Me

Acuity

After an evaluation of his lab results, the hospital felt comfortable moving him out of the ICU. He has been moved to a normal pediatric unit. He still cannot speak, eat, swallow, or move his upper extremities. He can only walk with large amounts of assistance. It’s tough to watch. The only way that he can communicate is by looking at something and laughing or crying. Things like “Which movie do you want to watch?” Then holding them up one at a time until he laughs at one.

Still, a week ago he was still unconscious, and ten days ago he was near death. Even if improvement doesn’t come as quickly as we would like, it is still coming. Sometimes it’s difficult to remember that. Still, at this point it is impossible to know what long term deficits he will have, if any. You can tell that being unable to do anything is wearing on him, and he gets visibly frustrated at times.

But progress is slow. I won’t do updates unless and until there is something to report.

On another front, his school contacted my daughter and asked for a doctor’s note for this extended absence. So it was provided to them. The next thing was the school telling her that he would have to disenroll or transfer to Florida virtual school. That is complete and utter horseshit. Federal and Florida law require them to offer him services. The law says that he is entitled to home education visits while in the hospital, and having spent time as a teacher, I know what the law says. We are going to go through the process, and if the services required by law aren’t provided, I will gladly hire an attorney.

By Divemedic, ago

Slow Progress

Went to see the grandson today. Right after I got there, the Infectious Disease Doctor and Physical Therapy showed up. Things were a good bit better today.

When I got there, he was writhing in pain and crying. I saw that he was flat on his back, so we raised the head of the bed. The crying stopped. I played with him for awhile (piggies, fart jokes, silly child games that 6 year olds find funny). He made the first sounds other than crying that anyone has heard from him in 9 days. He laughed. It was the greatest sound in the world.

Then the ID doctor showed up with physical therapy. They got him out of bed, and he took his first steps in 8 days. They were awkward, assisted by the PT people, but they were steps. 4 of them. He needs a little help holding up his own head, he barely moves his arms, and it will be weeks or even months before he walks again without assistance, but it is progress.

It doesn’t look like he will have permanent, full paralysis. He may or may not have permanent weakness, but only time will tell. For a child who was on his deathbed seven days days ago, this is nothing short of a miracle.

The culprit, according to the ID doctor? An infection by enterovirus that somehow infected his brain and caused massive amounts of swelling. In other words, viral meningitis.

He is still in the ICU, and we continue to wait and watch.

By Divemedic, ago

Improvement

My grandson’s name is Ryan. At about 1100 this morning, he decided that it was a good time to open his eyes. He even smiled when his mother made a fart joke to try and get him to laugh. His mother, his nurse, and myself were moved to tears.

His smile is crooked, indicating a possibility of some sort of neurological deficit. (If you will remember, the virus he was hit with frequently results in paralysis) He still hasn’t spoken a word in 8 days, but for the first time in 5 days his eyes are open and he is interacting with those around him.

Neuro will be evaluating him for function and deficits. The fact that he is again awake is a major improvement. We continue to wait and watch for any signs of what is to come.

I want to thank each and every one of you who has taken the time to comment, email, and wish or pray for his recovery. You are all too numerous to thank on an individual basis, but your support and care is of immeasurable benefit.

By Divemedic, ago

Watching and Waiting

With regards to my grandson: I spent most of last night at the hospital. I got the opportunity to look over his labs, and they all looked as normal as any child’s. The doctors were performing every test imaginable. He now has a feeding tube, and has been having seizures off and on all day.

They believe that they have finally identified the culprit, and the news is not promising for full recovery. It looks like he has acute flaccid myelitis caused by his being infected with a strain of enterovirus called EV-D68. From what doctors can tell from examining him during the short periods of time that his eyes are open, it looks like his left arm is not working.

It appears like the virus has been hitting children in the US pretty hard for the past few weeks. There is no vaccine, and there is no real treatment. In my grandson’s case, permanent paralysis and even death are possible. If it is in fact determined that this is what he has, the best we can hope for is permanent paralysis of at least one of his limbs. What a tough thing for a six year old child. My heart breaks for my daughter.

For now, they are starting him on a course of corticosteroids, continuing the IV immunoglobulins, and they will be transferring him to UF Shands in Gainesville for more care. Transferring him to Shands is both a blessing and a curse. It’s a great hospital, but the fact that he needs to go there is not good news. It’s serious enough that the CEO of the hospital where he currently is has personally gotten involved with the case.

I can’t visit tonight, as the ICU only allows for three people to visit at a time, and one of them is of course my daughter, so the family is setting up visitation schedules.

For now, we await the results of the testing.

By Divemedic, ago

Little News

Blogging continues to be on the back burner. My grandson’s condition has changed little, or perhaps a bit worse. He began having seizures last night. I appreciate all of the thoughts, well wishes, and prayers you have sent my way.

By Divemedic, ago

My Grandson

I have hesitated to post this until now. My daughter has two children, a daughter aged 7, and a son aged 6. Her man has two children of his own from a previous marriage. So I have a total of four grandkids. This post is about my daughter’s six year old son.

Last Wednesday, he came home from school complaining that he was tired. It had been a long few days, as all of them play sports, and the weekend had been filled with tons of activity. He went to bed early. He wouldn’t wake up fully on Thursday morning. He was running a slight fever, and was refusing to eat or take any fluids. He will occasionally open his eyes, but he hasn’t spoken a word since he complained of being tired on Wednesday.

By Friday, my daughter called me in a panic because she couldn’t understand why he was getting sicker. I told her to try and get him to take fluids. She tried, but every time he would drink, he would vomit them back up. So Friday evening, she took him to the Pediatric ED. This next part is for the medical people: His ABG showed pH of 7.28, a CO2 of 47, and an HCO3 of 11. He is on contact and droplet precautions because he tested positive for Rhino and Enterovirus.

So he got fluids. I thought for sure that the fluids would bring him around. No go. When he is sleeping, he writhes in pain, but that is the only reaction. He is rousable, and could walk with assistance to the restroom, but if not woken up, and coerced into going, he will simply wet himself while unconscious. Light hurts his eyes, and he will wince in pain when the lights are turned on. His fever on Friday night spiked to 103. So as soon as I got back from Miami on Saturday, I went to see him and my daughter.

When I saw him, I attempted to check his Brudzinski, so I placed him supine, placed one hand on his chest, and raised his chin to his chest, which caused his hips and knees to flex. I reported this to his nurse. My daughter reports that they went in later and woke up my grandson. They had him put his own hand on his chest and use his other hand to raise his own head. There was no response. I have never heard of a Brudzinsky being done that way, but I may be wrong.

While I was there, he opened his eyes, and I got him to smile because I was being a big goofball. My daughter reports as soon as I left, he went back to sleep and is even more difficult to rouse.

Anyhow, he has had numerous blood draws, head CT, EEG, and Lumbar puncture, all normal. The only abnormal finding on any testing is a small cyst on his spinal cord, but the neurologist thinks it may have been there since birth and says it wouldn’t be the cause of all of this.

Then this morning, he deteriorated again. Now he can’t even walk with assistance. So now he has been moved to the Pediatric ICU. He is on pain meds, so he is sleeping better, but there are still no answers. If they can’t get him to take anything by mouth by tomorrow, they are going to insert an NG tube and begin feeding through it.

As you can imagine, my daughter is a wreck. She hasn’t left his side in a week. When they take him off for more testing, she spends her time crying. My little girl’s heart is breaking, and I don’t know what else I can do. As soon as I am done typing this, I will be headed off to the hospital to see them again. The hospital is over an hour from here, so I will be home late.

Life is what happens to you while you are busy making other plans.

By Divemedic, ago

Damage

As is typical for storms, I am slowly finding damage to the house from the hurricane. Also as usual, it is electrical and electronic damage. While trying to find out why I am having so many Internet issues, I discovered that I lost the UPS that powers my routers and modem. That isn’t why I am having problems, but it is something that has to be replaced.

I also lost my intelligent irrigation system. The one that stings is the irrigation system. Its two year warranty expired 16 days ago.

By Divemedic, ago

Internet Issues

There is a lot of research I would like to do, but I am having internet issues. The hurricane appears to be causing all sorts of connection issues and has been for days. My connection for Internet and cable television is best described as intermittent. It works for about ten minutes at a time, then goes down for a while, then back up. So posting quality may suffer a bit.

By Divemedic, ago

The Effect of Cost Cutting

Five days ago, I posted about the hospital where I work trying to save money by cutting out the shift bonuses that were being used to entice the staff to work 50 and 60 hour workweeks. Today was the first day where I worked and there were no overtime people. Where a 50 bed ED normally needs 14 nurses to operate? We had 10 for most of the day. Meaning that we should have 5 patients to each nurse.

Nope, we were too busy for that. We tried to tell EMS agencies that we couldn’t take any more patients (it’s called being “on divert”). It didn’t work. At one point, we had 90 patients. For ten nurses.

I work a swing shift, which is supposed to be 11am to 11pm. Most of the ED works 7-7. By 9pm, my patients were:

  • A 37 year old female who kept having seizures. She had 6 of them the first 2 hours she was my patient.
  • A 26 year old male fentanyl overdose.
  • A 76 year old with a bowel obstruction that is vomiting coffee grounds.
  • A 35 year old who came to our facility two weeks ago complaining of chest pain and went into cardiac arrest. He is complaining of chest pain and has elevated troponin levels.
  • A 78 year old woman with perforated diverticulitis.
  • A 56 year old intoxicated woman who is with us for altered mental status and is covered head to toe in her own feces.

For those of you who don’t know, most of those patients need to be in a unit that offers a higher level of acre than what we can provide in the ED. The problem is that all of those units are already full.

In the meantime, there are 22 people in the waiting room, waiting for us to have room to treat them. At one point, there were 7 ambulances lined up at the door, waiting to drop off patients. So I wound up ordering Wendy’s through DoorDash at around 8pm, and eating it at the nurses station while I wrote notes on patient’s charts.

Needless to say, everyone was getting testy, patients AND staff.

As 11 o’clock approached, the charge nurse asked me to hold over because we still had more than 60 patients, and three of us were scheduled to go home at 11, which would leave her with no techs and only 8 nurses. Because I like her and she always does me favors, I agreed to hold over for a couple of hours.

Right at 1, when I was planning to go home, all hell broke loose. An intoxicated woman was brought in by EMS, who claimed they were unable to get an IV. Ten minutes after they dropped her off, she vomited about a 1.5 liters of blood.

So a third of the remaining nurses spent the next 45 minutes trying to keep her alive. All of their patients were getting ignored in the meantime.

One nurse remarked, “As long as we keep doing this, they will keep making us do it, until it becomes the ‘way we have always done things.'”

I finally left the place at around 2 am, having worked a total of 15.5 hours. But think of all the money they are saving by not having to pay those bonuses.

By Divemedic, ago

Shortages

Last month, I mentioned that the hospital where I work is bringing Philippino nurses in to fill vacant positions for less money than hiring Americans. There is more news on that front.

We have been short staffed for nearly three years. They have made up the shortfall by paying huge bonuses to get nurses to work extra shifts. They tried foreign workers. Still, they don’t have enough. Determined to save money now that the COVID funding has dried up, hospital administration announced on Saturday that there will be no more bonuses offered. Once the shifts that are already promised bonuses are paid out, they will be no more. Nurses who were making $2500 a day for working a 12 hour over time shift are now being asked to work the same overtime hours, but for $600-$900 each 12 hour shift.

I know that I was working 60 hours or more a week. I was making good money to do that, but now that the money has dried up, I am not working those kinds of hours for a fraction of the pay. No one that I know is willing to do that.

So now the entire staff of the ED is not taking any extra shifts. They are working their contracted hours, and that is it. Me? My contract says that I have to work 4 shifts a month. That is all I am doing. Everyone else is doing the same. So now the hospital is even more short handed.

Here is what was texted out to us this morning by the ED department head:

Hello team
We know this week has definitely had its ups and downs already and we appreciate all the hard work done by everyone. While we all fight this same battle we still have patients who are expecting the best care we can provide.
Starting tonight through the weekend we could use anyone on any shift to assist your fellow team and patients.
Please any help is appreciated.

As if guilt tripping us will get us to work all of those extra hours for a third of what we were making before. I want to help my patients and coworkers, but at the end of the day, this is a financial arrangement. It’s business.

So now the hospital is getting desperate. A third of the ED beds were shut down today for lack of staff.

The hospital where I work can only fill itself to somewhere near 60% capacity because they don’t have enough nurses, and that was when people were working extra shifts for bonus money. That means that patients often stay in the ED until there is an open bed on the inpatient floors. Our ED is frequently more than half filled with patients on “admission holds” awaiting beds. Couple that with the fact that the ED is also short nurses, and you have a problem.

Picture a 50 bed emergency room. To staff a 50 bed ED takes 14 nurses, 4 paramedics, 4 general technicians, 3 doctors, a nurse practitioner or PA, a respiratory therapist, secretary, three registration clerks, two lab technicians, three radiology techs, and two janitors. Every shift.

Now picture that you only have enough nurses for 10 per shift. Now you can only handle 40 patients at a time instead of 50. Now also picture that you have 30 admit holds, taking up beds and waiting for an inpatient bed- some for more than 48 hours. Now you can only handle 10 patients because your staff is busy caring for holds. So the waiting room backs up.

This means you have people sitting in the waiting room for 4, 5, or even 6 hours as they wait for treatment. And all of that was happening before you cut off the bonus money.

Now instead of 60% staffed, you are more like 45% staffed. Instead of 10 nurses, you only have 7. Now picture that across the entire hospital. A 600 bed hospital with a 50 bed ED requires 100 nurses or more each shift. You only have 50 or 60. Now what do you do? There aren’t enough foreign workers to fill that many spots.

My hospital can’t be alone in this. Here is the warning: there is a potential collapse of health care coming. It takes 3 to 4 years to train a nurse to the point where they are licensed, and another 2 years or so for that nurse to be proficient enough in their job to staff an ED, even longer for places like the ICU.

By Divemedic, ago