Friday, September 28, 2007

Intensive (S)Care- a bronchiolitis story

Since patrick has been going to daycare, he has brought home every lurgy going round. He's has a constantly snotty nose for over a month now, as well as coughs and conjunctivitis. I'd like to point out I'm not against daycare, it has been a godsend for us and considering the workers get paid less than I did for being a hospital cleaner 17 years ago, they do a bloody hard job for very little recompense.

So Patrick had been off sick with his conjunctivitis since last wednesday. On Monday I stayed home from work and looked after him- he was ok but a little sleepy. On Tuesday he had a cough and MrT looked after him. On wednesday we decided to take him to the doctor, as he had been sick for a while. I was working from 0700 to 2100, and MrT took him to the after hours service. He had red eardrums so they gave him some ibuprofen and some antibiotics.

But by the time I got home at about 2200 he was worse. Much worse. He was lethargic and clingy, had a resp rate of 80 and wasn't interested in boob at all. Then we noticed his tracheal tug, and his subcostal recession. Finally, MrT said "Does he look a little... blue... around the lips there?". He was.

So we took him off to the local Emergency Department where we were swiftly seen and taken to resus. He was shut down, tachycardic at 200bpm, and saturating at 80% on room air. He didn't even protest much when the put a cannula in. We were reviewed by ICU and then I had the surreal experience of sitting on a bed being wheeled upstairs to ICU. I have accompanied plenty of patients on that journey myself, so it was very, very odd. The staff (who know us both very well- MrT worked there all last year and I have worked there on and off for many years) welcomed us in and gave us heaps of hugs.

Luckily he escaped needing CPAP. By the morning, his subcostal recession had eased, and he wasn't quite as hypoxic, although he still desaturated- to the 70's- when he pulled his oxygen off. He was discharged to the Paed ward fro continuous spo2 monitoring and oxygen. By this morning, he was doing much better and they turned off his oxygen and capped his drip. By this afternoon, he had picked right up, and was satting at 90-94% on room air, and was ok for discharge.

So tonight he's home. The usual course of bronchiolitis is that it gets worse over 48 hours and then improves rapidly, so the expectation is that he is on the up and up. In case you're wondering, the evidence is that unless there are chronic lung or heart problems, it is ok to be discharged with sats 90-92%.

I'm horrified to think just how badly things could have gone. If we hadn't had some medical training, we could well have thought that he just had red ears and put him to bed. What could have happened then doesn't bear thinking about. He would have been hypoxic in bed, away from us. He could have apnoead (stopped breathing) because of his hypoxia. He could have got hypoxic and his heart could have slowed, or stopped.

Put basically, he could have died. Not at a far stretch of the imagination, but a horrible reality.

I don't blame the after hours doctor, either. We know her and she is a competent, lovely physician. Patrick simply deteriorated quickly.

What is the lesson?

Please, if you think your baby is not at all well, get help. Things to look for include-
a fast breathing rate
not wanting to feed
less wet nappies
stomach sucking in under the ribs when the baby breathes
the windpipe being 'sucked in' to the chest when they breathe.
but this is by no means an exhaustive list.

When I think what we went through with all the miscarriages, I sincerely think I would die of grief if Patrick died.
In intensive care. There's a baby in there.
Feeling much better and playing with my toys.

Friday, September 21, 2007

photos and stuff

Reet. Bumper crop of photos.

First: yesterday morning, me in the hammock looking up at one of our jacarandas.
and then joined by Paddy, who liked the look of my camera

eating corn thins
Today, I was out hunting breastmilk bags at the mall. He fell asleep, and I was suddenly struck by his resemblance, unfortunately, to the spawn of Satan, Tony Abbott
but then he woke up and he was his own smiley self again
This is a demonstration of his mobility. This took the time it took me to take in the washing.
Finally, I'm not really sure how to fix this because I'm rather dense when it comes to technology. So I'll ask you all to turn your laptops on their sides or lie down on the couch on your side all comfy. Cause here is the man doing his thing in the Jolly Jumper.

Wednesday, September 19, 2007

Ahh feck*

I have just watched Patrick 'bum-shuffle' across my therm-a-rest to get at a toy. Oh God! He's mobile!!

*Mr T thought I should edit this title for decency. It doesn't take much imagination to work out what it was originally...

two totally unrelated things. no make that three.

1. I guess I'm really a mummy now.

There was a sticky clear substance on my laptop. I swiped it off with a fingertip and sniffed.

In addition to the squirty milky spots, bits of chocolate and mashed banana there is baby panadol on my computer.

2. Something that really shits me is seeing people drinking takeaway coffee through the liddy thing. No-one used to do it until we saw photos in the trash press of 'celebrities' in the US doing it. Please, people, you look like toddlers with sippy cups! If you're old enough to buy your own coffee, you ought to be old enough to drink it like an adult!
(And nothing against trash press, btw. Do I read proper grown-up medical journals whilst I pass gas? Hell no, I hide a copy of NW in a textbook and read that!)

3. Patrick has conjunctivits and is barred from daycare until it clears up. Ewww, pus-eye. Hopefully it won't clear up by Monday and I can have a day off work. Whee!

(Actually numbers one and three are related. By the Panadol. Oops. What the hell. I'm tired)

Monday, September 17, 2007

hi ho, hi ho

my theatre hats drawer.

I've been thinking about the return to work post that I ought to write for about three weeks now. And after reading minnie's post, I feel I oughta. Sorry it's all over the place, bit more stream of consciousness kinda thing.

I am about halfway through my training, that is, two and a half years of five. I have until 2014 to finish my training all up, which includes another exam, the two and a half years of on-the-job work and my Formal Project (a research project). I know that seems like a helluva lot of time, but given I can't ever see myself working full time again, that two and a half years spins into 5, and given I don't want patrick to be an only child, that's probably 6 which doesn't give me much buffer time if I screw up the exam. So I pretty much have to go back to work again now.

About two weeks before I was due to go back, I got the call from the head of the department to have a meeting about my return to work. Now, even though my boss is a lovely, kind and caring guy, being called up before the boss still has that 'going to the principal's office' sting to it. And being an ex-nerd, I never got called up to the principal's office much at all, so I'm pretty scared of it. (Yes, I was a goth, but a nerdy one. Truth.). So I worked out what I had to say in advance- that I could only work Monday, Tuesday, Wednesday and that I would need time out to express during the shifts which meant I would have to have someone able to cover me during that time (ie no fair rostering me into a busy ortho list with no boss to cover). And I pretty much just had the verbal diarrhoea with that once we sat down.

He then looked at me and said words to the effect of "well, you don't have to come back just yet. You could wait and start again next January".



Two weeks before that I had no childcare organised, and had no desire to go back to work at all, and now, after busting my arse to get someone who wasn't an axe-murderer to look after Patrick they offer me this! Aaaaargh!

But when it came down to it, it was time to go back. My maternity pay had dried up and time isn't really on my side training-wise.

So I have gone back. It wasn't as awful as I expected. I pretty much slotted straight back in, with it all coming back to me pretty easy. There have been some changes since I was there: the big change is that we now have automated machines
not the old Ulco machines

(my old friend) and I'm still waiting for my inservice.

It's weird- in one way nothing seems to have changed: we have all the familiar old things (little old ladies with broken hips, complex personality-disordered chronic pain clients, silly young men with broken jaws, gorgeous little boys (nearly always boys) who have discovered that they can't fly and their bones are not made of steel...- and I feel like I never left, but there's always one of the nurses who hasn't seen me for 6 months who enquires after Patrick and we sit around cooing at his photos.

I really feel that I'm luckily able to switch easily from 'mummy' mode to 'work' mode quite easily: once I'm at home, the clogs are off and I'm just 'mummy' again. It's great to have some intellectual stimulation and be using my brain.

I do so miss Patrick when I'm there! But, it has to be said, not enough to make me give up. I'd love to be working less hours if that were possible (bear in mind that part-time doctor's hours is not 38 hours a fortnight but more like 50 or 60) though; it would more nicely balance out the roles. Last week I had to do afternoon shifts (1400 to 2400) Monday to Friday (Grandma T came to visit) so that was 50 hours for that fortnight which seemed like a lot.

In addition you may have noted that I went to Hobart to do some locum shifts- they were paying a shitload and mum could babysit whilst I worked (I did two night shifts). Adding that up will make 70 hours for the fortnight. I have this week off but am working the weekend (two 12-hour shifts) and the m,t,w- 34 hours- so that makes 58 hours for this fortnight. I think doing 38 would be just wonderful, if you are considering it.

Childcare has been good so far. Considering the amount those in capital cities pay for it, $69 a day seems pretty reasonable. The first time we dropped patrick off ( a short 'trial' morning) we felt just awful, but he had fun. Yesterday, as soon as he got out of the car he was excited, and despite the fact he is developing a good bit of separation anxiety, he didn't look back at me once he had new toys in front of him. Huh. Yes, I am sending him to daycare espite the fact I'm not working- we have to pay for it whether or not he goes so I feel it's a good opportunity to do the long list of things I can't do with Patrick about (like painting the bedroom or weeding the garden and planting tomatoes and capsicum- yesterday's effort). I feel kind of bad about it, but let's face it, it's no worse than people who let their parents look after the baby for a day so they can get things done, just that I'm paying for it, which is all the more reason to do it. Maybe I'm just trying to justify my slackness, but there it is.

Expressing at work has been a little problematic. Not equipment-wise: I take the medela harmony and a boxful of bags, put the milk in a little cooler-type lunchbox so no-one gets all weird on me, wash the pump in soapy water after each use and store it in a snap-seal plastic tub with some Miltons in it in the overnight rest (ie sleep) room where I pump. It's getting the time off to pump. I've always been a good moo cow thankfully (in the beginning I could get in excess of 200mL from each boob) but now I find especially with the pressure of "I must get back to work" I only am able to pump about half to two-thirds of what Patrick drinks every day at childcare. That and the awkward conversation with the consultant with whom I am working:

"I, um, need to have a 'mummy' break every few hours"
"A what?"
"Um, I need to feed my baby"
(Looking confused) "Where's your baby?"
"At home/daycare"
"So you have to leave...?"
"No, just go somewhere quiet for twenty minutes"
(looks even more confused) "Eh?"
(Me getting flustered and red) "A lactation break"
(somewhat frustrated now) "I need to go and express (hands cupping imaginary boobs in front of me) every three hours"
(very embarrassed and unable to look me in the eye for the rest of the day)"Oh, Oh, Sure, right, whatever you need"

but five hours later I still haven't been able to take a break and my consultant has buggered off somewhere, and I'm stuffing green guaze down my bra to stop the leaks (somehow there always manages to be a screaming neonate in recovery when I go in)

"I'm sorry, but I really need to have my break now. This is getting rather painful"
"Oh, can you just finish that case and I'll get there in half an hour"
(anyone who has worked with hospital doctors knows there is no such thing as half an hour. It's always an hour. Or more)
"Um, ok, but it's getting messy"
(sounding worried) "What, the patient?"
"No, I'm getting leaky. And it's uncomfortable"
"Oh, right... I'll see what I can do".

In my pregnancy I gad this idea I'd be able to express in the anaesthetic bay whilst I kept a close ear on what was happening by the monitor's beeps (yes, the machine that goes 'ping') but that was when I thought you could express in five minutes, tops, and I didn't know you got leaky.

So, summary.
1. Work is good, but I wish there was less of it.
2. It's nice to be bringing in the money instead of just spending it.
3. It's nice to be using the old coconut for a change.
4. The new anaesthtic machines aren't ergonomic (ie there is nowhere to put my feet up)
5. Daycare feels bad, but is working out fine and Patrick enjoys it.
6. If someone's going to pay me $145 an hour to do some low-grade emergency department work, then I'm a slut for money.
7. Having some time out from the baby is good and refreshing for your soul.
8. (I'm up to 8? Sheesh!) Trying to get time to express is the hardest thing about my return to work, and apart from the hours, is the only thing I'd change if I could.

And let's face it, I look good in a theatre cap:

Friday, September 14, 2007

The agon-etsy and the ecst-etsy

I am indebted to the twinkle's mum for introducing me to etsy. I have spent every minute not working or looking after Patrick perusing the wares. I love both the 'geekery' section

as well as the baby onesies, like this one

But it has to be said there are many categories I haven't yet visited, so much stuff waiting to be seen.

But it all looked so cool! There must be some tat there...

I found it. Unsuprisingly, under the 'weddings' category.

Are you ready? I'll let the seller describe it to you first.

"Mock Wedding Cake. The three-tier cake measures 12" wide by 15 1/2" tall and is made up of five rolls of toilet paper, four cotton washcloths, four cotton hand towels, and one toilet bowl brush. The cake is decorated with white organza and lace, yellow silk roses, pink and white silk roses with dew drops. On top of the cake orchids surround a white toilet bowl brush."

Are ya ready? All yours for only US$45 plus p&h...

Monday, September 10, 2007

I never knew I'd feel this way

Oh the agony and the ecstasy.

How can something be at once so amazingly beautiful and so incredibly frustrating?

I've never felt so hopelessly and painfully in love with someone as I do with my beautiful baby. The power of the emotion is such that I can't believe it's not a physical appendage that you could see or touch. He daily delights me and, like all people in love, I can't believe that anyone else has ever felt this much love; that this is the most perfect love in the whole world, and secretly, only we know about it.

But there are still times when I want to shake him, want to walk out the door and leave him. Namely, times when he won't go to sleep- when he's so tired but he just won't close his eyes no matter how much I pat, rock, swing, cuddle, wrap or feed him.

I suspect one feeds off the other: if I didn't care so much for him I wouldn't be so upset that he's upset- if I didn't want him to be safe, happy and healthy I wouldn't care if he was overtired and screaming, I'd just close the door and leave him to it (how do people do controlled crying? It would rip my heart out). And if I didn't feel so frustrated and mad when he won't do as he needs to do, it wouldn't be so much of a joy (and oh, the magical golden glow that fills my heart) when he is laughing and happy.

'Random flappy arms' is now obvious 'hold both arms out for a cuddle'. And when he does cuddle, he snuggles his head into my neck. The little cogs in his head that whirr and tick as he looks at his toys and figures them out has also allowed him to learn to embrace his mummy. The Papez circuits have developed that not only allow him to happily hold a rice cake and mush it into his mouth but also to laugh hysterically when I kiss his neck.

Alarmingly, though, he has also been hungry and grabbed hold of my top and yanked it down to get at my boobies- in company. He is a boy after all.

Thursday, September 06, 2007

Notes from a small island

All rugged up for the snow

Even though it's supposed to be the same temperature here and in Sydney, somehow it always just feels colder in Hobart. I'm here for a week to earn some big money doing a shitty locum job in one of the private hospitals. And considering they are paying the airfares, I'm happy to take their cash.
Yesterday we went out bushwalking at Mount Field National Park. It's probably the place where I have done more bushwalking than anywhere else, save the wineglass bay walk. It's a really lovely spot. We forgot to bring the Macpac baby carrier, so knowing that the track around Lake Dobson was fairly flat we set off with the Mountain Buggy, thinking we'd turn back as soon as the track became impassable with a stroller. Well, it didn't: hooray for the MB! I now feel a little justified in having the MB seeing as how it really is the 4wd of the stroller world, and just as wanky, but I just don't know that we would have been able to get around this time with anything less rugged.
Us walking around Lake Dobson in the snow. Richea pandanifolia in the background. Myrtle and deciduous beech forest. Beautiful.

Patrick in rapt contemplation of Russell Falls... which looks like this...

Today I have to catch up with all my mum's friends (wa-hoo) as well as work the night shift. Patrick is coping ok but he just now had an hour-long scream fest when I tried to put him to sleep. A whole freaking hour. My mum has come and removed him from me: if I had been at home I would have put him in the car or the stroller by now to get him to sleep.

Tomorrow we'll go to Salamanca and visit the in-laws.