Wednesday, October 7, 2009

A rant on standards of health care...

You know, I bitch about the standards of healthcare in the state of Florida. I bitch a LOT about maternity and pediatric care.

I had the chance to be very thankful for what we have today.

A bit of back story: Woman I used to know many years ago via IRC had her son last week at 32 weeks gestation, which is 34 weeks pregnant. He was underweight, extremely jaundiced, and had mild respiratory distress syndrome. No ventilator needed, but they kept him in an O2 tent under a bili light for a week.

The woman is a few years older than me, but very... immature. If you didn't know better, you'd think that perhaps there was some developmental deficiency, but there isn't. She's just immature.

Her son was discharged today, at 1 week old. He'd been weaned off the O2 over a course of 12 hours, and his blood oxygen level was stable. His weight? 4 lbs, 14 oz. His jaundice is still extreme. As in, I've never ever seen a newborn (or ANYONE, human or animal,) leave a hospital with that degree of yellowing to their sclera and skin.

She messaged me today, frantic and terrified.

Apparently, the neonatologist explained everything to her - in medical terms. When she asked for further explanation, she was told to write it down so that she could look it up later.

She was allowed to nurse him once, and sent home with instructions to avoid formula and bottles and nurse, but never allowed to consult with a lactation specialist.

He's still extremely jaundiced. Their recommendation was to take him outside as much as possible. In Upper Peninsula Michigan. In October.

After about 45 minutes of explaining in very simple terms how to detect respiratory distress in a newborn to her, as well as citing solutions for breastfeeding issues in preemies from my text books, I got her calmed down quite a bit. I also drilled it into her that with her preemie (and with any infant, really,) there is no such thing as an over-reaction. If she thought there was ANYTHING wrong, she needed to get him to a doctor immediately. I also told her that she needed to get ANGRY with anyone who chastised her for "over reacting" and not allow them to convince her that she shouldn't come back if she saw or felt like something was amiss.

I confess, I was frustrated at first with her level of immaturity. Instead of saying breast milk, it was "Mommy NomNom." "LOL" followed every statement of insecurity.

Once I got past my frustration, though, I realized two things. #1, she was excellent preparation for being patient with my future patients. #2, I was PISSED.

How the FUCK could they send a parent home so unprepared and a child so close to the line between okay and not okay?

She has no family, to speak of. Her husband is equally as unprepared and immature. They live in the middle of fucking nowhere, michigan.

They gave her no list of resources, no personal suggestions, no encouragement.

She knew nothing of La Leche League,, or even any books to read.

ONE nurse suggested kangaroo care to her. The same nurse that let her actually let the baby nurse. Once. Prior to that and after, they were forcing her to pump and bottle feed, despite telling her to nurse and avoid bottles and formula at home.

I did as much nursing trouble-shooting with her as I could - it sounds like he's latching but has a poor suck reflex. The texts I have suggest hand-expressing slowly, directly into his mouth after letting him attempt to suck. I told her to do that until she got ahold of someone in person at LLL, and to keep calling. They have consultants on-call for after-hours issues too, so just be persistent in calling until someone calls her back or answers.

As far as I'm concerned, what she experienced was not just harried hospital staff in a rush to discharge due to policy/insurance issues. What she experienced was a basic failure of human compassion and an absolute failure on the part of the hospital staff to do. their. goddamn. job.

With "Care" like that, there's no wonder at the fucking infant mortality rate. How can parents do their best for their children if they're not being provided with an education on how to do that? It especially boggles me that someone would dismiss a parent who was actively ASKING for further education! HOW CAN YOU IGNORE SOMEONE WHO IS ASKING FOR HELP IN DISPELLING THEIR IGNORANCE???

So angry. Livid, in fact.

Anyway, yeah. Thank you, State of Florida, for at least having the initiative to provide the resources you do, and the dedication you have to the children, if not the parents. Hat tip in particular to Shands Children's Hospital, Arnold Palmer Women's and Children's hospital, Baptist Medical Center in Jax, The Sebastian Ferrero Foundation, and all the others that I'm missing.

ETA: There is apparently ONE pediatrician's office local to her qualified to deal with son. She called them before messaging me, and was told that she was going to have to wait until his appointment on Monday, that they don't offer a nurse line for questions, and they can't squeeze her in before Monday. I told her she needed to try and find the funds to make the hour drive to another office if at all possible.


  1. Michigan has excellent healthcare across the state. Unfortunately, like any other state, rural areas don't always have the same benefits. I'm pretty sure BFE central or panhandle Florida has some hospitals that lack good birthing centers. Florida has the highest rate of medical fraud in the nation too. Not to mention another blogger I read had horrifying birth experiences in Florida, including surgical instruments left in her body. Shit happens everywhere, even though it shouldn't.

  2. Thank you for commenting! I do acknowledge that poor care can happen anywhere and everywhere, and I'm not in any way saying that Florida provides the best care. I also apologize if it seems as though I was bashing Michigan; I wasn't. It was more my frustration with the incident in general. (Though, I do wish that every hospital had the resources to provide their patients with a list of resources to help them out should they request it.)