Tuesday, March 24, 2009

What I have Been Up To...

Job Front - I applied for a promotion in my office. I don't know if I made the list. I should have. I don't know if the new boss will hire me for it. We'll see. In the meantime, another position, a promotion, has opened up. I am applying to do that too. I would much rather go work for the other agency than my current one. I am dreading going back to work.

Housing - We put an offer in on a house yesterday. The mortgage process is SO much easier this time now that we are not so broke. When we bought our current house, we were scraping money together for home inspections, etc. SO BROKE THEN. Now, different story. Our mortgage guy was impressed. He did our first mortgage. He was like no problemo. We bid on a 4 bedroom 2 1/2 bath cape cod. We really like it. We have decided that Cate and Sara will share the huge bedroom. Then Kirsten can choose which of the other two bedrooms she wants. Then the 3rd will be a guest bedroom (future nursery :)) and then we will have the master suite downstairs. There is a finished basement with an office and family room. Then huge first floor with a 3 season room. Can't wait to see if we get it. Latest we would move is July because we have 60 days to sell ours. So pray our house sells and we can come to an agreement on price with this house.

Medical - I did hear back from the nurse manager via a letter. She apologized and said that she had addressed my concerns and had recommendations done. The one thing that bothered me about the letter was that she apologized for "not meeting my standard of care". Hell they didn't even meet THEIR OWN standard of care. It infuriates me that they thought it was ok at the time. You have a patient having a visible allergic reaction to a med and you say so what? You have a labor nurse undermining an ob and perinatologist's diagnosis and recommendations and that is meeting my standard of care? Not too mention the same nurse flat out LIED in my records saying that when I was shivering during transition, she gave me warm blankets and turned up the heat. What actually happened was she said ugggh hormones when my dh asked why I was shivering. Then she walked out of the room. Only to have another nurse come in, check the warmer, say she was hot and turn down the heat. It made me so angry that I had meds that were ordered for me and I was told I didn't have them ordered because I didn't have stitches. ACK. Oh well. If I have another kid, I will make sure I run what my ob has ordered for me by me. I may even ask to see my chart.

One of my worse fears has come true. My endo is already back at 8 weeks pp. How the hell did that happen? I religiously took the loestrin and prometrium. Same time every day. Yet it came back immediately. Why? Well apparently, no one knew that fiorinal can cause interference with the pill. So the maximum doses of fiorinal I was taking for my headaches, basically negated any benefits that I was getting from the pill. Last week, I was doubled over with back and lower right stomach pain. I thought my kidney stone was back. So I saw my pcp. She said I could do outpatient and not get pain relief or I could go to the ER, get everything taken care of (BW, cat scan, pain relief). I chose the ER but ONLY if she called to tell them I wasn't a faker because last time for the kidney stone, I got NO pain relief because I didn't appear to be in enough pain. Anyway, she called and talked with the dr. Who happened to be the dr that first diagnosed me with endo and talked me into a lap. 3 years later she remembered me! I sent her a really nice thank you card because she believed me and convinced me to have the surgery. She still has the card. So it was hard for her to tell me it was back. The stone is gone. Which they think I passed it when I was in the ER last in November. The time I didn't appear to be in enough pain to warrant anything. ASSHOLE. Anyway, she said it was back. It was documented in my medical records. I had to see my pcp and my ob. My pcp does the pain management. She ordered oral toradol and lortab. She also got me an out of network referral to the pelvic pain clinic. I am going to get a lap done to cut it out as my ob LEFT it last time in. My specialist appt is on 4/1. Then I think I am going to have a mirena IUD put in and see if that helps. That can't be affected by oral drugs. I see my ob on Thursday. I cried after coming home from the ER because it was back so soon. The er dr said at least I could still get pregnant. They told me to get pregnant again immediately. UGGGGGGHHHHHHH. I did do a press ganey survey on that kidney stone issue and the mass in the uterus last week when I got an ER one in the mail.

Cate is beautiful. Her eyes are turning a clear blue. I may have a blue eyed child this time. She is 8lbs 10ozs. She seems to be in between Kirsten and Sara in temperament and personality. She is adorable.

Tuesday, March 10, 2009

What medical records can tell you....

So imagine my shock and surprise when going through my medical records from the d&c for Peyton. First my shock was that my ob missed. I am not sure how I feel about that. I know that it is a known risk. I am upset that the ER dr neglected to tell me there was this huge 10x6cm mass in my uterus. I had a right to know. My ob told him no way he missed. Well if your pathology report doesn't show a 13 week baby and you don't have that you got a 13 week baby on your operative report. You missed. Which is hard because my ob took such good care of me with Cate, Sara, and regular gyn, and the d&c minus the missing.

Next, at the very end of the file. The last page was an application for fetal death certificate. WTF. Apparently there is an obscure law that isn't known that in NYS you HAVE to provide within 72 hours a certificate of fetal death. Something like this should not bring joy to me. It does. It does because it says my baby existed. My baby no longer only exists in operative and pathology reports. He no longer exists in the image burned into my brain from that last US. Here is a certificate. A certificate that I had been pregnant and my baby died.

I have also decided to make it MY mission to let every woman that has suffered a miscarriage or stillbirth in NYS know about this certificate. The women that have let know are all calling for it. I called today and the nice lady said she would mail it to me today. I have also emailed the editor of our small town paper requesting to write an editorial on misscarriage and fetal death certificates. I want it to be anonymous. I don't want the whole town to know of my loss. I do want women to know that this is out there for them. Validation.

In addition, after consulting some websites, nursing friends. I have decided to take my complaint further on what happened in the hospital. I have drafted the letter. I intend to mail it to the CEO of the hospital, DON, Director of clinical services and quality management. What happened to me was inexcusable. I pay a ton of money in health care. Dammit, I had a right to be treated with kindness and respect. If I had treated someone like that, I would be fired. I want to see it changed. It won't be changed unless you speak up. One nursing website that I went to said that you could go as far as saying it was patient abuse.

Wednesday, March 4, 2009

OB Nurses at my hospital

SUCKED when I had Cate. Yes we had a great birth, but I never posted what happened before and after she was born! Check this out:

I told my labor nurse that I was supposed to get iv antibiotics. I was cutoff and told twice my beta strep was negative and then I was told we do not pre-treat infections around here. Sure enough I got a kidney infection right after delivery that required antibiotics to treat. I ordered my medical records. I always get a copy now after any hospital stay or procedure. Nowhere in my records is it listed that the nurse contacted Dr. X to ask about the antibiotics. I was also told when I was asking about the antibiotics, “what do you want, your epidural or antibiotics”. In fact, when I asked about the antibiotics, the nurse never said let me go check on that for you. She automatically cut me off and said we don’t pretreat infections around here.

In the past, I have had uterine infections after delivery and gyn surgery. Currently, I have a kidney stone stuck in the right ureter. The drs did not want to do surgery to remove it due to pregnancy. Two urologists that I consulted during pregnancy recommended IV antibiotics during delivery because they said I would get an infection. Dr. X when I discussed this with him said he would use iv antibiotics as well during the delivery. Somehow he forgot about that and didn’t write the order.

At one point, I was watching the monitor and told my husband that my blood pressure was still high. The nurse said “then don’t look at it” and snapped the machine off.

The labor nurse told me that she had personally reviewed my chart and labs and according to her I was not pre-eclamptic. I don’t know what labs she was looking at. However, the labs that I had – uric acid and creatine levels were high. These were not in my file. My urine protein was increasing each week. In addition, according to the peri, I had central nervous system involvement because of headaches, vision issues, nosebleeds, and brisk reflexes. The peri said cns involvement was more indicative of a seizure than protein.

The same nurse also told that I knew too much about my meds. I am not sure what the nurse meant or was implying, but I would hope that I would know what meds I am on as a patient. During the morning, she made us feel very unwelcome and uncomfortable. The only time the labor nurse was polite to us was when Dr. X was in the room and during the actual delivery.

I had an enormously difficult time in getting the fiorinal for my headaches that Dr. X ordered. It is in several places in my chart that he ordered it. Yet the nurses did not seem to want to give it to me. I took fiorinal from Jan 2nd on because of severe headaches. So this was not a new drug to me. The labor nurse tried to talk me out of the fiorinal and to take tylenol instead. That was a mistake because the fiorinal kept the headache to a pain level I could handle. Taking the Tylenol instead made it worse and took longer to control it. I had one nurse tell me that she could not believe that Dr. X would ever order it for a patient. I assured her that he had and she needed to check my chart (in fact he ordered it when I delivered my last daughter for the same reason!). I had another nurse tell me that she was uncomfortable in giving it to me because I had a codeine allergy and that fiorinal contained codeine. She is right, there is a fiorinal that does contain codeine. However, I was prescribed plain fiorinal (green and lime capsule) not fiorinal with codeine (yellow and blue capsules). I told her it was prescribed and to please bring it to me and I didn’t really care about her comfort level only mine.

Dr. X and I had discussed in the office about preventing PPD after delivery. I had it with my second daughter. I was worried about getting it again. In addition, it was the one year anniversary from when we lost a baby at 13 ½ weeks. I knew that crashing pp hormones, new baby, death anniversary was a recipe for trouble. Dr. X agreed. It was not easy for me to ask for help for this. I tend to think I can handle it all on my own. It wasn’t me who got help the last time it was my husband who sought it. I am not comfortable admitting I would need help with this. So it was a big deal for me to bring it up and discuss with Dr. X. In fact, it took me several visits to be able to get up the nerve to discuss it with him. When the nurse brought me the effexor, she told me “you know it is normal to feel this way”. I told her thank you for the medicine. She may not have thought she was saying a big thing. However, it was hard enough to ask for help. I didn’t need someone to minimize or judge what I went through with my other daughter and tell me this was normal. This was between me and my dr. We both felt that I would need something to help. What I went through with her was anything but normal. The nurse should have kept the opinion to herself.

After delivery, the night nurse that I had was helping me get up to go to the bathroom and get a shower. I remembered from when I had my other daughter that I was given a bag that had OTC meds in it and it was logged in on a sheet. I asked her for the dermoplast spray. I was told that it was not ordered as I didn’t have stitches. I had to ask for a peri bottle several times so that I could go to the bathroom and not have it burn as bad. I also asked her for motrin for cramping and was told that was not ordered either. I ended up having my husband bring me in motrin from home and taking it. I didn’t tell the nurses. Imagine my surprise when I pull my medical records and find out that not only was the dermoplast spray ordered by Dr. X, but so was motrin and lortab. It’s like the nurses never even read my records.

On Saturday night, I broke out in a rash on my arms. I showed the nurses and they immediately called Dr. X and he prescribed Benadryl. However, the Benadryl did not work. Two hours later I was covered with the rash on my face, chest, arms, and legs. When I went back to the nurses station, the nurses had changed shift. Their reaction was so what (yes I was actually told that). I had to explain to them that I had started a new med today (effexor) and that Dr. X said I was having an allergic reaction to one of its components. I had taken Benadryl and it was not working. Could they please call him and get something else ordered. They didn’t want to move and call him. After me asking several times, they finally called him and he ordered a different med and that worked to get rid of the rash.

On Sunday, my discharge paperwork was messed up. I got that straightened out. Then I realized I had never been given the paperwork to do the birth certificate. I asked and the nurse said she thought I had filled it out the day before. I told her no. No one had given me anything for it. So we ended up having to get that done quickly. I also did not have the bloodwork that was ordered to be drawn on Saturday morning done.

At one point in labor, I was shivering and dh asked what was wrong with me. The labor nurse went UGGGGH, it's just her hormones. She left the room. Another nurse came in to check and make sure the warmer was in the room. Commented it was hot. Turned down the heat. DH and I looked at each other like WTF. I told HIM to go and turn the heat back up. Yet the labor nurse documented that she gave me extra warm blankets and turned up the heat. WHAT. She did none of that!!!! I wasn't given ANY extra blankets during my stay.

I have to say that I thought the hospital stay with Kirsten was the worst ever. Hands down, my local hospital won with Cate. To think I stayed pregnant an extra 8 days just so I could deliver there. It was infuriating to read my records. Orders for meds were done and they were never given to me even when asked. That is just plain laziness. I debated about what to do. Should I complain about the care I received? Do I let it go? In the end I decided to file a complaint with the nurse manager of OB. I reasoned it by I always send thank you notes and cards when I get good care. Someone needed to know about the crappy care I got this time. There was NO excuse for it. There were only two patients on the floor on Friday, I was the only one there Saturday, and there were only two patients on Sunday. Only two rule out labor patients came in the whole weekend. There was just no excuse. The only bright spot was when I actually delivered Cate. Everything seemed to go right for that Thank God.

When I had my pp appt with my ob I said that the labor nurse sucked but he didn't comment. Course he has no recourse over the labor nurses at the hospital. I decided when I wrote the letter I did not want an apology. I wrote that I wanted to make sure it didn't happen to another mom. What if I had taken the labor nurse's advice and her saying there wasn't anything wrong with me and I just said ok, I am going home then. Cause I wanted Cate to stay in but my drs were like nope. So I wrote everything out that happened, good and bad (cause the baby nurses ROCKED), why decisions were made the way they were and what happened. I decided I pay for those services. I wouldn't treat someone like that at all!

If I ever have another baby or have gyn surgery at my hospital, I am sure they are going to be booting me out the door now that I have complained and I am sure I have royally screwed myself now. I know eventually I will be having another GYN surgery. Well dh is just about talked into Baby #4 next year. However he has some demands that have to be met first such as a new house and maid.