Hell Hath No Fury

When William Congreve first wrote those words 300 years ago (warning: wikipedia was used in the writing of this blog) he was talking about a lover scorned. He should have been talking about a mama who was ignored while her baby turned blue.

Bobby desatted at about 6:15 today (desat = oxygen dropped below the level his doctors deem appropriate). Our nurse had stepped out of the room so I went to get a doctor. She examined Bobby and decided he was in no immediate danger. I agreed, but expressed concern that his saturation levels have gotten lower and lower over time for no apparent reason. If it was a matter of waiting for him to heal up, wouldn't he be getting better? She agreed and then asked the nurse to watch Bobby and went to talk to the attending physician.

From 6:15 to 7:00 Bobby continued to desat. His nurse lectured me on how to read the monitor, telling me that he wasn't really desatting, that the wave form of the monitor wasn't an accurate read. When that got tired, she claimed that he wasn't desatting, that the pulsox (the tool that's attached to his toe to read his oxygen levels) wasn't on tight enough. Then she said that he was desatting but that its expected in children like him and nothing to worry about (apparently Bubby is one of those very special children who doesn't require oxygen to function). On and on and on. I keps watching the monitors and Bubs because it was very clear that he was desatting.

Then the nurse went to give her report to the nurse taking over at 7:00. I heard her talking about how Bobby hadn't been in pain all day (ridiculous) and then about how his saturation rates were a bit low. I continued to watch Bobby. In fact, I watched Bobby turn blue - the first and only time in his life he's actually turned blue.

Somehow, the nurse had heard the doctor say 'keep an eye on him' and translated that into 'continuously turn off his oxygen level alarms, fail to actually look at the child when the alarms go off and, for good measure, issue a wholesale denial that his oxygen levels are low. Bonus points if you can make condescending remarks about how the monitor is difficult to interpret. Because while logic might tell you otherwise, it does in fact take a nursing degree to look at a monitor and see whether or not a wave form is smooth or irregular.'

The nurse, being helpless to deny that Bobby was in fact blue, paged the doctor who asked if something specific had caused the turning blue. I said 'nothing in particular. He's been desatting for the past hour but no one would listen to me'. I was so mad that I just left the room for a few minutes so as to not interfere with Bobby's care.

He's fine now. It might be that his lungs are still struggling post op. We are increasing his feeds so it could be that acid reflux is causing him pain, thus constricting his blood flow and lowering his sats. It might also be that he has an undetected vein in his head that is causing some of his blood to not end up in the lungs, thus lowering his oxygen levels. The latter would have to be investigated by another cardiac catheterization. If they find such a vein they put a coil on it (during the catheterization) so as to kill it off.