Long Night

Last night was a long night for more then the reason that time changed.  James deteriorated to a point we have never seen him before.  He had "somewhat" (explain that later) uncontrollable fevers.  We had him packed in ice but couldn't bring it down.  With the rising temperature (40.9) came extremely high heart rate and high blood pressure.  His respiratory rate was high, but not too extreme for James.  He was working hard to breath and needed more ventilation and assistance and would often deSAT.  They spent a lot of time suctioning him, but this didn't seem to help.  They had to medicate him a couple times to bring his blood pressure down and finally sedated him further in order to make him rest and relax better.  Lots of blood work was done and an extra x-ray, but in the end there were no answers.  Eventually a shot of tylenol slowly helped to bring the temperature into a more reasonable level.

 

Looking at numbers is sometimes easier then looking at your child.  A nurse looks at numbers and doesn't have the same special bond with the child.  I found as long as I looked at the numbers I was okay, but looking at James was very difficult.  He just looked completely awful, we had never seen him look so bad before.  We had been telling them all day that he didn't look good, but until the actual clinical signs begin to show there's nothing to be done.  And even then, what can be done when you have no idea what is going on.  Yesterday they did start him on antibiotics.  The lavage showed a bacteria and since it was not very strong they felt it was likely just an unsterile culture or too mild to treat.  But given the current situation we have nothing to lose but to try.  This is a bacteria that should have been killed by the previous antibiotics, so I'm not sure how to explain why it was found.

 

As if dealing with James last night wasn't enough we also had to deal with the most awful nursing staff we've ever seen.  I think this in itself is what made the night so long and awful.  Right from the beginning of the shift it was battles with a nurse who thought she knew everything and within two hours could tell me more about my child then I had learned in the last 2 3/4 years.  I'm not sure what I would have done if I heard the words "hospital policy" one more time.  After a few smaller battles she then basically refusing to give him tylenol because hospital policy and pharmacy says you should have one or the other and ibprophen seems more effective for him.  This after the child has been receiving both for days (and even prior to his ICU admission) in order to attempt to control his high fevers.  I figured I had to chose my battles and it almost being time for his ibprophen I'd bid the time and pack him with ice instead.  And this is why I say he had "somewhat" uncontrollable fevers.  Finally at 3 am everyone was in a panic because they couldn't get him stabalized so they decided to try some tylenol ... and wouldn't you know, in the next hour his fever slowly came down.  Still a fever, but much more reasonable.  It's one thing if it's one nurse you're doing battle with, but there were two, the nurse and the head nurse.  I felt sorry for the training nurse who felt stuck in the middle.  And then you can see them whispering away everytime they leave the bedside.  There were several other issues we had to deal with, plus their attitude of thinking they needed to teach me how to do everything. I won't bother getting into them because I still get rather worked up talking about it and after several almost yelling matches last night I rather put it behind me.  This morning we talked to the charge doctor about what had happened overnight, not surprising he knew immediately who we were talking about when we told him who are chief complaint was against and said he would deal with the issues immediately.  Oh ... and there's no hospital policy about tylenol and ibprophen, it's the doctors call ... like I didn't know that!

 

Thankfully by this morning James fever was gone and with the extra sedation he was able to rest nicely finally.  He looks better, but his eyes tell us alot and considering he's had them closed all morning sleeping it's hard to really say.  Either way it doesn't mean we're at the end of this road as we've had the fever come down before just to respike, and as I left for lunch his temp was climbing again.  We have no idea in the end why the temp finally came down, we just pray it won't skyrocket again.

 

Needless to say I got little to no sleep last night so I will try now.