A day on the floor

Josh called me in the late morning to say there had been a big glitch. I felt my adrenaline start running until he explained that Wren had been woken after a 20 minute by the Nurse Practitioner doing her exam. Argh. I explained that was an inconvenience not a glitch!

Progress after Rounds
We had rounds a short while ago. They were uneventful. Basically, we measure how Wren is doing on two levels. The first is how is he doing in his recovery from surgery? He is doing very very well. His chest tube will be removed as soon as Hansen Quan is available and his last IV soon afterwards. Then he can take trips in the red wagon and will be on track for his Friday discharge.

The second level is "how is Wren's repair?" For me, that means how is his LV performing - what are the gradients, how is his EKG and how long will this last. The end part will have to wait but for now everyone seems pleased but still asking questions. The main question is the variability in Wren's EKG. Post-operatively it looked better than pre-op but still showed some "ST Elevations". These were reduced the next day and the Fellow commented that she was pleased it improved but concerned that the improvement meant that the previous day was not his baseline. Todays' EKG looked like the first - spurring talk of a repeat EKG on the 14th and concern about what is the cause. For those like me who have to google "ST elevation" - the most common cause is not getting enough blood to a region of the heart, as in a heart attack. So, its bad. But nobody is talking to us about it so I am seeking answers.

The Hospital as Factory. The Parent as Customer
So, I am very very pleased with the quality of care Wren is getting here but, as in every inpatient experience, I have two big complaints:
1) There is no single person who seems responsible for the patient's care. It gets passed along like a car down a production line.
2) Secondly, while everyone is respectful and regards our opinions seriously - there is no daily update given to parents. It feels as if we bought a car from a fabulous showroom and once the car was purchased [surgery] we were sent to the factory by mistake to watch it being produced and all the way along everyone thinks they are doing their job if the car is being made right. We don't need to keep the customer informed. We're busy.

But I would like to receive a daily update on Wren's progress, issues and concerns rather than have to enter the scrum of rounds to find it. I would like to have more than the most cursory nod to say "he is doing well." I would like someone to talk about the implications of ST elevations and to give me a picture of the pre-v-post operative picture. Are the concerns that something occured intra-operatively or during recovery? Is the concern that Wren's coronary artery is not receiving full flow due to some obstruction to flow in the aortic valve area or is it a legacy of prior obstruction? How long do ST Elevations persist? Nobody is answering the door.

I told the nurse I wanted to speak with a cardiology fellow and she suggested the NP. I suggested the cardiology fellow. She looked fed up. I said that I would at least like to speak to a cardiology fellow BEFORE we are discharged. I now imagine taking a stand and refusing to relinquish the bed until someone answers my questions.

Messing with Stuff
Wren wants to get up and go home. He has started messing with his lines, tubes and monitors. He sticks his feet through the bars of the crib and says "that me! That Me1" He pulls off the puls-oximeter every 10 minutes and says "I done it!" He is just bored and so am I. Plus, our room is super hot with a west facing window. If you hadn't heard, we are facing a mini-heatwave in CA with temps in the 70s today and 80 tomorrow!

He also sucks and chews on the cable to his heart-rate monitor and kicks the wires with his feet.

He calls "Want to get down now! Want to getting down. NOOOW.

Etcetera
And then there are some things that make me laugh. There was the sign in the PACU that I have been wanting to write about for days. It is a notice to staff "WHAT TO DO IF AN ADULT COLLAPSES IN THE PACU." Apparently, if an adult collapses or codes in the PACU they are screwed. The fine print notes that LPCH does not respond to adult emergencies and that Stanford Medical Center does not respond to emergencies at LPCH. I guess your only hope is that there is some kind of external medical team - paramedics - who can help and then transport you to the Stanford side. There were some suggestions about what staff should do to handle things in the meantime.

Another thing I'd noted is that women greatly outnumber men among medical personnel. Yesterday and the day before we had groups of 9 women rounding - everyone from Attending to fellows to residents were female. Echo techs: female. X-rays: female. Nurses: female.

However, there are men out there somewhere because half of the nurses are pregnant. A nurse told me that people often ask if there are many matches made at the hospital. She said it was rare because women favored pediatrics and so there was an inherent shortage of men in the hospital. In addition, the men who came were usually married (she speculated they were the nice, caring, family type!)

Its a great pity because never before have I seen so many gorgeous, divine, young, pretty nurses. Its like a Baywatch Hospital Edition. Blue scrubs and blonde pony-tales every which way just not plunging into the ocean. According to one nurse we spoke with, nurses like this hospital because its good and has great weather. A number of nurses come from the East Coast or Chicago to work here.