Tag Archives: policy

Lumpy, Sneezy, Dopey and Doc (or Why Policies Can Suck It) – Part 3

 

Josephine Rae Born 8.16.11

Part 3:  Dopey

It occurred to me while planning this post that I may start out talking about my experience in the hospital and migrate to a conversation about depression.

Do not be alarmed.

I’m actually dreading this story.  You see, I haven’t allowed myself to revisit it for fear of that evil bastard, self-pity, to rear its head.  I think the moral is an important one though, so here is my third rant in the series:

When my daughter was born, she was a healthy 8 lb. 14 oz baby.  Not bad, right?  To us, she looked like a skinny little slip of a thing compared to my firstborn who tipped the scales at 10 lbs. 1 oz.  I felt a twinge of guilt that I hadn’t fed her enough or that my constant Benadryl or coffee habit had diminished her potential for Amazonian greatness.  Still, for five days early, nearly 9 lbs isn’t a bad birthweight.

Once in my hospital room, my nurse suggested I try to feed the sleeping baby.  I asked if I should wake her to do so and she gave a non-committal reply to “just try.”  I gave it a half-hearted effort because little Jellybean was completely cashed. Being born is hard!  Sadly, the next time the nurse came in, she informed me that my daughter’s blood sugar had gone below the hospital’s threshold for normal and that she had to go to the NICU.

I was incredulous.  I asked if I could just feed her and have the sugars tested again.  It seemed like a reasonable and logical approach.  (Before you dismiss my unprofessional medical opinion, when her sister, Ginormica, was born, the nurses sagely put a bottle of formula in Daddy’s hand and a tube taped to his finger so she could feed straight away.  This happened a few times before my milk came in and we were none the wiser about HER risk for low blood sugar.  The nurses simply mitigated it.)

This time, however, Dopey, as she will be henceforth referred to, mistakenly informed me that she “had” to take my daughter away but that I could visit her in the NICU to feed her whenever I wanted.  My daughter was then taken to the Intensive Care Unit for Newborns and put on monitors for her heart rate and blood oxygen levels.  She wasn’t given any formula.  She wasn’t put on a IV.

And she didn’t come back to my room for FIFTEEN HOURS.

There are several problems with this:

  1. Newborns should be with their mothers unless there is a serious medical risk that would prevent their proximity.
  2. The NICU was full of desperately sick babies on oxygen under dim lights and parents who look gutted by fear and desperation.
  3. I had just been sawed open like a magic trick except with actual blood – which regularly made its way to the NICU floor in macabre puddles when I arrived to nurse my newborn in hopes of springing her.
  4. Hospital policy increased the minimum blood sugar level requirement for my daughter to be released from the NICU above the level that got her locked up but didn’t apply any policy for regular feedings or timing of testing.  The nurses simply took her blood sugar on a schedule whether she’d been fed recently or not.  Three sufficient test readings were required to be released and if one reading dropped below the threshold, the testing started over from zero.  Talk about stacking the deck…

In hindsight, I should have fought harder to keep my daughter with me.

I should have told Dopey that she can suck it but she cannot take my daughter away.

I should have asked for the Floor manager, a Patient liaison, my OB, a Peditrician – ANYONE with sense enough to say, “let’s not overreact or follow the letter but distort the spirit of this new policy – this is a big, healthy baby who needs to eat.  Let’s feed her and see what happens” instead of “let’s take away this newborn because we have a new policy and I want to be a good rule follower.”

Anyone who knows me at all can tell you what I think of rule-followers.

I should have fought harder to exert my will in the interest of my and  my daughter’s well-being.  I should have asked more questions and challenged authority and raised a stink that would have put Dopey in hasty retreat.

I can hardly believe I dithered and fumbled and followed.  I blame the hormones; it’s the only logical explanation for behavior that is so wholly foreign to me.

To add insult to injury, Dopey actually wheeled the empty basinet back into my room after she delivered my daughter to the NICU saying, “I’m just going to leave this here.  You’re a C-section so you’re here for four days… she might be back by then.”

I can tell you now, though I wouldn’t have admitted it for fear of being committed, that I almost broke that day.  There was a moment when the world went unanimated and a crushing excess of emotion swirled up inside me.  My vision went black around the ridges and I choked on the air I was trying to breathe.  In that moment I feared that the me that is fun and outgoing and light-hearted would retreat permanently – into the recesses where fantasy and nightmares reside, where there is a running dialogue of self-loathing and paranoia and helplessness – into the lead-lined box of depression.

This story gets complicated because when I retell it, I feel a sense of injustice rising up like bile in my throat.  I was cheated.  Even worse, so was my daughter.  I don’t care that I had to get out of my hospital bed with a burning incision and stabbing abdominal pain, gushes of blood everytime I went vertical, and the annoying catheter bag that never seemed to be emptied in order to be wheeled to the NICU during my daughter’s incarceration.

I care that my newborn wasn’t in my arms or at arms-length for FIFTEEN OF HER FIRST TWENTY-FOUR HOURS.

I don’t forgive that nurse for her carelessness or callousness.

I don’t forgive the hospital for creating a policy that ignores the mother in the mother-baby equation in order to cover their proverbial ass or to charge insurance companies for something that can’t be refused – intensive care for a newborn baby as an offset for the increasing squeeze on their maternal care fees.

But I escaped with my daughter in tow.  My healthy, fat baby hardly left my arms for two weeks after that.  And when my husband mentioned that I might
have attachment issues that need to be discussed with a professional, I reluctantly let him hold his daughter… for a minute.

I don’t know why the dark water didn’t suck me under this time.  I remain guarded that it still might.  I can only point to this – that I mentally steer myself toward what I have, instead of what I haven’t.  The feeling of being cheated (and outrage at people’s moral bankruptcy) tamped down much of my pregnancy and new motherhood joy three years ago.  I didn’t compartmentalize the negativity of a toxic environment and it took me two years to rebound.  Now, I reign my mind into the here and now and wriggle back into its comforting softness to fill up the whole space so there isn’t room for any ‘what ifs’ or ‘whys?’ to suck the air out of my happy.

And I do it every day, over and over.  And I breathe.  And I cuddle my beautiful child and know that she is 1/3 of what matters to me most.

And that’s enough.

But my mistrust of healthcare and its policies aimed at maximum profit grows.  How about you?

Lumpy, Sneezy, Dopey and Doc (Or Why Policies can Suck It) – Part 1

Part 1:  Lumpy

Earlier this year, I found a lump in my breast.

Since I’m not a regular self-examiner, I found it because it itched.  It was huge.

The timing of this discovery coincided with a) a report about breast cancer during pregnancy in older women and b) finishing a book where the heroine’s best friend dies from breast cancer leaving two young daughters.

What went through my head was
holymotherf*ckingshitImgoingtodieandneverseemygirlsgrowthisisn’tfairwhatthef*cknonononononono!

Or something along those lines.

What’s worse is I forgot to mention it to my OB.  For a month.

When I finally did, she suggested I get it checked. (um, yes.)

So I had an ultrasound done by a  radiology technician.  The doctor never came in, never introduced himself, never called me with results.  The results did not indicate cancer (evidently cancer shows up on film like bright white alien life) but because it was so big the radiologist wanted me to have a biopsy.  He never mentioned that to me.  Instead, my OB followed up with him, heard that a biopsy was the way to go and relayed that info to me.

So I called several oncology offices for a biopsy.

No office would schedule a biopsy without an exam appointment first, which meant not only the delay of getting the original appointment (two weeks) but also the delay of the follow up appointment (unknown time) and double the appointment with a specialist appointment (what am I made of money?).

Being five months pregnant at the time, I lost my mind.  I literally scream-cried at several people.  I’m not proud of this but it is what it is.  I had reached the point where logic and rationality left and hormones took over.

My OB and her reassuringly competent nurse took over.  They got me a few names and told me what I needed to say to get the right appointment.  The exam/biopsy by the first doctor who would see me was nothing short of violating.  I don’t know if what he did was normal or not but it was mortifying and I felt abused and disgusted for weeks.  Those biopsy results were “inconclusive” so I was told I needed to go through the process again.  I would have rather “died” but since that was actually on the table, I decided I’d better suck it up and get a second opinion.

I chose a doctor via my hospital network rather than revisit the site of the ‘attack.’

That experience was SIGNIFICANTLY better – sterile, clinical and very very public.  Rather than one dude in an office exam room, I had two doctors, a radiologist, and three nurses in the room with gloves, gowns and masks.  Two nurses were hands-on comforting at all times.  The doctors were slow and careful in their practice and talked to me about my family and in particular my unborn daughter the whole time, sharing anecdotes about their own families and offering kind, reassuring commentary.

They definitively concluded that the lump was normal breast tissue – likely a duct that went haywire under hormonal showers and would
either go away on its own or be a benign part of my breast until I wanted it removed in a simple surgical procedure.

Here’s the kicker:  my sister-in-law, a nurse in Australia, suggested that exact diagnosis when I first discovered the lump.

Maybe this was a case of CYA.  Maybe our litigious society mandates that doctors ignore Ockham’s Razor and pull as many levers as possible in our complicated and expensive sick-care system.

I have an estimated 47 separate bills from this experience – from the doctors, the hospitals, the labs, the radiologists, the techs, the
offices, the insurance company, etc.  Everyone billed me separately with terms and codes I couldn’t possibly understand.  I tried calling a few times to determine what exactly I was paying for and why more wasn’t covered by my insurance but I quite frankly gave up.

It was exhausting and confusing.  I’m pretty sure that is intentional.

Whatever the case, the system is broken and is making me broke.