Sunday, August 10, 2003

You know that slow modem I mentioned last time? It’s gone. I’ve switched to a cable modem.

And I’ve decided that I ought to move a few things from my SFF Net newsgroup over here. For example, my account of a very unhappy day back in mid-June.

The whole situation with my son Julian’s hospitalization caught us off-guard. I was sitting at my desk doing minor stuff Saturday afternoon when I got a call that Julian had collapsed with heat exhaustion on the twenty-mile Boy Scout hike he was on. The call was from one of the other hikers, and didn’t make it sound serious; he said that they’d be taking him to the next checkpoint, Edward’s Ferry, and driving him home from there. I could come get him if I wanted, instead.

I didn’t see much point in that, so I agreed he’d be driven home.

I figured it was just the weather — temperatures in the high 80s and humidity of 99%, after months of cold, wet spring — and inadequate conditioning, as training hikes had been rained out or had conflicted with other stuff he’d wanted to do. Julian’s a big, strong, healthy guy who hikes a lot, so I didn’t think it was a big deal.

Awhile later — at about the earliest point he might have been expected by that plan — I got a call back from Starpower, who I’d been trying to reach. For those unfamiliar with our local situation here, Montgomery County has two cable TV systems, Comcast and Starpower. We have two local phone services available, Verizon and Starpower. We have a zillion long distance services available (like everywhere else); one of them is Starpower. And we have multiple high-speed internet providers, Starpower among them. And in every category, Starpower came along later, so we had Comcast cable and Verizon phone service and Working Assets long distance and Earthlink internet service.

It had occurred to me when we got our new computers, SuzyQ and Chloe III, that it might be time to switch from dial-up to broadband, and the only sensible way to do that here would be cable modem, as Earthlink says we’re 400 yards beyond the limit of DSL service. (This decision was helped by SuzyQ’s dial-up access being lousy — she was on the other phone line from Chloe, and the signal strength on that line is such that SuzyQ drops carrier every five minutes.) If we were going to do switch anything, why not switch everything over to Starpower and get one monthly bill instead of four, while saving about $20 a month because hey, they’re the new guy, they compete on price, so they’re a couple of bucks cheaper on everything.

The only drawback is that Starpower doesn’t carry the Game Show Network. They have every other channel we care about, but not that one — at least, not yet; I’m campaigning to get them to pick it up.

Anyway, I’d been waffling — Julian watches the Game Show Network a lot, and I confess a certain fondness for some of their shows myself — but we’d finally taken the plunge, and the Starpower guy called while we were waiting for Julian, and we went over all the details, down to what I wanted for my new e-mail address. This took awhile — the better part of an hour, actually. Possibly more than an hour, I wasn’t really noticing.

Anyway, somewhere about halfway through the call Julie started asking why Julian wasn’t home yet, which I ignored because I was doing business on the phone and hey, it hadn’t sounded serious. I just figured they’d taken awhile getting him to Edward’s Ferry.

But I finally hung up, and the phone immediately rang, and it was the wife of the Scout leader who’d organized the hike, calling to let me know that her husband was on the ambulance with Julian, and they’d meet me in the E.R. at Shady Grove Adventist.

Ambulance? E.R.? Huh?

So I immediately got out the car and headed to Shady Grove, about ten minutes from home, and got there just as they were moving Julian from the hallway into a room in the E.R. He looked like crap — groggy, filthy, wet, with mosquito bites covering his legs and poison ivy on one arm — but basically intact. I peeled off his soaked hiking socks; someone had gotten his boots but left the socks on, which was a Bad Idea, as his feet were wrinkled and blistered, which can’t be good in someone dehydrated.

I still wasn’t especially concerned; he’d come back from hikes just as filthy, soaked, and bug-bitten before, but upright and with a big grin on his face. The nurse said that he was dehydrated all right, and they’d put a liter of saline into him, but he should be fine once they got a second liter in.

At that point he rolled over and vomited on the floor, as we couldn’t get a basin in place fast enough. Sigh. But he warned us it was coming, and generally seemed pretty coherent, and the nurse didn’t seem to think it was a big deal.

Anyway, I hung around for awhile, filled out the relevant paperwork, gave them his insurance information, then came home to get some supper and Julian’s clean clothes. (At Julie’s urging I’d brought clean socks and shoes initially, but hadn’t included a shirt or pants, which would obviously be needed.)

Julie had made pizza, white pizza with ham, and I got home just as that came out of the oven. The three of us ate, and then I headed back to Shady Grove, thinking I’d be bringing Julian home with me in a couple of hours.


So I got back to the hospital about 7:30 and went to the room Julian had been in, and he wasn’t there, a woman with a baby was, so I asked, and he’d been moved to 5B — and, I was told, he’d been vomiting, and combative, and pulling off sensor leads and the like, which didn’t sound like Julian at all.

So I go to 5B, and there he is, and he is now totally out of it. Before he’d been groggy, sort of fading in and out of consciousness, but now he’s completely unresponsive. He’s not comatose or anything, he appears to just be asleep, and not even all that deeply, but he can’t be awakened, doesn’t answer questions, violently resists being moved from his preferred position of sleeping on his right side. This is not at all what he’d been like when I left, or at any previous time.

He is clearly not going home any time soon.

The blood work has come back, with scary numbers on sodium (near 0) and CPK (over 1,700, where normal is 33 – 145), and there is some question as to whether the dehydration shut down his liver and/or kidneys, possibly doing permanent damage. He’s unresponsive and obviously dysfunctional.

They want to do a CT scan, not so much for any particular reason but just because they can and it might show something useful, and I agree to help, so a technician and I roll him down the corridor to the scanner, where we try to roll him onto the scanner bed. He does not cooperate. In fact, he actively resists, grabbing onto the metal frame of the bed he’s on — he is staying RIGHT WHERE HE IS, and on his side, thank you very much, and we are NOT going to roll him onto his back or onto another bed, no matter how much we yell or pry or push.

He never wakes up, never says a word, but he still resists vigorously.

Julian weighs 275 pounds. He’s big and strong. If he doesn’t want to move, it’s gonna take more than two guys to move him without hurting him, and the two of us are all we have, and there are other patients waiting, so after awhile we give up and take him back to the ER, figuring we can try again later.

Back in the ER I am informed that he’s to be moved to ICU — his current worsened state qualifies as critical condition, and he needs closer monitoring than the pediatric ER can handle. The PICU has no beds open, so they plan to send him upstairs to the adult ICU, which sounds fine to me.

Except then plans change. I talk to two different doctors and a couple of nurses and there is some confusion, but it eventually falls out that while our insurance company (Kaiser Permanente) has no problem with sending him to Shady Grove for emergency treatment, they do not currently have a contract with Shady Grove that would cover admitting him there as a regular patient. One is in the process of negotiation, and exceptions can be made — but probably not after hours on a Saturday for an under-age patient going to an adult ICU.

(The lack of a contract is not as stupid as it seems; Shady Grove has a complicated history that includes some bad stuff. Since then they’ve cleaned up their act, but Kaiser wasn’t in any hurry to jump back into bed with them, as it were.)

So now the plan is to send him to Children’s Hospital down in Washington, which is Kaiser’s preferred venue for pediatric patients of all sorts and which does have space in their ICU. In fact, Children’s has already sent a transport team, and they’re on the way, as it’s fairly urgent to get him somewhere other than where he is.

Have I mentioned the Scoutmaster?

The guy who organized the twenty-mile hike, so that some of the members of Troop 1097 could get their hiking badges, was there when I first got there and there when I left to go to dinner, and now he comes back to check up on Julian again. He’s very upset about the whole thing — and I don’t blame him, but it’s not his fault, Julian already has his hiking badge and usually knows what he’s doing and just went because he really likes hiking; this was really kind of a freak thing, having the stupendously sweaty weather after months of cold and rain, so Julian wasn’t in the shape he should have been. Anyway, whenever he’s there I seem to spend more time trying to cheer him up than anything else, which is not helping my own mood or natural optimism. I keep reassuring him Julian will be fine, but hey, I don’t know whether he’ll be fine. He’s had regular medical check-ups, much more thoroughly than most kids his age because of previous high-adventure stuff, but the human body can find all sorts of ways to break down.

Anyway, he goes away after awhile, which is a relief. Nice guy, but I didn’t want him there. I’d much rather just sit there reading and waiting by myself, or talking to the staff as appropriate.

I’d mentioned the CPK number. I should probably explain what CPK is. It stands for something like “creatinine phosphorokinase,” though that’s probably not exactly right. It’s produced by the breakdown of muscle tissue under stress — that is, when you overwork a muscle, you get CPK.

A number in the 1,700 range is what you might expect to see in a marathon runner or triathlete who collapsed at the end of the event. It’s Really Not Good — the kidneys should be filtering it out before it gets to that level. That Julian hit that level without even noticing that he was particularly tired or sore… well, some members of my family have had problems with insensitivity to pain. I once had an abcess in my jaw that my dentist didn’t believe at first — he couldn’t believe I could possibly have an abcess that size, in that location, and still be able to talk. Or even stand upright without painkillers. He thought I should be curled in a ball whimpering.

And it’s not that I was toughing it out; it’s that it really didn’t hurt very much.

And my nephew James had a few nasty accidents as a kid where nobody noticed he was hurt until they saw the blood. Another nephew, Gordon, once broke his wrist, and no one noticed for a day or two. Hell, when I smashed my hand, broke it in three places, it didn’t actually hurt all that much, it just swelled up…

So it seems Julian has the same problem. And yes, not feeling pain is a problem. (Especially since it’s only certain kinds of pain, under certain circumstances.)

Anyway, stupendously high CPK levels are a sign that muscles may be damaged, but more importantly, they’re a sign that the kidneys are not doing their job. Kidneys need lots of fluid, of course, so dehydration often causes a partial/temporary shutdown, but that shutdown combined with an overwhelming flood of CPK can turn into permanent damage if you don’t do something about it.

Mostly, you need to pump in lots of fluid, to get the kidneys back up to speed, and you need to keep doing that until the CPK level gets back to something near normal.

Anyway, after the Scoutmaster leaves I do, in fact, sit there reading, occasionally talking to doctors, wishing Julian would wake up. He doesn’t. He’s inert. He doesn’t
know his name or who I am, when questioned — if he answers at all, the answers are nonsense.

At 11:00 the shift changes, and the night nurse comes around, checking on the patients. She gets to Julian at about 11:10, and asks him his name and age, if he knows where he is, if he knows who I am.

And he answers, sleepily but correctly. In fact, he wakes up — not the blank unseeing open eyes that I’ve seen a few times over the past four and a half hours, but really awake, if still groggy.

I want to say something, to tell the nurse that this is a huge improvement, to call to Dr. Friedman (who is across an aisle and divider from where I’m sitting, talking on the phone), but I can’t — I’m overwhelmed just not crying. Up until then I’d been holding it together pretty well, being calm and upbeat and rational, but seeing Julian suddenly snap out of his… trance? Daze? Unresponsive state? Fugue? Anyway, whatever it is, he has just woken up from it and is himself again, and my eyes are tearing up and I can’t talk, and then the nurse has gone on to the next patient and Dr. Friedman has gone into a back room and I don’t know what to say and am still not sure I can talk without weeping.

And that’s when the transport team from Children’s Hospital arrives, a trio straight out of Central Casting — big burly black guy who talks about football, tall skinny white guy who doesn’t say much, short feisty redhead who’s clearly in charge.

The three of them troop in, and pull their stretcher alongside Julian’s bed, with the white guy at the head and the black guy at the foot, while the woman goes to tackle the paperwork.

Julian looks at them, and someone (I forget who) tells him he’s being transferred to another hospital, and he responds with some perfectly sensible question — I forget what; I was still a bit dazed myself at that point. I said something reassuring.

The black guy starts chatting with him, asking if he plays football, since he’s obviously got the build for it, or maybe went out for wrestling. Julian and the black guy and I have a pleasant conversation. The white guy doesn’t say anything, just listens.

The redhead comes back and listens for a moment, too, then says that they aren’t taking this kid to any ICU. The orders said he was unresponsive and non-functional, and that description obviously doesn’t apply any more. They’ll be happy to take him to Children’s, but only to a regular bed, not ICU.

The staff from Shady Grove acknowledge the sudden improvement — Julian clearly is out of critical condition and doesn’t need the ICU. But in that case, does he need to go to Children’s? Maybe they can just check him in here at Shady Grove, which would be infinitely more convenient for us.

They ask me which I’d prefer, here or Children’s. I ask Julian.

He says he’d rather just go home. I say, “That ain’t gonna happen,” and vote for Shady Grove.

The Shady Grove staff starts investigating this possibility. There’s a bed available, the doctors have no problem with the idea — but it has to be cleared by Kaiser, unless Julie and I want to pay for the hospital stay out of our own pockets. Which we don’t.

So they call Kaiser, and the ambulance crew waits, the three of them hanging out chatting with me and Julian — well, except the white guy never says much of anything.

Julian is obviously himself again — tired, a bit bleary, but himself.

Did I mention the monitors they had him hooked up to, measuring heart rate, respiration, and blood oxygen? They’d all been normal the whole time, which was reassuring. If the blood ox had been low I’d be worried about brain damage, but the lowest it ever went was 89%. And Julian is certainly sounding undamaged at this point.

Anyway, we wait, and eventually Kaiser says they don’t have anyone there who’s going to authorize anything with Shady Grove at midnight on a weekend, so it’s off to Children’s.

The transport crew would like me to ride in the ambulance. I’d like to have some way to get home again, so I decline, but agree to follow them in my car, so as to take care of paperwork at Children’s.

And they load Julian on the stretcher — he’s entirely cooperative, in stark contrast to the earlier attempt at CT — and roll him out, and I go get the car, and we head off toward I-270.

And from there on, it was more tedious than frightening — though I gotta say that an emergency room in a children’s hospital at 1:00 a.m. on a Saturday night is a really depressing place. Julian recovered just fine. They kept him three and a half days, until all his blood work came back at least close to normal; they’d pumped a truly prodigious amount of saline solution through him by then, and he’d missed two of his final exams. He made them up at the end of the week.

This is not an experience I ever want to repeat.

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