And the lows. One of the first babies that I helped deliver was brought into the ER not breathing. The baby was taking breaths really only when stimulated and would kind of grunt, and then scream for a bit, and then stop again. Mom was furious that we "weren't doing anything" when we were doing everything that we could to stimulate baby and get all of the labs going. Mom even hit one of the nurses. Here is where it gets hard to be diplomatic. Baby has a partial cleft palate and I suspect a neural tube defect d/t the sacral pit (which I observed at delivery). Mom tested positive several times throughout pregnancy for drugs and alcohol and cannot understand what is wrong with her kid, and is furious because she thinks that we don't know anything and aren't doing anything. Very frustrating when a mom says to you "What is wrong with her, why is she not breathing?!" and you want to shout at her that if she actually gave a shit about her she wouldn't have done drugs during her pregnancy and that it is likely her fault that her kid has birth defects and is in trouble now. Baby had to be flown somewhere that has a NICU.
And tonight.....I had a pre-teen in that had severe abdominal pain. Foster mom says that she has had abdominal pain for about 2 months but that today it is worse, she is concerned about an ulcer. Kid is very histrionic and a poor historian.....everyone warns me that she has "a history". I love and hate cases like this. One because I don't like to go in jaded. 2, because I make it a point, jaded or not to work them up like everyone else, even when everyone else writes them off.....which it sounds like a couple other people did today. A high white count and a growing fever tell me that there is something wrong. Her pains everywhere aren't as reliable. She is saying that her tummy hurts but points to her vagina, then it is her flank, then it is upper quadrants. I decide to get a CT, just to be safe, but am thinking that maybe she has a UTI. Looks like she has free fluid in her abdomen and perhaps an abscess. Dx. appendicitis vs. PID. AND PID could be likely because the child has a history of being raped. So then there is a lengthy discussion between me and the foster mom about doing an exam to check for cervical motion tenderness. We don't want to traumatize her anymore than she already has been. So I suggest to the mom that we are going to operate and put her under anyway and approach things the same way, so why don't we talk to the hospital that she will be going to and suggest that they make all appropriate checks and swabs and such when she is under anesthesia. Mom thought that was a great idea. This poor kid literally needed hand holding and does not trust people, especially adults very much. I don't blame her. Her mom was a drunk and an addict, allowed her to be raped, and killed her 2 year old brother and drove around (with this little girl in the car) with the dead little boy in the trunk of her car for months. I spent about 3 hours with her explaining everything and reassuring her, talking to her, and hopefully helping her. She asked me if I would come with her to the other hospital because she was scared that they wouldn't take good care of her like I was. That was sweet and really flattering. I told her that I had to stay here to work, but that she should come visit me when she got better. It broke my heart. That poor sweet girl has a very long rocky road ahead of her. I wish only the best for her. At least, for my part, I feel like she could trust me for those few hours, and that there are people that want to help her, even if all I can do is take away her tummy pain.
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