that?
Bug- Because you don't know any good jokes. You have to know jokes and makes kids like me laugh. I know jokes too but that's your job not mine. I'm not scared, but you can't let others get scared.
Dr.- You're very right.

At this point she tried telling a joke and Bug laughed saying "that's worst joke I heard." She then told one and had everyone laughing. At this point the anesthesiologist nodded to the team to used the sleepy medicine and she drifted off to sleep.

As I was walking out of the room the anesthesiologist motioned for me to come to her an with a very serious face she told me, "Your daughter is right. It's my job to help make sure these kids are not scared and their last memories are happy silly memories. Many of them will wake up confused, scared, and in so much pain because of what we have to do. I need to help them better."

Failed Feeding Tube and Tube Change

So almost three weeks ago during an appointment with the pediatrician Dr. M to take care of paperwork for the military for our upcoming move we discovered the stability button in Chantelle's G-Jet (GJ feeding tube) had failed and her tube was sticking over three inches away from her stomach. At the sight of this my heart dropped into my stomach, and Dr M commented that he was sure that not right.

I took the opportunity to show him exactly where the stability button is "supposed to be" and at that excused myself from the exam for a moment leaving Bug with him as I left and went to the immunization clinic to ask for a slip tip syringe. (Of course only being there for a quick appointment I did not have my bag with me, nor did I have anything in the vehicle I was borrowing) Not understanding what I was needing and that I did not need a needled syringe the immunization tech was very unhelpful. Not in the mood to run to the blood lab, Dr M and I med back up and we decided that I would simply call Johns Hopkins as soon as I got home and we would devise the best route of action from there.

We hurriedly finished the EFMP appointment and paperwork and I left. Once home I called the GI clinic, explained what was up, that we had no spare, and waited.

Finally about 4:30 that evening we were told to take her to Urgent Care to get a KUB with contrast (stomach Xray) to determine placement. After calling the insurance we get authorization and head over to urgent care only to find out that because she has GJ tube she needs contrast and they are unable to use contrast so we had to go to the ER instead. (sigh... very annoyed by now as it is now 7pm).

We left for the local ER and watched an ambulance race past us with both lights and sirens. Resigning myself to a very long night.

Once checked in I checked the time board and noticed a 15 minute wait, yet knew this was not to be with the ambulance that passed us and knew another had turned off a road just minutes from the hospital. Within five minutes of sitting down and both of of us settling into a book, four more ambulances pulled up. Within minutes, the time board jumped to a 45, 60, then 90 minute wait. The other hospital 30-40 minutes away had wait times even longer. Since we were there for a simple KUB, I was NOT making a 30-40 minute drive then waiting all night since we were already early in the line.

By the time Bug made it back to a room, I explained exactly what was up, what we needed and why. We were blessed with an amazing nurse and PA. The xray order was made, they sent her back right away for her "tummy pictures" and thank goodness her tube was in place and nice and deep in her jejunum, where it needed to be. We arrived home just after midnight, exhausted but thankful to be able to use her tube until we could have it replaced. This meant she got to stay home and not be hospitalized this time.

Unfortunately Bug was unable to attend school for the rest of the week as I had find a way to secure her feeding tube. Frustrated and still waiting for a spare tube, I got creative. Unfortunately, while she was back at school, she was unable to participate in PE or recess. The risk of her tube being pulled out was to high.

Tuesday the 13th, I got a call that they could finally do the surgery. Of course the intended day would have been October 15th. My only request was the following Monday on the 19th. If possible I wanted to keep her home on her birthday. Thankfully, Children's agreed. Finally, two weeks after her tube support, we were going to be getting her tube changed.

Realizing that we never got the confirmation call telling us for sure what time to be there on Monday, I called to verify our arrival time and discovered her surgery had been cancelled because her tube still had not arrived. As of Tuesday morning, my message stated her surgery once again had to be cancelled and rescheduled, again due to the tube not arriving.

However, 3:45 Tuesday afternoon the surgery prep nurse called for the third or forth time that day letting me know they had just received her feeding tube and Bug needed to be at Hopkins peds surgical center by 7:30 Wednesday.

At this point we now had to get her pre-op steroid prescription, and begin  her pre-op process.

Surgery went very well, and when I came back to the PACU the silly child was already wide awake.

She went into surgery at 10, we headed home at 12:30.