Monday, January 12, 2009

Sleep Doctors

So Monday, we were up bright and early to forge our way to Tripler for Lily's MRI and CT scan. Lily woke up throwing up and then threw up her meds a half an hour later. I felt very confident that when they asked me in the sedation center if she had anything to eat or drink since midnight, I could say no. Theoretically she was in the negative range after the past 2 hurls. We were running late due to traffic, and as we were hustling down the hall, we passed the anesthesiologist from Monday's procedure. We did not hit it off well. I am starting to formulate an opinion of anesthesiologists based on my experiences which are more than the average mortal and less than the average health professional. I think they mostly are suited for patients who are unconscious. Last Monday he waltzes into our curtained corner and starts drilling questions. That didn't put me off- I've been in pre-op before- it's a busy place. People rush. Time is of the essence. He is putting me off though with his accusatory tones and questions about why we didn't have a pre-op appointment with him and why isn't her full chart there and can he use her port? I just show up where I'm told, relatively close to the time I'm told to be there. I am not the keeper of her chart, so can't help there and the port is there to be used. Is it accessed? Can I use these tubes? Yes. Dude are you flippin blind- the child is sitting there naked except for a pullup- her port dressing is pretty obvious. Of course I was polite and say yes. What I'm asking is has it been used recently? Has anyone upstairs been using it? I'm not sure if there is port protocol or ownership issues, but I'm pretty sure all answers default to me, and I have already said yes- like 85 times. She was admitted last night for fluids, it was accessed then and yes they were using it up until we unhooked it to come down here. Why was she admitted? Are you dense- she requires fluids before chemo and we are going to start chemo as soon as this g tube is placed. So they were using this port so I can use it too, good that makes life easier. I mean I guess I should take it easy on the guy, her entire chart is not sitting there- so how could he possibly know any of this? Oh that's right, everyone's records are now computerized- go flippin look, do we seriously need the tome that is Lily's medical history in the chart for today's procedure? We go over all the medications she's on and he finally goes to get the happy juice. I hear him grumbling at a nurse about how Dr. E hadn't signed the chart, she needs to sign it and something or other about everyone here seems to know this kid except him. Confidence inspiring as always-but it's Lily- everyone loves Lily- and lets face it, she's around there- a lot. Fortunately it's a minor procedure and I know that Dr. E will oversee everything so I sigh and try and keep Lily distracted. Lily is a riot on the sedatives. She fights it and waves her arms around and sings songs, except it sounds like she has a mouth full of cotton. She finally passes out and they are on their way. When she wakes up she is PISSED off. Again- can't say I blame her. She looks at the feeding tube and panics at the sight of the blood. For 2 days she keeps the blanket over it and no one can look at it or touch it. She makes the doctors hold their hands behind their backs when they look while she shines the flashlight on it. Only her favorite nurse is allowed to clean it. The night we finally accessed it, I was panicked since Julie had already gone home- but with the ativan/morphine combo- it went pretty well.

So back to Yesterday- wow the temporal distortion of cancer is amazing. Forever life will be- before Lily had cancer- when Lily had cancer and the part I'm looking forward to- the after cancer time frame. Days feel like weeks, weeks go by, did that really happen yesterday- it seems fresh yet so long ago.....We bump into Mr. Sunshine Anesthesia of the Year in the hall. Hey is that Mallory? Yes, this is Lily. I have her case today- an MRI and CT? He actually pauses and looks at me- so I take the opportunity to give him the run down of everything he needs to know for today- since he likes to be in the know and all. She's thrown up twice this morning and she's gonna need a stress dose of hydrocortisone. We tried, it came right back up. Her button on her G-tube is also clogged, so Dr. E is gonna try and switch that out and on the tail end of sedation they want to pull the stitch on the tube. I can give her hydrocortisone, no problem. Which are they doing first MRI or CT? Don't know, they tend to be fickle. He seemed to appreciate that. So the itty bitty doctor jus wants to be in da knowwww. Here's me rolling my eyes. So we get to the sedation center and he makes this big fuss about my having to sign the consent forms since we are there every other week. I am highly amused- really a little insight into what makes people tick can get you a long way. The forms are such an insignificant thing- it's 2 signatures, now if he could streamline the discharge process- I'd be impressed. Miss Patti who is a bubbly bundle of fun nurse ,who usually helps us is doing her best to avoid him and he is ranting on and on to another nurse. He finally leaves and although I know it's highly inappropriate- I know Patti will give me her opinion if I phrase the question the right way. I mention that he rubbed me the wrong way last week and if she had worked with him before? She says he is not great with adults but that he is very good at what he does. A ha. So there you have it. Phil and I wonder if they pull people aside in med school and say- hey you might wanna consider a specialty where your patients are completely incapacitated? Those with ego trips need to induce the incapacitation...anesthesiology. I mean it's that or the morgue. Even though surgeons' patients are mostly out, they still have far too much interaction with humans who are awake, they aren't always good at it but they have to do it. But that's just my opinion. Lily is doing good. Much less puking and she's up and about today. She ate a little dinner with us last night, which was really nice.

We have also devised a process to administer mitotane that has worked so far 2 times without clogging Lily's button. Phil sent Stew on a mission to procure a heavy duty mortar and pestle from Williams and Sonoma downtown. Stew, after witnessing the clog and distress it caused did some research on his own. He found on the internet- it's not that mitotane won't dissolve in water- it just requires higher quantities. 1 liter per milligram to be exact. So we would have to dilute it in 750 liters of water per dose. Perhaps we could fill the tub with it and she could soak in it? She always drinks a little bathwater anyways. That seems slightly unrealistic, and somewhat we grind up the pills in the mortar. We then mix it with warm milk. I then grind the milky mixture in the mortar and add a little more milk. Not at all a process- just a little fun chemistry for me to practice when I don't have anything better to do like change sheets, run IV's, keep Bella from destroying the house and what not.

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Lily Kay Monkey

Lily Kay Monkey
November 2008 Photographed by Shelley Detton (7 Layer Studio)