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Tuesday, November 15, 2011

A Stitch in Time

I got a phone call yesterday about  mid-way through my day informing me that Lily had fallen on the playground.  Actually, the way it went down was something like this:

1:13 p.m.
"Hello, Mr. W?  This is the school nurse.  Lily fell down on the playground today.  We tried to call your wife but she didn't answer her phone."

The first thing that ran through my head was. . . 'is Lily okay?'  This was followed immediately thereafter by 'Are. . .are you tattling on my wife for not answering her phone?'

The nurse continued, "We think she's going to need stitches."

There was a long pause, during which I was uncertain what I was supposed to respond, so I went with, "What do you need me to do?"  The nurse responded that I needed to come get Lily.  I explained that my wife and I were both 30 - 40 minutes out and that we'd be there as soon as we could, but could Lily go back to class, since the last time I picked her up they had her. . . all 3'6" PDD NOS ADHD of her sitting in a chair, still; waiting until someone showed up.  That seemed like torture to me, but the nurse said, no, they were worried she'd bump her head.  Whatever.

As I was getting packed up to go, my wife called.  "I got a call from the school, what's going on?"

"Lily fell on the playground and needs stitches.  I'm going to take her to the Emergency Room at Children's," I replied sensitively (ish).

Waterworks.  Okay, possibly I could have couched my reply a hair more carefully, but I had stitches when I was a kiddo, and didn't really think it was any big deal.  I explained this . . . probably just as sensitively (ish).  It was agreed that my wife would meet us at home and we'd all go to the E.R. together.

1:45 p.m.
When I showed up to the school to pick her up she was sitting very nicely, reading a book with her visibly upset dedicated aide.  The nurse said, "Her bandage is soaked through.  I was going to change it as soon as you got here.  Do you want to see it?"

"Why?" She sorta caught me off guard.  I guess her thinking was maybe I thought the school was blowing it out of proportion because I'd asked her earlier what she wanted me to do, and I think she'd just assumed I'd  know that Lily needed to go to the E.R., instead of asking.  Maybe she wanted to prove to me that it really would need stitches.  I'm not really sure.  I continued, "I mean, I don't know what I'm looking at.  I'm relying on your judgement as to whether or not she needs to go to the E.R."

"Some parents like to see," she responded, a bit defensively.

I shrugged, "If you're changing the bandage I'll see it regardless.  Go ahead."  I felt like the whole encounter was a little "off".  Maybe it was just me, but it seemed like the nurse was ready to go to battle if necessary.  Maybe they have irate parents spitting nails about the carelessness of the playground staff or something.  I don't know, it just seemed weird.

I gather that what happened was that Lily was skipping across the pavement, and caught a toe.  She has ZERO reflexes, (like the doctor who tested them kept doing double takes when her knee wouldn't respond to the little hammer taps), and didn't try to catch herself, landed on her face, glasses jammed into her eyebrow, and the lens cut a gash into it.

She changed the bandage.  Jesus!  Okay, I'm no doctor, or nurse, or. . . whatever.  I'm not.  But in my medical opinion, she needed stitches.  Deep cut right above her right eyebrow.  Deep.  It shook me up a little.  I think I was expecting it not to be quite so deep.  Did I mention deep?  Remember when I said "whatever"?  Yeah, that was before I saw the cut.  I got it then.  I wouldn't have sent her back to class either.

Lily was a champ.  I gathered her up and we hopped in the car and drove home.  She was in good spirits.  Sometimes it's a bonus that she has the pain tolerance of Wolverine from the X-Men.  Her mother greeted her warmly, tears now long since dried up, Mama Bear mode initiated.

Emergency Rooms are ridiculous.  It's not all their fault, because people use them like a doctor's office.  My own pediatrician often sends Lily to the E.R. for stupid things like blood draws or tetanus shots, and while Children's Hospital is uniquely qualified to handle. . . children. . . sending someone to the E.R. for a 10 second blood draw amounts to killing an entire day in a waiting room while they process in the order in which the kiddos are received (or the severity, of course) sometimes resulting in an 8 hour visit for a 10-second draw.  Regardless of how you do the math there. . . stupid.

2:35 p.m.
Children's Emergency room has never failed to disappoint me not only in the duration they require my child to wait in order to receive care, but also in their lack of understanding of what the aforementioned spectral abbreviations mean for the child who is being asked to wait.  I was disappointed once more, but this time only because I expected to be disappointed, and they didn't disappoint me, so I was disappointed that I was wrong.  If you followed that reasoning, you don't need me to tell you that means Children's did a nice job.
"I want Misdowalds."

She occupied herself staring at the fish tank, 'reading' stories, or looking at the wall of bubbles.

There was only one real touch-and-go moment, when Lily pulled the band-aid off her head, exposing her cut.  I had to pin her hands and my wife had to get a nurse (who took way too long to make her way to me with a new bandage and gauze) while Lily, upset with being restrained, attempted to chew her way to freedom.  It all lasted perhaps a minute or three, tops, and there was no breaking of the skin (mine), so all things considered, we (I) made it through unscathed.

Here's something that bugged me:  She's got a deep cut on her forehead.  Do you know how many people wanted to take a look at that deep cut?  People removed her bandage and then replaced it with a new one.  I'm not a bacteriophobe, but it seems to me that maybe one person should look at it and then the next person who sees it, is seeing it because he/she is in the process of working on it.  The admitting nurse took it off to look at it.  The nurse that put the new bandage on it (because it was loose from the admitting nurse looking at it and Lily pulled it off) looked at it.  The E.R. resident looked at it.  The E.R. intern looked at it, and the doctor who finally stitched her up looked at it.  Why?  Why did those previous people look at it?  By the time we were in a room . . . at. . .

4:10 p.m.
. . . three people had already looked at it, and there were two more to go before the process would ultimately be completed.

I get that the hospital is a learning experience for the intern, so that makes sense.  I even get the admitting nurse to some extent, so she could direct us to the appropriate area of the E.R.  I don't know.  We answered a series of questions at one point enough times that my wife just rattled off a series of answers in anticipation when the next doctor/nurse would start in:  "She fell on the playground, her glasses cut into her forehead, no the glasses didn't break, no she hasn't eaten or had anything to drink since 12:10."

I added my own flavor these as they continued to grow more redundant:  "Did you talk at all to anyone who has already seen her?  I'm concerned that you don't know the answers to all these questions already.  You're aware she's autistic right?  You're aware she's had emergence issues when sedated, right?"  And so on.

Each person who learned that Lily had been sedated for surgery in the past and woke with "Emergence" issues vowed to look up in her records what the sedative du jour had been in order to avoid it this time, until the next person would arrive on the scene, also unaware of the issues.  That piece was disappointing.

Lily was more or less a good girl in the room.  We played music for her on our iPhones.  She seemed more or less uninterested in the iPad, although she did watch a little Dora on it once I connected to the wifi and pulled it up on Netflix.

They were waiting for the magical "four hours without any food or drink" to arrive before sedating her.  I hoped that meant they'd be getting her ready by 4:30 (since we'd been telling everyone 12:10 to 12:30 was her lunch), but it ended up being only about 30 minutes after that.  Lily was very hungry, and the hardest part was telling her she had to be patient.  She really didn't understand not being allowed to eat.

5:00 p.m.
The team assembled in her little room.  We gave her kisses, told her we'd be back, and they ushered us out of the room and into the waiting area again, to be summoned when they were done.  I sat on my seat, my wife sat on hers, and we produced smart phones so that we wouldn't be forced to speak to each other while we waited.

Okay, we did produce smart phones, but we also chatted, and she gave me money to go buy a bag of white cheddar popcorn from the snack vendor.  I felt guilty eating when Lily hadn't really eaten since breakfast (she only ate strawberries at lunch), but it's not like we were eating in front of her or anything.

5:35 p.m.
They gathered us back up and we returned to the room.  Lily was awake and upset, but honestly was doing pretty well all things considered.  She has a bit of a gag reflex, and she was stuffy to begin with, but with the crying she'd been doing, she threw up a bit and there were towels and wet wipes scattered across the bed.

She was connected to electrodes and the machine that goes "ping!" (or at least used to) and a lead was connected to her toe that glowed red and made it look like E.T.'s fingertip when he heals Elliot's booboo.  We stood on either side of her little bed, stroking her hair softly and telling her what a good girl she was and how brave, and eventually she fell back asleep and I retired to a comically squeaky chair that I was perpetually afraid would startle her awake.


6:22 p.m.
no response.
I attempted to engage my wife in a chat conversation from across the room.  I tweeted that bit of excitement.  She attempted to access my other daughter's electronic school records (apparently an update came while we were in the waiting room) and kept getting irritated with me because each new chat message would knock her out of the database.  I'm sure that would have been annoying.

6:47 p.m.
An hour after the procedure they brought us papers to sign and released us from the hospital.  My parents had picked up Emma from the daycare and were eating dinner with her.  I called them and they ordered food for us and were going to bring it home so we could eat.

We stopped at McDonald's on the way home and tried to get Lily, who was still plaintively croaking, "I want Misdowald's [sic]", to eat some of it with extremely limited success.  But she was coming off of a sedative that is known to cause nausea to some extent, so we weren't super surprised.

We finally got home sometime around 7, before my parents returned with Emma, and I made Lily's bed and we put her to sleep (until 1:30, when she decided to wake up for a couple hours).  Long day for the little spud.

After a fitful night's sleep, we kept her home.  My wife stayed with her and had her folks come over so she could get some work done, and catch a nap (since she was awake for the majority of the 1:30-3:30 festivities).  She was looking good, and back to her happy self.  Just another day-in-the-life.

I don't know if my expectations of emergency rooms are so low that four plus hours spent at the hospital for five stitches seems "good", or if it really is good, but saying it out loud makes me want to punch myself.  "I'm so happy it only took the E.R. four hours to stitch my ADHD daughter's head wound!"  Yeah, it sounds asinine.  But. . . I thought it seemed like they did what they could in light of the fact that they couldn't sedate her until 4:30 at the earliest.

Still, I'd like to hold off on future Emergency Room visits.  To echo the words of the intern as we checked out of the hospital, "It was nice meeting you Lily, I hope I don't have to see you again."  I laughed, but after we left I figured he probably heard someone say it.  And that person probably heard someone else say it, and so on, back to the dark ages of Emergency Room work.  Still. . . it's true.





26 comments:

  1. I am so sorry you guys (especially Miss Lily) had to go through that! I (knock wood) have NEVER been to the ER with my 9 year old twin boys and as M has autism and J has ADHD it certainly isn't because they are so sedate and calm! Hang in there, Papa Bear.

    PS: Do you need a Social Story for the doctors? "I will not make children bleed out for 4 hours...I will not be a raging douchcanoe..."

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  2. I had three brothers, and they had a file on us at the local emergency room.

    Not really sure how my mother lived through all of that.

    You've really done a nice job here of describing the wash of different emotions.

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  3. What a horrible day!! Hope she is not hurting too much now!

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  4. What a brave girl! What a ridiculous hospital experience! What patient parents you are!
    Holy crap, when we took CP to repair his chin after I pushed, I mean he FELL off the bed, it was an hour to sedate, treat, and release him.
    I hope the next time, cause there will be one, isn't as shit-a-riffic

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  5. I'm glad she's okay. Poor girl. I HATE ERs too. We had to take our daughter to one TWICE so far and it was miserable.

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  6. @Jen. . . i do love your social stories . . . and the word "douchecanoe". . .

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  7. @ Lisa - she seems like she's doing alright today. Eating well (as well as she ever eats) and taking a BIG NAP.

    @robot mommy - i really thought they went fast this time. Hmmm.

    @whispering writer - I have never had a "good" ER experience. I'd have taken her to an Urgent Care or Med Express, but she is autistic and ADHD and a child. . . "Children's Hospital" seemed like the "right" choice.

    I go to those others and I'm out in less than a half hour.

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  8. @lahikmajoe - If Lily were a boy we'd probably have just rubbed dirt in it and told her to "toughen up".

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  9. Aaaaawwwwwww poor Lily! But um, isn't there a form you sign that if the parent/caregiver cannot be reached the school can make an informed decision? Like take Lily to the ER and you can meet them there?!

    And why does everyone need to look at it - please don't make my kid into the class project. Please take your ER/Stitches 101 course to someone else, thanks...

    But glad you made it out and that she's doing well :)

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  10. Well, to be fair to the school, they called her and couldn't reach her, so they called me. Which is SOP. I mean, I'd like to think that my decision making is ALMOST as informed as my wife's.

    *grumbles*

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  11. awww what an amazing girl!! How horrible to go through something like that. Hope she's feeling better soon!!

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  12. It's strange how are kids have such a high pain tolerance to something we'd freak out about and then if they drop a french fry, it's Armageddon!

    I too, hate the ER for any reason. It must've been scary for the emergence from the sedation. So sorry for all you and the mommy went through. It's hard and scary for parents! But sounds like Lily was quite the little trooper for the whole thing!

    PS- Does she have to wear the glasses on the playground?

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  13. My kid fell down on our watch and gashed just above his eye. They strapped him down on a stretcher and super-glued it. It was quite impressive. I asked if we could take the stretcher home, but the doctor just looked at me and laughed like I was kidding. Then we went to McDonald's. McDonald's must be the post ER destination of choice.

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  14. Sorry that happened! Glad she was so tough about it all, though.

    We've been kind of disappointed with the ER doctors and nurses when it comes to autism awareness... I wish they would be more trained in it, or at least listen to the parents when we try to tell them how best to work with our kids.

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  15. We've been to the ER twice with Child 1, who gets very dehydrated when he gets the stomach flu. One time we waited so long he puked in the waiting room. I was like "HA HA HA! That'll learn ya to make us wait, suckers!"

    On the other hand, I've also been to the ER with Child 2 with recurring croup. You know how long you have to wait when you run into a crowded ER room in your pajamas with a barely conscious, practically not breathing child thrown over your shoulder? Not long at all, actually. Not long at all....

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  16. What you need is an "in" with the emergency room. For us, the "in" I'm talking about is one of the most skilled ER nurses at our local hospital -- my brother. He's a cranky SOB when we show up there and I've gotten quite a lecture on the two occasions we've shown up with Little Miss, but we always get the best care ;-)

    I'm glad to hear that Lily is recovering from her tumble with all the flair that children typically have. You did good, daddy. You did good.

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  17. Well that is a major bummer, but it sounds like she was a trooper during the ordeal. Now she will have a cool wound to show her friends.

    I think it's some kind of universal ER rule that nobody gets out in under 4 hours. Hope it's your last visit for a good long time.

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  18. Sheesh, I suck at replying to comments these days. . .

    @Rhonda - She's back to normal
    @Karen - the glasses aren't for her vision, they're to correct her from crossing her eyes. I guess I'd have to say "yes" because when she's not wearing them her eyes sometimes cross, and if she's seeing double, she can't possibly be safe on the playground (not that having her glasses ON proved to be super safe in hindsight. . . )
    @lgalaviz - She would eat McD's every day if we let her. . . and somethings. . . we let her.
    @Christy - specialization is great, but it does mean you lose sight of some things that should be general knowledge. Like autistic kids.
    @jillsmo - I'll go in pj's next time. . .
    @m2lm - what could he possibly scold you about?
    @flannery - yeah, she'll be the stitched rockstar for a while. This morning when I dropped off at daycare, a little boy walked right up to my car as I was getting out and said, "Can I see Lily's stitches?"

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  19. No fun at the ER - no matter where you live. But I can tell you this - since our Lily had open heart surgery at 4 months of age, no matter what we go in for now, all you do is say "heart" and you get whisked back. I would never wish heart surgery on anyone but it does open some doors.... (that's me looking for the bright side)

    And she will definitely be the most popular girl at school now - until someone breaks a bone or something. It's got to be something really bad to top stitches. Kids have their own version of "wound triage", much like women telling labor and delivery stories.

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  20. way to look on the bright side!

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  21. I just can't imagine what was going on with the kids who were seen before you! I. Always thought bloody head wounds trumped most others. It sounds like you guys handled the ordeal very gracefully!

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  22. This issue (i guess) was that she needed to have fasted four hours before they sedated her. . . so she HAD to wait four hours from 12:30. They couldn't sedate her until 4:30 minimum. They sedated her at 5:00. . . so to me, that seemed sort of fast.

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  23. Jim
    Not that your days are hectic without emergency situations, it is unbelievable what you guys go thru in a day - I was exhausted just reading about everything. Eating is such an issue - some people eat too much some not enough some eating nothing at all. I see what it is like again as I watch my 18 month old grandson saying he is done and the plate is still full of the food that I graciously prepared for him - he lives on a lot of yogurt.
    As I go thru life it just seems that it all is not we envision - We never saw Ozzie and Harriet or Beaver Clever's mom dealing with these issues - and now all of the holiday commercials make it all look so easy and wonderful. I pray for your family daily.

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  24. yogurt. . . lily lived on Dora Yogurt or "bunny" (Trix) yogurt for like a year.

    Thank you for your prayers! (and comments)

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  25. Holy Crapola - what an ordeal! I have to say, Ted has the same (lacking) reflexes as does Lily, apparently. So lacking, in fact, our one-time pedi neuro couldn't find them. At all. IDK if this says more about her or Ted.

    Anyhoo, glad everything ended relatively well. I hope Lily got a lollypop (but maybe not, as I read your newest post before this.).

    YEAH Lily and YEAH Team Lily!

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  26. no lollipop. Nuggets were her reward . . . but I think her tummy was too queasy to eat them.

    The reflex thing is troubling. We're meeting the new doctor in a week or so and hopefully he has some ideas.

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