Its finally the weekend!

Well, my call night wasn't so wonderful. I got a call at 9:30 from a hospitalist pediatrician saying that they had a kid with intussuception at another hospital and was being transferred to our hospital. Intussuception is when the bowel (intestine) telescopes on itself and gets stuck. Its common in kids. They all the sudden develop crampy abdominal pain that lasts about 5 minutes and then nothing for awhile and then pain again for 5 minutes in a pattern. They usually have red jelly stools. It is usually corrected with a barium enema. No big deal.

From the get go I had a bad feeling about this kid. This hospital she was at diagnosed this with a an xray. This is usually diagnosed with ultrasound. The kiddo was only 4 months old. Usually they are from 1-4 years old. She had no bloody stools. Anyways, I told the pediatrician I would let my surgeon know. We have to be on call because if they can not "reduce" (fix) the problem with the enema than surgery has to come in and open the belly to fix the intestine before the blood supply is lost and you have dead bowel. I call my attending, there is a problem with the hospitals. Apparently our ER is too full as is the hospital and they are not accepting any kids. Blah blah blah. I finally go to bed and leave it as we will be called if they need us. Wasnt really sure if the kid was coming to our hospital or not.

About 3am my pager goes off. I stumble up. Its a page on the little girl again from our ER. I knew right away bad news. I call in, the doctor says, this girl is SICK. She is in shock and had a bad belly. Come right away. So off to the hospital I went. Barely got to brush my teeth and I ran.

The story goes that this little girl started vomiting on Wednesday night. Still wasn't acting right so mom took her to her pediatrician Thursday morning. Was told to keep her on fluids only and watch her. She continued to get worse so mom took her to a small hospital at 7:00pm. From 7:00pm until 1am I'm not to sure what happened. The other hospital could not get an IV. They stuck her 9 times. All they had was a x-ray that they thought was intussuception. Finally they transferred her to our ER. From the time she arrived, via ambulance, there was 15 minutes when she was okay. In her car seat, with mom, etc. Then she "tanked". She had no IV and they were unable to get one. So she got what is called an IO. Its an IV straight into the thigh bone. The kid needed fluids and that was a last resort. They called the Pediatric ICU team down, and they intubated her and put her on a ventilator. We finally got a central line with ultrasound after she was sedated. After they stabilized her in the ER, off to surgery we went. We cut skin at 5am. As soon as we got 1/2 way through the skin, I knew we were in trouble. I could see black bowel. We opened the abdomin and the smell was there. Dead Bowel. It is a distinct smell that I will never forget. Ends up the little girl had what is called an internal hernia. It is a band that was around the intestine. It was very tight and ended up cutting off blood supply to 1/2 of her small intestine. She lost 100 cm of small intestine. She has 125cm left. We had to do an ostomy so she will poo in a bag for awhile. Eventually we will go back and close the ostomy.

She did fine during surgery. We didnt have labs back on her before OR but her blood count was in the toilet. She was one SICK little girl. She was stable in the Pediatric ICU when I dropped her off after surgery at 7 am. I didnt get a chance to check on her this afternoon. As long as she makes it through this intial problem she should be okay. She cant afford to lose anymore small bowel or she will not be able to handle feeds. I hope for the best for her longterm.

The parents were at the bedside the entire time she was being worked on in the ER. Both parents were in tears but really holding it together quite well. I'm not sure I could stand to see my child worked on like that.

Im not really sure what happened with the transfer/hours wasted last night when she was sitting in the other hospital. If she would have gone down hill at the other hospital she probably would have died because they are not able to handle problems like that. Shes also lucky she didnt tank in the back of the ambulance. I sure hope there is a good explanation otherwise we may have problems.

I finally left work at 2pm. We had cases scheduled that followed all day. By the afternoon I was like guys, I'm exhausted and GROSS. God bless showers. When we work on little babies the OR is at least 90+ degrees. We have the heat on as high as it will go to keep the little baby warm. Needless to say I was soaked by the time we were finished.

So that was my exciting/exhausting call night and Friday. I'm very glad its the weekend.