So Thursday night Julie was concerned about Kiara. Not one thing was severe but a few non-specific symptoms made her nervous. Good thing, because if it were up to me, we would have waited overnight and reassessed in the morning, to what end I’m not sure, but certainly a more negative outcome. So on Ju’s intuition we went off to the Wallaceburg ER at about 5:30 PM. We saw the doctor there and higher than normal white counts combined with the other symptoms (stiff neck and such) concerned him enough to check with London on their protocols for her specific condition (ie. Recent shunt surgery). London Neuro ordered her to come down the London ER to be assessed, and off we went. At arrival we were hustled, after triage, right in to the beds in the ER past all the folks waiting in chairs, a large numeral and text on a white board at the front desk announced that the estimated wait time to be seen (for non-life threatening circumstances of course) was currently at 5 hours.
I had mixed feelings as I walked past all those folks; Guilt for bypassing the queue, Relief that we didn’t have to wait in the germy ER waiting room with all the coughing, hacking and infectious individuals around and more than a little fear that we were apparently more concerning to staff than all the rest of the adults and children. It is now 10:30 PM and time to wait for the NeuroSurg and Pediatrics to consult. First order of business is blood tests….Kiara is not a fan of the blood draw. Strong for a little girl she certainly surprised the three staff plus a parent that it took to keep her still through the process. Somewhere between 3 and 5 AM she had an LP (Lumbar Puncture or spinal tap) again a lovely process of holding a child perfectly still as a resident pokes a sharp needle into the subarachnoid space surrounding the spinal cord to collect some cerebra-spinal fluid (CSF). Careful not to miss by a couple millimeters and possibly hit the spinal cord, that would be bad. Julie, sensing the resident isn’t exactly as contemporary with shunted children as we would like, suggests that he tap Kiara’s shunt for CSF, a much safer & easier course of action than poking into the spinal dura in the germy ER. He proceeds to look at her like she’s a moron and tell her that the LP is what is going to happen. This is completed and again we wait most all patients are processed through the ER, but not us we get to watch them all come and go and in the wee hours of the morning there is only us and one other patient in the Children’s ER. Pediatrics sent a couple of students to come down to rule out anything else as the source of infection. Obviously, the three other doctors and six nurses that have looked in her ears, listened to her chest and asked her if it hurts to pee obviously may have missed the ear, chest or bladder infection causing Kiara’s fever. Everyone is very nice though and I understand why the process is so stringent later in the morning.
At 6:30 AM they tell us that Kiara will certainly be admitted as the tap came back with a high protein result, potentially indicating infection. We will have to wait for a room assignment and this won’t happen until after the nurses finish shift change, the Doctor (the full-on Neuro-Surgeon) is also coming in soon and will further assess the situation. Antibiotics (two) are prescribed the first runs through quickly and the second goes on to the IV rack only minutes before shift change at 7:00 AM. Kiara asks Julie to scratch her behind her ear as she has a little itch, not uncommon with Kiara as she can only scratch a limited range of her body. While scratching Julie notices a bug bite on her hairline. The skin around it is red and the “bite” looks contrasted in white. Then she notices another “bite” and another and another. These are not bites…..she’s reacting to the antibiotic! Vancomycin strikes, in a flash her skin is red and there are hives showing up at once all over her body and progressing exponentially. Kiara is crying she is so itchy. When I notify the nurse, seemingly the entire ER swings into action. Two nurses are all over Kiara and others are calling the On-Call Neuro and other things I’m unsure about are happening. Benadryl is hung and infused within moments and the hives start to recede. Most people only remember the waiting when in an ER…the interminable waiting. When the need arises however, the team in the London ER, perform a dance so incredibly well choreographed and effective that you are left in awe. What a well-trained, professional staff to be certain.
The Doctor comes in to see Kiara, by her tone and speech you can tell she is miffed that the resident performed an LP on Kiara without calling her and she couldn’t understand why he would perform a full on LP in the ER anyway instead of tapping the shunt which would be far more effective and would also tell her what is going on in the shunt. Long story short we need to tap the shunt to see what’s going on in there. It is explained to us that one result of the tap culture leads to a course of prophylactic antibiotics, short stay in the hospital and release…..the other leads to a much more radical course of action, ripping out a septic shunt and nuking Kiara with substantial anti-biotics until whatever bacterium lived in her CSF was eradicated. This would mean living during this course for several weeks, in hospital, with the added drag of an external device to do the job of the shunt, basically a direct hose running from her brain cavity, out the top of her head, to a valve on an IV stand. ( For fun one day every parent of an eight year old should have something sticking out the top of their child’s head that is itchy and annoying and make sure they don’t accidentally tear it out which would be very bad) Only after her body is totally clear of any infection can she have another operation to get a replacement shunt. We hope, obviously, for the first option. The shunt gets tapped quickly and easily….Kiara doesn’t even know what is going on as opposed to the trauma of the, in ER, Lumbar Puncture. We are wheeled up to our assigned room around 10:00 AM Friday, Julie and I got out of bed at 5:00 AM on Thursday and haven’t shut our eyes yet. At 10:30 with Kiara napping Ju and I crash out on some chairs in Kiara’s room. We are woken just before noon, that one and a half hours of sleep felt good, but definitely insufficient.
The Nurse Practitioner (and right-hand of our Neurosurgeon) is there, her expression grim. We trust this woman implicitly and she has proven an amazing practitioner and guide. The labs just came back and Kiara definitively has an infection in her shunt. The most prudent course is to open up her head again and remove all the shunt hardware. Fight the infection without a shunt in, and then after a minimum of two weeks put in another shunt. She’ll be in hospital. Our hearts are broken for Kiara….another two surgeries and another even more lengthy hospital stay. The Doctor comes in and we ask what we are to expect as far as the removal surgery; tomorrow, Tuesday? When will it happen? The Doctor looks at us and gently tells us that they intend to take the existing device out in about a half hour, the sooner it is out, the better. Twenty hours after entering the Wallaceburg ER, Kiara is recovering from shunt removal surgery. The next couple of weeks look to be very tedious for this little girl, the ever-present external shunt and IV a constant reminder of her situation. There is something inherently wrong with a young kid trapped in the hospital for weeks during the height of summer vacation.
I had mixed feelings as I walked past all those folks; Guilt for bypassing the queue, Relief that we didn’t have to wait in the germy ER waiting room with all the coughing, hacking and infectious individuals around and more than a little fear that we were apparently more concerning to staff than all the rest of the adults and children. It is now 10:30 PM and time to wait for the NeuroSurg and Pediatrics to consult. First order of business is blood tests….Kiara is not a fan of the blood draw. Strong for a little girl she certainly surprised the three staff plus a parent that it took to keep her still through the process. Somewhere between 3 and 5 AM she had an LP (Lumbar Puncture or spinal tap) again a lovely process of holding a child perfectly still as a resident pokes a sharp needle into the subarachnoid space surrounding the spinal cord to collect some cerebra-spinal fluid (CSF). Careful not to miss by a couple millimeters and possibly hit the spinal cord, that would be bad. Julie, sensing the resident isn’t exactly as contemporary with shunted children as we would like, suggests that he tap Kiara’s shunt for CSF, a much safer & easier course of action than poking into the spinal dura in the germy ER. He proceeds to look at her like she’s a moron and tell her that the LP is what is going to happen. This is completed and again we wait most all patients are processed through the ER, but not us we get to watch them all come and go and in the wee hours of the morning there is only us and one other patient in the Children’s ER. Pediatrics sent a couple of students to come down to rule out anything else as the source of infection. Obviously, the three other doctors and six nurses that have looked in her ears, listened to her chest and asked her if it hurts to pee obviously may have missed the ear, chest or bladder infection causing Kiara’s fever. Everyone is very nice though and I understand why the process is so stringent later in the morning.
At 6:30 AM they tell us that Kiara will certainly be admitted as the tap came back with a high protein result, potentially indicating infection. We will have to wait for a room assignment and this won’t happen until after the nurses finish shift change, the Doctor (the full-on Neuro-Surgeon) is also coming in soon and will further assess the situation. Antibiotics (two) are prescribed the first runs through quickly and the second goes on to the IV rack only minutes before shift change at 7:00 AM. Kiara asks Julie to scratch her behind her ear as she has a little itch, not uncommon with Kiara as she can only scratch a limited range of her body. While scratching Julie notices a bug bite on her hairline. The skin around it is red and the “bite” looks contrasted in white. Then she notices another “bite” and another and another. These are not bites…..she’s reacting to the antibiotic! Vancomycin strikes, in a flash her skin is red and there are hives showing up at once all over her body and progressing exponentially. Kiara is crying she is so itchy. When I notify the nurse, seemingly the entire ER swings into action. Two nurses are all over Kiara and others are calling the On-Call Neuro and other things I’m unsure about are happening. Benadryl is hung and infused within moments and the hives start to recede. Most people only remember the waiting when in an ER…the interminable waiting. When the need arises however, the team in the London ER, perform a dance so incredibly well choreographed and effective that you are left in awe. What a well-trained, professional staff to be certain.
The Doctor comes in to see Kiara, by her tone and speech you can tell she is miffed that the resident performed an LP on Kiara without calling her and she couldn’t understand why he would perform a full on LP in the ER anyway instead of tapping the shunt which would be far more effective and would also tell her what is going on in the shunt. Long story short we need to tap the shunt to see what’s going on in there. It is explained to us that one result of the tap culture leads to a course of prophylactic antibiotics, short stay in the hospital and release…..the other leads to a much more radical course of action, ripping out a septic shunt and nuking Kiara with substantial anti-biotics until whatever bacterium lived in her CSF was eradicated. This would mean living during this course for several weeks, in hospital, with the added drag of an external device to do the job of the shunt, basically a direct hose running from her brain cavity, out the top of her head, to a valve on an IV stand. ( For fun one day every parent of an eight year old should have something sticking out the top of their child’s head that is itchy and annoying and make sure they don’t accidentally tear it out which would be very bad) Only after her body is totally clear of any infection can she have another operation to get a replacement shunt. We hope, obviously, for the first option. The shunt gets tapped quickly and easily….Kiara doesn’t even know what is going on as opposed to the trauma of the, in ER, Lumbar Puncture. We are wheeled up to our assigned room around 10:00 AM Friday, Julie and I got out of bed at 5:00 AM on Thursday and haven’t shut our eyes yet. At 10:30 with Kiara napping Ju and I crash out on some chairs in Kiara’s room. We are woken just before noon, that one and a half hours of sleep felt good, but definitely insufficient.
The Nurse Practitioner (and right-hand of our Neurosurgeon) is there, her expression grim. We trust this woman implicitly and she has proven an amazing practitioner and guide. The labs just came back and Kiara definitively has an infection in her shunt. The most prudent course is to open up her head again and remove all the shunt hardware. Fight the infection without a shunt in, and then after a minimum of two weeks put in another shunt. She’ll be in hospital. Our hearts are broken for Kiara….another two surgeries and another even more lengthy hospital stay. The Doctor comes in and we ask what we are to expect as far as the removal surgery; tomorrow, Tuesday? When will it happen? The Doctor looks at us and gently tells us that they intend to take the existing device out in about a half hour, the sooner it is out, the better. Twenty hours after entering the Wallaceburg ER, Kiara is recovering from shunt removal surgery. The next couple of weeks look to be very tedious for this little girl, the ever-present external shunt and IV a constant reminder of her situation. There is something inherently wrong with a young kid trapped in the hospital for weeks during the height of summer vacation.
