Tuesday, March 31, 2009

Our hospital experience, pt 2

You would think that in the maternity ward, at least, a baby losing consciousness would bring some attention, but at ValleyValley Reminiscence Hospital, you need to go that extra mile to alert anyone of consequence. Our child, once resuscitated, was taken to the NICU for a check-up by the pediatrician, and returned to us in about 10 minutes. I don't know in what world anything thorough happens in 10 minutes, but I can damn sure tell you that checking out a baby's health should take a lot longer than that. A very shaken TBO and I spent the rest of the night and the next morning wondering what on earth was going on, but no one other than the nurses on the floor bothered to check up on us, and most of them had no idea anything had happened. No doctors, no specialists, nobody who knew anything. In fact, if we hadn't spoken up, I have no doubt that nothing else would have ever been done to make sure Owen was actually ok, or even to simply reassure us that he was currently fine.
Once a baby is delivered, for the most part, the OB/GYN's job is done, except for some follow-up check-ins with the mom (made more frequently for C-Section moms, of course). The newborn baby then becomes the pediatrician's patient, although in most cases, I assume the two doctors work fairly closely together, at least while the new mother and child are still in the hospital. During the next OB/GYN visit, we asked our doc if he knew what had happened to Owen and what we were supposed to do. He didn't have a clue what we were talking about--clearly no one had bothered to write anything down on TBO/Owen's chart, or even mention it to him in passing. He asked if the pediatrician had come to see us--which one would think might be advised when the baby has nearly died--and we told him no, we hadn't heard from anybody.
We will always be grateful to TBO's OB/GYN doc for what happened next, even though it put into motion some of the worst examples of VVR's incompetence. This doc obviously cared about us, and just as obviously had some pull at VVR, because not 15 minutes after he left our room, who should show up but the pediatrician? This doctor, on the other hand, was a useless piece of jet trash. She spent a grand total of 15 minutes with us in 3 separate visits over the course of the entire 5 days we spent at VVR, and even those 15 minutes were perfunctory at best. Her first action when she showed up was to ask for "our side" of Owen's going blue, replying, "Gee, that's not the story I got" by means of explaining her total lack of professional concern for our well being.
The deeper issue her statement revealed, though, was one of communications breaking down at VVR. Why did the ped doc get a "different story" than a recitation of what actually happened? I can think of one answer--the nurses were covering their asses. I'm sure a baby turning blue while they were actually present in the freaking room probably wouldn't look too good on their next performance evaluations, right? The other, more pernicious, possibility was that both the nurses and the ped doc were lying to each other and us, because, if you'll remember, the ped doc supposedly checked Owen out the night before in the NICU. So, did she actually check Owen out the night before, as was reported to us? Was she even notified at any point? What did the nurses say to her had happened if she was notified? Who knows? All we know is that it took us telling our OB/GYN that we were worried to get any kind of response, professional or otherwise, from either the ped doc or VVR at all. Owen was taken up to the NICU for an extended series of tests over the next few days after this.
During the first 18-24 hours Owen was with us in the room, TBO had no problem (as soon as we could escape the nurses insistence on TBO's using the dreaded side lying position, that is) feeding the boy from her breasts. He latched on properly (which apparently is the major issue with breastfeeding), sucked with vigor, and did everything well, as far as we could tell. When he was taken to the NICU, however, we no longer had control over his feeding, and even though we were relieved to get some actual oversight to his breathing and some tests run to see if there was a medical cause for his episode, this added another layer of potential miscommunication between us and our taking care of our new child. Not only did we have a large handful of nurses and lactation consultants on the regular ward to deal with, we now had the NICU director and the nurses upstairs to decode as well. (Oh yeah, we had a pediatrician supposedly in the mix also, but I think we can be forgiven for not counting her among the people interested in Owen's health.)
Over the next day or so, we were bombarded with examples of how poorly VVR's employees communicated with each other and with us. TBO was placed on a regimented diet after her surgery. At first, she was only allowed ice chips, and then, after some gastrointestinal activity could be proved, she moved on to clear liquids and finally real food after her digestive tract showed complete functionality. In TBO's case, these stages flew by--she was on solid food after a little more than a day, but you couldn't prove it by how some of the nurses behaved. Somewhere, somebody knew what was happening, and must have written something down on something, because when TBO passed each stage of digestive function, her next meal was correctly prepared and delivered. On the other hand, after TBO had moved on from perhaps needing help along those lines, at least one nurse was out of the loop, because for two days, one of them would ask TBO if she was still prescribed milk of magnesia. Helpful? No, infuriating--TBO had never been prescribed milk of magnesia, and she had moved past that stage anyway! While one instance of such behavior might be humorous, this was but the tip of the iceberg.
Next: The iceberg.

Monday, March 30, 2009

Our hospital experience, pt 1

TBO had our baby 3 weeks ago, at a hospital I'll call ValleyValley Reminiscence. The first inkling we had that our stay at VVR would be, shall we say, less than ideal, came when we first arrived in the maternity ward, where TBO was about to be induced. The nurse on call, when told by TBO that she had wanted her childbirth to be as natural as possible, given the givens, spoke at length about how she had given birth 4 times naturally, and that it wasn't as bad as everybody makes it out to be. We had been instructed, on the other hand, that the drug used to induce labor creates contractions about 10x as intense/painful as normal, and that no one sane lives through them without taking the epidural, especially after the water breaks. No matter to this nurse, as she took every opportunity over the next 8 hours to let us know that she had given birth 4 times naturally. This kind of attitude went a long way to making TBO feel like a failure when, after enduring several hours of mindless agony, she asked for the epidural. Having witnessed her pain secondhand, I can assure everyone that in no way should any person think of her as anything less than heroic for enduring as long as she did.
The labor progressed fitfully after that, but at least TBO wasn't groaning at the top of her lungs every 2-3 minutes anymore. The boy (I'll call him Owen) descended rapidly--too rapidly, as it turned out, because TBO was only dilated 40-50% of the required way when Owen was actually in the physical position to emerge. This is not good, and poor Owen began to react negatively to TBO's contractions. His heartrate would plummet during her contractions, and after one protracted and dangerous slowdown, the docs called for an emergency Caesarian. Things moved with an alarming alacrity then, lemme tellya. Within a span of 5 minutes, TBO was laid out on an operating table and after another 5 minutes, Owen was in the world.
A Caesarian Section is, as the adage goes, akin to sausage and legislation--no one should witness their making. I was positioned at TBO's head, but only a 3 foot by 2 foot screen separated us from the action, and because I was off to one side, it took only a little tilt of my head to see what the docs were doing. I made that mistake just as they were pulling Owen out; for some this might have been a glorious moment, and I surprised many by taking it all in calmly. What happened next was what made this moment bizarre for me. The nurses immediately whisked Owen off to a side table, where they proceeded to pound the boy mercilessly about the back and stomach in attempts to get him to cough up whatever junk resided in his stomach and lungs. I was shocked by the ferocity of their attacks, wondering seriously whether they would break his ribs. At this point, one of the nurses cheerfully called out, "Daddy? This is a great time to take some pictures! Come on over!" I was stunned, but dumbly/numbly submitted to their demand and took a couple shots. While at the side table, I made the mistake of turning my head 90 degrees, just in time to see the doc stuffing TBO's innards back into her body. Lots of innards. I did not take a picture of that. I also didn't capture the doc's cauterizing her internal wounds, nor his masterful and incredibly fast suturing of her outer layers of skin.
After a short while where I was just kind of wandering around the room, the nurses gave up their quest to cause Owen to vomit, and instead sent tubes down his nose into his various internal cavities to suck out the fluids and solids remaining. These procedures lasted a few minutes after which both Owen and I were whisked off to TBO's bedroom, where another nurse was given the task to make the boy cry. No simple butt-slapping of longtime media tradition here; apparently the most effective manner in which to cause massive squealing is sharp slaps to the soles of the baby's feet. Repeatedly. Apparently, for up to the half hour this nurse took before she finally gave up. Owen was clearly having none of it, and refused to cry out in anguish in response to being beaten yet again. (He has since learned this skill on his own.) (The crying, that is, not the being beaten!) TBO spent a couple hours in recovery, after which the happy family was reunited.
At this point, I have to note that TBO spent a great deal of time and energy investing in learning all there is about breastfeeding, and defending her stance that she would breastfeed come hell or high water to those who questioned its value. I also must note that Valleyvalley Reminiscence makes a lot--I mean, a lot--of noise about being a breastfeeding supportive environment. Every wall in the maternity wing of VVR is plastered with posters declaiming the benefits of breastfeeding and stressing VVR's support of this aspect of mothering. This was one of the reasons TBO had decided on using VVR, even though it is not exactly around the corner from our house. We presumed all of this advertising meant that the employees of VVR were on board with breastfeeding as well, and were well versed in the techniques, struggles, and successful implementation of a breastfeeding regimen. We presumed wrong.
Upon arrival at the room, TBO was tasked with feeding the boy, which we knew was key to beginning a successful breastfed infancy. (The few hours delay due to the C-Section was unfortunate, but obviously couldn't be helped, and we all wanted to start ASAP.) Present in the room were 2 nurses, TBO, me, and her parents. The nurses, whom if you remember we presumed knew what the hell they were doing, insisted that TBO had to use a certain breastfeeding position, even though TBO objected due to its discomfort for her. This particular position has the baby placed next to the breast alongside the woman, with both mother and child laying on their sides. TBO was violently opposed because she felt she was smothering the boy, but the nurses overruled her intuitions, stating flatly that 1) babies are born with snub noses for this very reason--their nostrils are "out of the way"; and 2) Owen would push away from TBO if he were in any danger of suffocating. TBO capitulated--these were the f$%^ing experts, after all, weren't they?
Um, no. Owen stopped breathing and turned blue. The nurses? They weren't even paying attention. TBO had to cry out for them to return to the bedside of a first-time mother who had just been through an emergency C-Section as she attempted to breastfeed for the first time her 3 hour old baby. I ran out to the desk outside screaming, "We have a blue baby in here! Help!" The first nurse on the scene grabbed the boy and shook him violently, yelling, "Owen! Owen!" (If anyone reads that sentence and is not both appalled and horrified, you obviously never saw many legal or medical dramas growing up, because quite often any storyline concerning the death of a baby would revolve around Shaken Baby Syndrome. I won't even get into the absurdity of calling out the name of a newborn, as if he would respond!) I was aghast; this child is not asleep, you moron, he isn't breathing! Soon enough, people with brains larger than peanut-size arrived to resuscitate our child, but immediately thereafter and for the next day or so, the nurses continued to insist that TBO use that same breastfeeding position.
Next: It gets worse.