Wednesday, January 09, 2008

Baby Guts

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Dr. M (the surgeon) explained the procedure of putting my son's guts in the right place. The kink in his intestines cut off the blood supply to that part of his bowel. He then said, "Bowel can be alive one minute and dead the next, and I can't bring dead bowels back to life." With that, we were signing paperwork while on the way to the OR.

My son is only 5 days old, released with a clean bill of health from the hospital he was delivered at. So how come there is a surgeon (the best one there is for this procedure I'm told) involved?

We entered Primary Children's Medical Center sometime Tuesday afternoon, and were in the waiting room for a very surprisingly short amount of time. It takes 2 different teams, comprised of 2 people each, 5 tries to get an IV into one my son's tiny, very dehydrated veins. My brother is flipping out at reading that, wishing he was there to have done it.

We try to feed the little guy some more while there. We have some breastmilk in a bottle to measure how much he eats, and have been trying to feed him in that manner all day. He drinks about 2 oz. in 10 minutes. I continue to hold him very very still, not even daring to try to burp him. Twenty minutes later (that might be the longest he's kept anything down) it all comes up as bright yellow, runs down his face, through the blanket, and on to my pants (it looks like I had an accident, and not for the last time that day).

The nurse practicioner informs us that Intermountain Medical Center (IMC) can't find the Gastrointestinal Tract X-Ray (GI Test) they ran on Saturday. Ten minutes later he tells us that IMC found it. They had the test under "baby Smith". What a unique name to store a medical record under. I mean, how many Smiths could there possibly be? How many of them do you think are or were babys at one point or another.

Hold it right there, So there was already a GI Test before you went to Primary Children's?

Once a pediatrician (Dr B.) finally got around to coming to visit us at IMC, more than 36 hours after the baby was born (An astute nurse figured out that my firstborn had fallen through a crack in the system, and had not been given a doctor. The pediatrician we chose, Dr C., doesn't do rounds at IMC, we told them that...more than once.), a series of events led him to believe there might be a bowel obstruction, more specifically he said, "He might have turned bowel." Dr B. ordered there be a GI test performed to determine if that was the case.

My kid has been spitting up ever since he was born. This sounds normal, I know. I'm not one of these crazy overly protective new parents. Andrea and I are pretty laid back I think. The spit-up started out green and yellow, and eventually moved to just being bright yellow (glow in the dark yellow). He spits up everything, and constantly. They put a tube down his thoat and suctioned a few ml of the yellow gunk out of hist tummy. After a minor procedure performed on my little man (one that would really really hurt if done later *wink wink*), the pediatrician had left the nursery and my boy throws up again...a lot more than before. A nurse runs out of the nursery to go find the pediatrician, who immediately orders a GI test...which would take 2 hours to do, and another hour before we hear back about.

Other interesting things to note: The kid doesn't like having his legs straightened out. In fact it's almost the only thing that will wake him up, and make him cry. Once his little legs are pulled up into his chest, he'll "stop crying suddenly." He has had little to "no stools at all." He's very "lethargic". He almost literally slept for the first 6 days of his life.

Whatever conversations transpired about that first GI test and between the radiologist and Dr B. I'll never know. To cut a long story short. He was diagnosed as having "severe reflux". We were released from the hospital that afternoon (Saturday).

So, if we were sent home on Saturday with a baby that has no bowel obstruction, how did we end up at the ER on Tuesday?

We spent Saturday and Sunday, mopping up yellow junk and trying in vain to feed a child who just won't eat, and even when we can aggravate him enough to keep him awake to eat, he vomits all of it.

Monday morning we call to make a newborn/first visit appointment with the pediatrician we've chosen, Dr. C. We go to see Dr. C. Tuesday morning at 10:40 AM. She quickly becomes concerned at the feeding pattern (he isn't eating often enough), so the doctor tries some tricks to get the kid to eat. She's not successful either. After hearing about all the vomiting she's not happy with calling the problem just reflux. The doctor rights up 5 tests she wants run STAT (still don't know what that stands for, but in waiting room terms it means, wait your 20 minutes behind everyone who was here before you. In lab terms it means, call the doctor with the results in 45 minutes...not 3 days) at Primary Children's lab. "If there is no bowel obstruction, then I'm looking for a metabolism problem," she says. She also orders us to use the breast pump after the test, to feed the baby from a bottle, so we can measure how much he eats, and report back that amount within 2 hours.

We call Dr. C. and tell her that we have bottle fed 2.5 oz to the kid, which he promptly threw up. Then we go home and wait. A while later the doctor gets the test results and calls me. She says, "I want you to go to the Primary Children's Emergency Room. Right. Now."

So, with that explained, where were we?

The radiologist at Primary Children's reads the aforementioned GI test and determines that my little one has a malrotation (the intestines aren't where they should be), with a possible volvulus (the intestines turn back on themselves in a way to cause a kink, stopping blood flow). Let's repeat what I'm saying there. The radiologist at Primary Children's read the GI test that was done at IMC and saw that the sick little boy does have an obstruction. In fact he has his intestines are all messed up. Another GI test is performed in roughly one tenth the amount of time it took at IMC. We watch as the radiologist points out where the volvulus occurs.

The ER doctor (I can't remember his name, but he was awesome, and excellent at communicating the situation) tells us what's wrong and sends in the surgeon that's on call that night.

Dr. M (the surgeon) explained the procedure of putting my son's guts in the right place (Ladd Procedure). The kink in his intestines cut off the blood supply to that part of his bowel. He then said, "Bowel can be alive one minute and dead the next, and I can't bring dead bowels back to life." With that, we were signing paperwork while on the way to the OR

After the surgery (about midnight at this point) Dr M. explained how the surgery went, and the conditions that made it more difficult, and take a little longer (the capalaries in the lymph nodes that process the milk ruptured, leaving everything in my baby's stomach covered in white, making it harder to see what and where everything is). Then he said, "He isn't breathing. What you have is an exhausted little boy, he's too tired to breath, so we're doing it for him." He walks the wife and I to PICU (Pediatrics Intensive Care Unit), where we spend the rest of the night.

Over the following day, and night, he stays in PICU. Over the course of about 36 hours he's eventually taken completely off oxygen, so that he's breathing on his own. He also has a PICC line inserted which he'll receive his nutrition through for the next week, after which he'll start to get fed increasing amounts of his mom's breastmilk.

As of Thursday my little champ has been moved out of intensive care, and doing great. His friends in PICU were sad to see him go, but happy for him to move on.

By the way, I'm quite pissed at IMC for doing a test with the express purpose of looking for a turned bowel, only to not see one in the exact same test that Primary Children's did see one in. How do you not notice an appendix in the wrong place, or that a patients intestines never move to the left side of their body? There is a word for when this happens, but I'm not going to use it unless I have to. "You wouldn't like me when I'm angry."

We owe some thanks to a few doctors:
Had it not been for Dr. C's persistance that something other than "reflux" was going on, this story would be much much worse.
The ER doctor for taking the whole thing seriously, and not treating us like the whiney parents that many other physicians would have.
One hell of a surgeon who knows exactly what he's doing.

In unrelated news: I went home Friday morning to clean up, and while on my way to get Andrea's celebratory lunch of pork salad from Cafe Rio, I was rear-ended by a Corolla, that was rear-ended, by a Chevy 2500. Good thing I was in the 4Runner and not the Mazda3. What a week eh?

*Some of the quotes are not 100% exact, but as close as I could remember.
**I only wish that even a portion of this is embellished.

5 Comments:

Blogger Matt "The Bull" said...

Amazing to me how such a broken, incompetent system is able to save a life every once in a while. as they say; even a blind hog can find an acorn every once in a while.
If you don't sue IMC I am going to.
The two phycicans that misshandled the first "work-up" is more what I am used to. If this would have happend to you where I live your poor little son probably wouldn't be with us. Maybe its just "today" but I feel more rage than anthing when I think about this story.
Sounds like he's turned the corner here is a great picture of malrotation with volvulous and the LADD procedure http://www.pedisurg.com/PtEduc/Malrotation.htm

5:14 PM  
Blogger April said...

Wes, I'm sure it's overwhelming to think about, but I'd be happy to point you in the direction of a fine attorney who actually works up pediatric malpractice cases (especially if you guys are going to have some bills from his extended stay or any rehab/special feeding issues that may exist for the next little while, like renting a breastpump and bottles etc). I'd be happy to send him your explanation from the blog and see what he thinks...just say the word. p.s. it's not my husband - although he is a fine attorney it's just not his area of specialty.

We're still pulling for Dylan and are happy to hear that he's in the next step up nursery. Can't wait for the "all clear"!!!!

3:42 PM  
Anonymous Jess said...

My complaints on my blog are so silly compared to what is going on with Dylan. It is truly infuriating, especially because he is baby and these idiot doctors can't afford to get it wrong. I'm glad he is doing better and hope he is all the way better soon!

3:42 PM  
Blogger Lance & Alayna said...

I say sue! It is completely ridiculous that Dylan was ever even released from IMC. Obviously they opened before they had it all together. Sue for anything extra (besides the actual delivery). Besides the surgeon and other doctors calling to rip on the radiologist that read it wrong, the hospital needs a wake up call. Hospitals should not be a "get'm in get'm out" service center.

12:37 PM  
Blogger Seth said...

Just make sure they pay all your bills when you sue... Statute of limitations for a child expire when they turn 18. I hope Dylan does well and doesn't have any risidual problems. I know I wouldn't take anyone I know purposefully to the Death Star (IMC), neither would some of the people who work there, for at least a year. Some hospitals are too big for their own briches. I'm surprised you had a decent ER visit though, those are hard to come by. I think my place of business does a decent job most of the time in the ER. Even though it pays my bills I think America's health care system needs help too, stemming from the insurance scammers, I mean companies. Add that to your list on J-dawg's blog once those bills start coming in. You have to have insurance for everything now-a-days, but don't try to use it! I could go on, but choose not to.
Good luck Dylan! You're in good hands now.

9:54 PM  

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