Hospital

This is part 2.  For part 1, go HERE.

The hospital.

We loaded up on the stretcher for the ambulance ride to the other hospital.  As an ER nurse, being wheeled out of your own ER on an EMS stretcher is a disconcerting feeling to say the least.  Sarah had Michael and was waiting to follow us.  We were set up and drove over.  When we got there, we were met by the special pediatrician that my ER doctor had contacted.  About that time I got a message from our good friend Ruthie saying she remembered working with a pediatrician from Yakima when they were on a mission trip in Cameroon or something.  Did we know Dr. Harthcock?  Shortly thereafter, Dr. Harthcock, the specialist my ER doc had called, walked in to the room and introduced himself to Sarah.  Weird, small, and amazing world sometimes.

Max was still on an insulin drip and feeling pretty bad, but improving.  Sarah was now there and trying to get up to speed on everything.  There is a huge initial shock to get over and I had several hours worth of a head start.  We talked with the doctor and with each other.  Every little way we could think of to try to deny the truth at least crossed our minds, but if there is one thing we have a lot of practice at, it is adapting quickly to change. We don't have to like it, but we do it.  This one was going to take a while.  With Sarah there and as caught up as it is possible to be, I was able to go lie down on the couch and pass out for a bit.  It was around 11 or so, I think, and I hadn't slept much.  

I have some experience dealing with diabetic ketoacidosis.  I have seen many patients with that particular problem.  I saw what was happening with Max fit the pattern I expected so now I could relax.  Sarah, on the other hand, was blindsided.  I am amazed that she dealt with everything so well, but she did.  Mommy bear looked down at her baby and did whatever it took.  It was nice to know that whatever happened, Sarah could handle it.  Our next job was to get Max on board and up to speed. The first day and night he was still in bad enough shape that he didn't really fight us about it.  Sarah wanted to stay that first night with him, so I took Michael home with me.

On the way back from the hospital Michael asked what would have happened if we hadn't taken Max to the hospital.  I told him that Max would have gotten sicker and probably would have died if we had waited too long.  There was a long silence as he processed that.  Then he gasped and with a bit of a hitch in his voice said he just thought Max's tummy was sick, he didn't know it was that serious. From that moment on, Michael became a superlative big brother.  He read everything he could get his hands on about diabetes and has never once has complained about subsequent diet and lifestyle changes.

The next day, Max was improving.  This was obviously awesome, but one thing became a problem.  Now that he felt better, Max couldn't understand why he couldn't go home (and he couldn't eat...he was STARVING), the shots had to keep coming and we kept having to check his sugar with a finger prick.  This led to a blow up when he refused to cooperate with an insulin shot.  The ER nurse in me took over and I tried to convey the sense that you can't fight this the same way you can't fight the oncoming changing of a season, or the turning of a tide. 

He didn't like it.  But we got there.

On the second and third day we had another doctor from the group.  She was awesome, I wish I remembered her name, I think it was Dr. Mendoza.  Something other than the obvious problem was happening and it took Sarah a bit to figure out what it was.  As if she wasn't dealing with enough right about then.  The doctors and nurses all had heard that I was an ER nurse.  So they would come in to do some education or talk about Max and they would talk to me.  They would also talk to me in such a way that skipped over valuable information that they knew I would already know, being a nurse. Sarah, the one who probably needed to hear everything most, wouldn't get everything she needed to hear.  It got bad enough that she would get mad and I would have to sit away from her or behind her to make sure the educators and doctors talked more to her than me.  But, we figured it out.  We work well as a team. 

By the third day, they agreed to release us.  They told us the deciding factor in discharging us wasn't actually Max's health.  They kept the initially diagnosed pediatric patient in the hospital until they think the parents are ready and able to assume care of a kid with diabetes.  I guess we convinced them.  That is one of the moments when reality set in.  We would now be responsible for all of this...every day.  Sugar checks, insulin administration, carb counting and all of that was now on us.  Finding the right supplies and making sure everything was on hand and stocked up in sufficient quantity was on us.  Who am I kidding?  Mostly it was going to be on Sarah.  I am surprised she didn't walk out of the hospital a few inches shorter from the weight of all the new responsibility.

They thought we were ready.  Max was only too happy to get the IV out and head home where, he assumed, we would get back to normal at last. 

Our journey had only begun.

Diagnosis

(This is part one of what I expect to be a three part series.)

3:30 in the morning.

Max walks in and wakes us up, telling us that his tummy hurt and he was sick. He threw up in his bed. 

For the past week, he had been sick with what appeared to be hand foot and mouth disease. That day he had finally seemed to be over it and was eating again. Sarah gets up to go look and sure enough, he threw up all over his bed. I ask if I can help clean it up, but she says she has it. It is a top bunk against the wall. As unpleasant as it may be, it really is a one person job. Meanwhile, I am in bed comforting Max. Something isn't right.

I know he is sick, but something is wrong, really wrong and it takes me a moment to wake up enough to realize what that is. He smells like nail polish remover.

I'm an ER nurse. I know what that smell is and what it means, but...no way. Max isn't diabetic. No one related to us is diabetic. Can't be.

And yet I look down and see a groggy little boy breathing fast and deep. My hand against his chest can feel his heart pounding away like mad. Maybe he has a fever. I get (or more probably it was Sarah, I don't really remember) the thermometer and check. No fever.

What could it be? No, what else could it be.

After lying there for a minute thinking about dehydration and ketones and the danger of acidosis, I take Max into the living room and sit with him on the couch. How long until Walgreen's opens and I can get a glucose meter. Hell, we should have one of those around anyway. No way that he has diabetes, but I would sleep better knowing that for sure.

By this time, sleep is out of the question. Walgreen's doesn't open until 9am here. That is hours away. If he is diabetic and in DKA, I shouldn't wait. All in all it took nearly three hours for me to shed the denial, realize the situation, and get moving. I'm a little ashamed of that, but there is a special dread ER workers have about taking themselves or their families in to be seen in an ER. That takes something pretty big to overcome.

I told Sarah I was going to my ER to get his blood sugar checked and she got ready to wake Michael and get them dressed. I told her to stay home, don't wake Michael. I'll call if something is wrong. Hadn't quite shaken all of that denial off yet, really and there wasn't anything she could do there other than wait and worry. There would be plenty of time for that later.

We drove to my ER and checked his sugar. It was 469. DKA (Diabetic KetoAcidosis). My co worker whispered, “Shit. I'm so sorry” and I walked out front to check in to the ER.

I snuggled up against him on the bed while they started the IV and drew blood. I knew the script and let Max know what was coming. He was sick, but he understood. There wasn't much fight in him at the moment. They started the process for a transfer. The hospital where I work doesn't have pediatric services. Dr. Monick, the ER physician on duty that morning knew a pediatrician she recommended to us who just happened to be on call that morning.

I snuggled up in bed with Max trusting my co workers to do what I had seen them do so many times before. I let go of the burden on having to be on guard and just held Max. I started to grieve. I didn't know what was next, but I had a good idea. I have seen enough diabetic complications. I could see the bare outline of the struggle coming up and didn't want it. I grieved the loss of perfection in my little boy. I wanted so bad for all the best for him and now this. As a parent. I had an idealized version of my kids growing up. It never included diabetes.

Then I stopped, as much as I could anyway, because it wasn't about me. I wasn't the one who would deal with a lifetime of extra burden. This was about Max. And the best way for me to help him was to stop thinking about what was lost and start figuring out the best way to deal with the new reality that was in front of me.

I still had to call Sarah.

She sounded as confused as I was when I first realized what was happening. News of that magnitude takes a little while to process and she was coming in to all of this a little late. She made it to the hospital just in time to see us loaded up in an ambulance for the drive across town.

Next: Hospital stay.