As the night progressed on Monday, the baby started working harder to breathe especially when eating. I also noticed her secretions were getting thicker. It was too late for urgent care so our only option was the emergency room. I packed her up in the car seat and headed out for our second trip. They did a chest x-ray and gave her a respiratory treatment. The true test was feeding her a bottle. She ate comfortably and seemed to be breathing normally. The doctor discharged us Tuesday morning and instructed us to use a humidifier and bulb suction at home.
As I drove home, I knew she would need more than just humidity. My pediatric nurse experience told me something else was going on. So, I got on the phone to try to get her an appointment with a pediatrician to see if I could get a nebulizer with albuterol treatments.
Unfortunately, navigating the MediCal system is NOT easy. First, there is the task of finding a physician who will actually take a patient with MediCal. Second, getting in to see a doctor that day. Third, knowing what information the office needs from her insurance card (which I didn’t have at this point).
Andrew convinced me to go to bed to get some sleep and he’d work on finding a doctor. After four hours of sleep, he woke me up and told me he found a pediatrician and asked if I wanted to go with them. Thankfully, her mother had taken her to this office before so they had the baby’s information already (all we had to provide was the foster care placement paperwork).
The Nurse Practitioner (NP) assessed her and said she needed respiratory treatments. He prescribed albuterol nebulizer but stated it may take a week or two to get the machine. What the -? She needs a nebulizer now but she can’t get it for another week? Maybe two? Andrew and I found this to be totally unacceptable so we told the NP to order it but we would just by one from Amazon (plus, I figured it wouldn’t be a bad idea to have one for any future kids).
I was scheduled to work Tuesday night so we talked about whether or not I should call in sick. Andrew said he could handle it and we should save my sick time. Reluctantly, I left for work. I will say, though, she looked pretty comfortable before I left and was breathing well. We went over using the albuterol inhaler (the nebulizer wouldn’t be delivered until Wednesday), the humidifier and the bulb suction.
Shortly after my shift started, I got a call from Andrew telling me that something was seriously wrong with the baby, that he took a video and sent via text, and asked if I could watch it and call him back. On the video, she was pale, gray, and visibly struggling to breath. I called him immediately to tell him to call 911 and he told me he already had made the call. I informed my manager that I needed to urgently leave.
When I got to my car, I called Andrew again – the ambulance had just arrived. They told him she was very sick and they would be going to the nearest ER (Andrew told me at some point she stopped breathing and turned blue). Unfortunately, the nearest ER doesn’t have a pediatrics department so I was concerned about the care she would receive there.
When the ambulance arrived, they rushed her to the back. They quickly placed an IV, sedated her and placed a breathing tube. She was now on a ventilator. It was so scary being on the other side watching as a caregiver; however, despite the lack of a pediatrics department, the staff did a great job.
We called our agency to let them know what was going on and that she would be transferred to a local hospital that had a pediatric intensive care unit (PICU). Thankfully, I had worked in the same unit 2 years ago so I knew many of the doctors and nurses.
When we arrived to the hospital, Andrew and I explained what we knew of her history and the events leading up to calling 911. They ran all kinds of respiratory cultures to determine what caused her to get so sick. In the meantime, they started antibiotics to cover any bacterial infection. They decided to keep the breathing tube and sedation to let her body rest and heal.
When the hospital SW arrived in the morning, she came to talk with me about the baby’s social situation. I explained that she had just come into my care and I hadn’t met the mother or have any of her information. The SW asked if someone had contacted her about her daughter being in the ICU and I stated that to my knowledge no one had. I would have, of course, made the call myself but I didn’t have any information.
Meanwhile, the morning doctor came in to tell me that the infant’s blood pressure was lower than they wanted despite giving extra fluid. They wanted to place a central line emergently (a central line is kinda like an IV but it goes into a bigger vein and can last longer). When they started, I realized that watching the procedure was more than I could handle at that moment (even though I’ve seen the procedure done dozens of times in my career).
When I left, the SW found me and stated she was going to have the mother visit and asked that I stayed away unless the mother requested to meet me. In our foster care training, it was explained to us that the first meeting of biological and foster parents can be awkward and tense. The added stress of this first meeting happening in the ICU was not helpful.
Thankfully, the mother did want to meet me. I was able to explain everything that happened and I was also able to go through all the machines, equipment, and medications her child was getting. She wasn’t able to stay long but it was nice that I was able to reassure her that not only was she getting excellent care from the hospital staff, we were going to stay with her child throughout this process.
To be continued…