First ER visit (everything seems fine)

[ToLiveIsToFly]

Frankie was puking up everything he ate starting at 3AM yesterday morning. Particularly frustrating to me because I was out of state and helpless, though I was flying home that day.

Mommy took him to the doctor first thing in the morning, who told her exactly what she expected - he was fine, it was just a virus, it would pass, but to do everything she could to keep him hydrated.

He was happy all day, but he just wasn't keeping liquids down, and when she called the doc again on the way to pick me up at the airport he sent her to the ER. She didn't want to have nobody in the backseat with him in case he puked and aspirated, so she told me the intersection she was at and that I should take a cab, meet her there and drive them to the hospital.

So I got in a cab and told him where to go, and he didn't move. He wanted to know "how far west the intersection was". I had no idea, and told him so, and he refused to move the cab until I told him. So I was looking it up on the blackberry with the slow internet and getting more stressed. I'm sorry to say I didn't remain calm, but I think I refrained from swearing. In his defense, "I have to get moving RIGHT NOW so I can drive my infant son to the hospital" might well have sounded like the kind of thing I'd make up, but it wasn't. He didn't get a tip.

We went to the hospital. I dropped mommy and Frankie off and went home to get him some clothes to replace the vomit-covered one. By the time I got back, he was in an ER room already, which was nice, since I was expecting we'd be in the waiting room for hours and hours.

I found them and they had already seen a resident who said he looked pretty good and shouldn't need an IV. Then a nurse came in and said she was going to hook up an IV. Margy was all WTF the last person said he didn't need one. Then the on-call doc came in and treated us like the kind of parents who thought we knew better than the doctors - how he had a small child too and understood why we would object to an IV and so let's try some kind of anti-nausea drug and see if that works. We tried to tell him we didn't have a problem with an IV if that was what was called for, but that it seemed clear to us that they just weren't talking to each other, but he was gone as quickly as he came.

45 minutes later, no drug yet, and we were getting grumbly and Margy said that she felt like nobody was listening to us at all and she felt like filing a complaint. 30 seconds later doc walks into our room all defensive. It was clear he knew what we had been talking about even he was nowhere near within earshot, which seemed creepy. He sent us home, told us to go back to the doctor's office in the morning.

The doc thinks he's fine, he's been drinking a good deal of water and milk and hasn't thrown up in 24 hours. We might keep him home tomorrow, but he seems fine and happy.

When I went to the daycare to pick up breastmilk I found out that over half his class was out with the same thing.

[tlynn78]

When I went to the daycare to pick up breastmilk ...

Now that's what I call a full-service daycare!

Srsly, glad he seems to be on the mend.


t.

[jsuchard]

I'm glad all eventually went well.

Unfortunately, your ED visit is not really out of the ordinary. I think I see more than a couple patients each shift who could give a similar story of multiple opinions and medication delays.

I'm not trying to be callous about it, but it's really true that the Emergency Department is much better prepared to deal with life-or-death medical emergencies than the much more common, more mundane issues that are often self-limited. If you were the only patient there, then you'll probably get great care regardless of the problem. But when there's lots of patients, the sickest ones get all the attention, and the others take the back-seat. If you are at the ED and feeling ignored, chances are that another patient there would gladly trade places with you.

What I appreciate the most about your story is that you went to your regular doctor first. Then you re-consulted the doctor when things weren't going as well as hoped. If a patient's own doctor recommends going to the ED, because they can't handle the situation out of their own practice, then I am in no position to second-guess why they came.

[Appa23]

I am sorry to hear that you had such a bad experience at the ER. I have to admit that we likely have been spoiled by how great our Children's Hospital is in Omaha. Our only headache has been proving that the older 2 kids actually are our kids the first time that we went there.

Well, I guess that we did wait a long time for a new room when the baby apparently had jaundice the day after we left the hospital (well, the baby had jaundice when we left the hospital after her birth, but they did not check the results until we were home.)

[Beebs52]

Really sick babies are the creeps. I'm glad that, hopefully, all is well. When they're small they're so indecipherable. ER's are just funhouses, I tell ya. Though, I must admit, I've had relatively good luck the few times we've availed ourselves. The situations were usually fairly conducive to immediate attention and we didn't have to wait much.

Prayers and vibes for the babe.

[kayrharris]

Get well wishes to Frankie. I hope he is much better tomorrow.

[ToLiveIsToFly]

I'm glad all eventually went well.

Unfortunately, your ED visit is not really out of the ordinary. I think I see more than a couple patients each shift who could give a similar story of multiple opinions and medication delays.

I'm not trying to be callous about it, but it's really true that the Emergency Department is much better prepared to deal with life-or-death medical emergencies than the much more common, more mundane issues that are often self-limited. If you were the only patient there, then you'll probably get great care regardless of the problem. But when there's lots of patients, the sickest ones get all the attention, and the others take the back-seat. If you are at the ED and feeling ignored, chances are that another patient there would gladly trade places with you.

What I appreciate the most about your story is that you went to your regular doctor first. Then you re-consulted the doctor when things weren't going as well as hoped. If a patient's own doctor recommends going to the ED, because they can't handle the situation out of their own practice, then I am in no position to second-guess why they came.

I hear ya. We knew at the time that the reason our doc sent us to the ER was the reason that I suspect gets you the lowest priority - the patient needs to see a doctor before the morning, but we're closed until then. Maybe Zofran and/or IV fluids weren't things that could have been handled out of our doc's office, but I suspect it was the after-hours thing. If it was MY tummy, I probably would have waited until the morning, but when your doc says take your ten-month-old to the ER, you go.

I certainly don't enjoy waiting for hours, but I also don't begrudge it for the very reasons you mention. In fact, we were in and out in less time than I might have suspected.

One thing I didn't say well in my original post and one I simply forgot to say that change the story somewhat:

The first is that when I was saying that after 45 minutes Margy was getting grumbly, she wasn't getting grumbly ABOUT the 45 minute wait. She just had a lot of time to do nothing but think, and the more she thought about the communication - the resident saying one thing, the nurse coming in to do the exact opposite of what the resident had said, then the attending talking to us like we were spoiled five-year-olds - the more it annoyed her. THAT was what she was getting grumbly about and complained about. Not the wait. We do understand that there are people in worse shape than us in the ER and are more than fine with the way they do triage.

The second is that when I re-read my original post, it makes it sound like the doctor sent us home without actually doing anything. He sent us home after giving Frankie Zofran (is that the right word?) and waiting around long enough to make sure some stuff would stay down. It seemed at the time to help immensely.

[ToLiveIsToFly]

Unfortunately he's back, and he and Mommy are staying overnight. I stayed home with him today while Margy went to work (only fair, I had been out of town and she had been dealing with him the previous 5 days).

I tried to get him to drink as much as I could all day, and he drank a good amount of breast milk (though he absolutely refused water and pedialyte). Margy called from the train station in a panic; she had forgotten to FedEx an important package before she left downtown. She still had it with her and needed a ride to the nearest place that was still accepting packages. Off we went, and since Frankie needed fluids and breast milk seemed to be all he would take, she nursed him in the car while I drove. He drank greedily, which we thought was good until 5 minutes later when he re-enacted a scene from The Exorcist.

I dropped them off at the ER, dropped off the package and came back to join them. This time they did do an IV drip and now they're keeping them overnight. He also got me in the ER. Ruined my phone. Which seems pretty inconsequential right now.

[secondchance]

Good luck with the baby! Hope we'll be hearing better news tomorrow.

[peacock2121]

I am sorry all three of you are going through this. It has got to be frightening.

Hoping it all gets handled soon.

[kayrharris]

I am so sorry Frankie is so sick. Let's hope it's run it's course
and he'll be back to normal very soon.

[Tocqueville3]

It's so very scary when a your little one is that sick. And Frankie is soooo little. Has he been running fever? If not, then that's prolly a good sign.

I am praying that he stops with the puking and gets to feeling better very soon. It's hard to imagine that little boy in your avatar doing an impression of the Excorcist. He's too adorarble!

[jsuchard]

...when I was saying that after 45 minutes Margy was getting grumbly, she wasn't getting grumbly ABOUT the 45 minute wait. She just had a lot of time to do nothing but think, and the more she thought about the communication - the resident saying one thing, the nurse coming in to do the exact opposite of what the resident had said, then the attending talking to us like we were spoiled five-year-olds - the more it annoyed her.

The communications issue is always tough, especially at a teaching hospital (i.e., those with resident physicians).

Of course, if you have three people, you are likely to get three opinions that differ to a lesser or greater degree. If the resident, nurse, and attending physician were all there at the same time, then they could all reach a consensus within a minute or so; but we rarely get the opportunity for everyone to be there at once. And since each member of the team is also dealing with other patients, it may take quite some time for a meeting to occur [this usually only happens automatically with critically-ill patients].

By definition, the resident is still in training, and is working essentially like an apprentice to the attending. Any medical decisions made are ultimately the responsibility of the attending, and that is why treatment may be delayed until the attending can assess the situation, even if just for a moment. Really, the whole concept of a residency program relies on there being differences between the opinion of the resident and the attending; if they always agreed, then there would be no need for teaching and professional development. And it's not always a matter of knowledge, since you can almost always find differing opinions among different attending physicians too. That's why they say "Medicine is an art, not a science." I've also heard it said that, "Medicine is show-business for ugly people," which is pretty close to the mark.

Regarding the "RN vs. MD" issues: suffice it to say that the RNs generally want all of the orders and interventions done at the same time. So if she (he) thought a patient had a good chance of getting an IV, they want to start the IV right away, rather than evaluate and treat the patient in an algorithmic pattern (i.e., if they tolerate oral fluids, then we don't an IV; if we need an IV, we probably also need blood samples for labs; we would probably also need a urine sample, but this may be dependent on other factors, etc.).

I agree that ondansetron (Zofran) is a great drug. Generally effective, and much fewer side-effects than the other nausea drugs. After several years, it is now available as a generic drug.

It's too bad that you ended up with a repeat visit and a hospital admission. (That's what we call "Failure of Outpatient Therapy", and it's a major reason that people get admitted.) If it's some kind of benign stomach bug, it should be no more than a couple of days in the hospital.

[Beebs52]

Here's a question. When our oldest was a baby, very brand new, he did the projectile vomit thingie. It was determined that he had a bit of pyloric stenosis. I quit breast feeding, since I wasn't the best dairy farmer around, and eventually all calmed down.

Is that a possibility?

[Beebs52]

http://kidshealth.org/parent/pregnancy_ ... nosis.html

A link

[minimetoo26]

Here's a question. When our oldest was a baby, very brand new, he did the projectile vomit thingie. It was determined that he had a bit of pyloric stenosis. I quit breast feeding, since I wasn't the best dairy farmer around, and eventually all calmed down.

Is that a possibility?

Rain Man was a projectile puker, but this baby is 10 months old now and it's not habitual. I never had one so sick he needed IV fluids, but came close once. It's scary...

[ToLiveIsToFly]

Here's a question. When our oldest was a baby, very brand new, he did the projectile vomit thingie. It was determined that he had a bit of pyloric stenosis. I quit breast feeding, since I wasn't the best dairy farmer around, and eventually all calmed down.

Is that a possibility?

Thanks for thinking of us. I don't know enough to rule it out as a possibility, but I'm thinking this isn't it for a couple reasons:
- He's 10 months old, and the article says it usually comes on before 2 months
- He's always thrived on breast milk until now
- None of the doctors have mentioned it as a possibility
- The daycare said that half his class is out with the same thing (sorry if I didn't originally post that)
- Mom also spent a bunch of time tossing cookies last night.

[Appa23]

I am sorry to hear that you had such a bad experience at the ER. I have to admit that we likely have been spoiled by how great our Children's Hospital is in Omaha. Our only headache has been proving that the older 2 kids actually are our kids the first time that we went there.

Well, I guess that we did wait a long time for a new room when the baby apparently had jaundice the day after we left the hospital (well, the baby had jaundice when we left the hospital after her birth, but they did not check the results until we were home.)

I had been thinking that our youngest already is ahead of our oldest two in ER visits (2 for the Pudding while only one for Boy and Peanut), but I apparently had been regressing my memory of The Boy''s visit to the ER after his circumcision, as was seriously bleeding from popped stitches.

For some reason, the attending doctor decided that it was his job to yell at my wife for having subjected our son to the surgery, that is was totally unncessary and barbaric. (BTW, someone from his office did the out-patient procedure.)

[ToLiveIsToFly]

The latest update is that Frankie will be discharged later this afternoon. The doctor says that what he's got usually lasts 7-14 days and peaks around day 4, which is tomorrow. Fun, fun. Margy's got the same thing.

Well, enough whinging. Everyone will get better. We've been pretty lucky so far as far as Frankie's health goes. We've got great medical care and jobs with enough flexibility that we'll get through this just fine.

[christie1111]

Here's a question. When our oldest was a baby, very brand new, he did the projectile vomit thingie. It was determined that he had a bit of pyloric stenosis. I quit breast feeding, since I wasn't the best dairy farmer around, and eventually all calmed down.

Is that a possibility?

Rain Man was a projectile puker, but this baby is 10 months old now and it's not habitual. I never had one so sick he needed IV fluids, but came close once. It's scary...

Daughter1111 did once. Toddler so I am saying prolly 2 years old. Dr. knew I was a scientist and had me keep track of fluid in and how long before fluids out kind of thing.

She got to a point where she was not even willing to take the fluids in and was getting lethargic sort of and so the Dr said take her in.

Of course getting an IV in a dehydrated toddler is lots of fun! And then she had to pee before they would release her from the ER.

Hope he is feeling better soon and no one else in the family gets it.

[ToLiveIsToFly]

Here's a question. When our oldest was a baby, very brand new, he did the projectile vomit thingie. It was determined that he had a bit of pyloric stenosis. I quit breast feeding, since I wasn't the best dairy farmer around, and eventually all calmed down.

Is that a possibility?

Rain Man was a projectile puker, but this baby is 10 months old now and it's not habitual. I never had one so sick he needed IV fluids, but came close once. It's scary...

Daughter1111 did once. Toddler so I am saying prolly 2 years old. Dr. knew I was a scientist and had me keep track of fluid in and how long before fluids out kind of thing.

She got to a point where she was not even willing to take the fluids in and was getting lethargic sort of and so the Dr said take her in.

Of course getting an IV in a dehydrated toddler is lots of fun! And then she had to pee before they would release her from the ER.

Hope he is feeling better soon and no one else in the family gets it.

Thanks. There's just the three of us, so I'm the only one left who HASN'T gotten it. And I sure hope I don't. It looks like no fun, and while I have many strengths, suffering stoically while sick is emphatically not one of them.

[Beebs52]

Here's a question. When our oldest was a baby, very brand new, he did the projectile vomit thingie. It was determined that he had a bit of pyloric stenosis. I quit breast feeding, since I wasn't the best dairy farmer around, and eventually all calmed down.

Is that a possibility?

Thanks for thinking of us. I don't know enough to rule it out as a possibility, but I'm thinking this isn't it for a couple reasons:
- He's 10 months old, and the article says it usually comes on before 2 months
- He's always thrived on breast milk until now
- None of the doctors have mentioned it as a possibility
- The daycare said that half his class is out with the same thing (sorry if I didn't originally post that)
- Mom also spent a bunch of time tossing cookies last night.

As soon as I posted this I realized that he was probably too old for it. I know that Greg, our oldest, was probably a month or so old at the time. I'm glad all's relatively fine. I always loved trying to shove Pedialyte and stuff down kiddos.

Be well. You, too!