ER is over

Today was the last day of my ER rotation. That’s 5 of the 13 rotations for this year done. Yeah!! The ER was nice – I worked 21 eight hour shifts and had 7 days off. The shifts ranged from 7am-3pm, 9am-5pm, 2pm-10pm, 5pm-1am, and 11pm-7am. I saw quite an array of people with lots of differing personalities and problems, ranging from no reason for being in the ER to every reason for being there and very sick. Here are examples of some of the more interesting things I saw:

An older man who had a tumor growing on his head for a year before seeing a doctor finally because it was giving him headaches and leaking lots of junk on his shirts. It was about 5 inches wide and 1-2 inches deep and was eating into his bone. We took a biopsy and he ended up having a really bad squamous cell skin cancer. He will need a lot of work with plastic surgery to try and fix it.

A teenage girl who came in 1 week after being diagnosed with strep throat with no other medical problems. She was put on an antibiotic and had a rash appear on her stomach and the front of her legs, and we thought it was just a reaction to the antibiotic. We got some basic labs that came back showing signs of cancer. Further testing showed she had a new leukemia (blood cancer).

A lady had back surgery about 10 days before and had gone to a rehab center. She was not having very many bowel movements and started having a lot of pain and bloating in her abdomen. She ended up having a hole in her large intestine from all the pressure that had built up and was quite sick from it. The CT scan of her belly showed lots of air in her abdomen (a really bad sign) and she was rushed to the OR, where a large part of her bowel was taken out and she was in the ICU on a ventilator for almost a week afterwards recovering.

A man who was wheeled in by EMS with really bad chest pain. We were sitting in the other room and heard, “I need a doctor and nurse in the room now!!” so I rushed in after the attending doctor to watch. The patient had stopped breathing and had an abnormal heart rhythm. The doc ran in and gave a large thump with his fist to the man’s chest while the machine was getting ready to shock him. I think he ended up being shocked 3-4 times before he came around and said “Ouch!” with the last one. He was rushed up to cardiology to get a rapid procedure to look at the blood vessels to his heart, and they found a giant clot blocking the main vessel in his heart. He is so lucky because if he had been at home when he lost consciousness, he wouldn’t have had the machine there to shock him, and so he probably would be dead.

A lady who got something in her eye from raking leaves. We placed a fluorescent dye on her eye and then used a machine called a slit lamp to look at her cornea to see if there were any abrasions (cuts), which would fluoresce a light green color, and I got to see it.

I got to suture (sew) up a few people’s lacerations – one on an eyebrow and one on a head – all by myself, which was so much fun.

I would go see the patient, then talk with the doctor over me, and we would talk about the possible things going on and decide what labs or other tests to order. It was a nice month because the ER is run by the attending doctors, and we are there more to learn than to run it. So we could go a little slower and take time to learn about our patients. I also enjoyed the people I worked with.

There were some frustrating things that would keep me from choosing ER as a career: 1) I saw firsthand the problems that our current healthcare system has with respect to the ER – so many people who use it as their primary care office because they don’t have insurance so they don’t go to a regular doctor, which drives the premiums and taxes up for everyone else; 2) I got annoyed by people who use the ER like McDonalds: they think they can come in, pick and choose (sometimes demand) what tests they want ordered or what pain medicines they want, and then get mad when things are not done as fast as they like because they need to be somewhere else; 3) I don’t like the lack of continuity of care while working in the ER – you see patients, figure out what is going on with them, and then send them out, and it is hard to know what happens to them. I guess if anything this year continues to make me more and more excited for the upcoming training when I will get to learn dermatology, which I am liking more and more the more I see of it.

In other news, Kolby has now done 2 weeks of piano and loves it. He can already play a song that is recognizable (“Merrily we roll along”). The boys had doctor’s appointments this week for well-child checks and they all seem to be doing well. We went on Thursday to JC Penney to get a family picture that we will send out for Christmas. The lady who did our session was the same one who had taken the pictures of the boys in their Halloween costumes a few weeks ago, which turned out so cute, and she was so good again this time – we want her to do it for us every time we go. I can’t wait to get the pictures back – they turned out so nice. Thursday night was Daddy-Eli night and we went to see Wall-E together. Eli was so excited to get a little bag of popcorn and watch the movie on the big screen. We took the van in for a $20 oil change on Friday that ended up costing about $400 – the area where you put the key in locked up and so we had to have a locksmith go to the car place and replace that; the battery was dying and needed to be replaced; and we got the oil change. At lease that van works so well for us most of the time. Yesterday Kolby had a practice for his primary program that he participated in at church today. We had dinner tonight at the Eccles, a family in our ward. The kids had so much fun playing together and we had fun just talking. It has been a pleasant evening and a nice week.

Pyloric Stenosis

Since we came to Boise on December 1st Isaac has started spitting up. All of our boys have actually spit up quite a bit when they were babies, but this is different. He has done it about once a day and it is very forceful – kind of a projectile spit up. At first we thought that it was just because he was kind of stuffy, but it has continued for a while now. Michael mentioned once that he was the right age for symptoms to start showing for some medical condition, but honestly I didn’t really think much of that comment because every once in a while Michael learns about medical problems and then wonders if he or one of our family members may have them.

So, after this went on for a while, we were starting to wonder if it might be something more than just his reaction to being really stuffy or something. We were at Cass and Marci Smith’s house for dinner last week (Cass is a pediatric GI doctor), and Michael and Cass talked that night about the condition Michael had mentioned earlier, Pyloric Stenosis. Cass said he thought we should keep an eye on him and keep that in mind. I took Isaac in and had him weighed yesterday morning. He was weighed a couple days before we came out here, and he had lost about 7 ounces since then, and babies his age are generally supposed to gain about an ounce a day, our pediatrician told me. I called our pediatrician in Milwaukee, and he also thought that it was possible that Isaac could be showing signs of Pyloric Stenosis, and that we should have him seen by a doctor here. (I guess this shows me that Michael is really becoming a real doctor and I should pay more attention to his ideas about medical problems).

So, I took him into the emergency room yesterday (our insurance will only cover emergency room visits when we are out of state, so we couldn’t just find a pediatrician here to see him). We were there all day, and Debbie was nice enough to watch the other boys for me while I went (since Michael was on an airplane all day). In the emergency room, they weighed Isaac, took his history, and decided to have an ultrasound done to see if he had this Pyloric Stenosis. I had read a little about the condition on the internet before taking him in. Basically, it is when the muscle of the pylorus (the tube that empties into the stomach) gets too thick, and makes it so that the milk does not enter the stomach like it should. This condition is much more common in boys than in girls, and the symptoms are projectile vomiting, the baby loosing (or at least not gaining) weight, and the baby often appearing otherwise healthy (unless it progresses to where the baby is not keeping anything down, and then the baby can come dehydrated and lethargic). So, they did an ultrasound of his stomach and measured the thickness of the pyloric muscle. They told me that his pylorus looked elongated and was measuring between 2.5 and 3 mm thick, which is thicker than normal. But they said that it would measure 3.5 mm if it were true Pyloric Stenosis, which would require a surgical procedure to fix.

So, the doctor said that we would just watch him and see how he does. Isaac was seen by an ER doctor and a pediatric surgeon, and they told me that this problem will either go away after a few weeks when he may just grow out of it, or that it may develop into true Pyloric Stenosis and require the surgery if the spitting up were to continue and get worse. I talked to the surgeon this morning, and he did say that the majority of babies with this problem will develop true Pyloric Stenosis before they are 2 months old, so hopefully if Isaac doesn’t worsen in the next couple weeks, he will just get over it and we won’t have to worry about it any more. He hasn’t spit up like that for a day now, so I am hoping that it will just go away and we won’t have to do anything more for it. Poor little guy he’s already had enough surgeries for a 7-week old baby, he doesn’t need one more.

A Busy Week

So, it has been a busy week. I think we will continue to be very busy until we leave on our trip on Saturday – there is so much that I’d like to get done before we leave. I guess we’ll probably continue to be pretty busy after we get there too, with Michael’s interviews and working at the dermatologist’s office and with all the boys. I guess with this many little kids we’ll probably be busy more often than not the rest of our lives. But we wouldn’t want things to be boring around here, I guess. :)

So, on Monday after taking Kolby to preschool I took Isaac for his follow-up appointment with the ENT doctor who did his surgeries while he was in the NICU. He said that Isaac has now recovered fully and can be treated like a normal baby his age. That was nice to hear. Then we stopped at the pediatrician’s office for a weight check, and Isaac had gained a few ounces from his birth weight. I wasn’t surprised that he had at least gained a little weight, because he has had trouble nursing so I had been pumping and feeding him with a bottle for almost a week at that time, so I knew exactly how much he was eating and he was getting enough to eat.

On Tuesday Michael had his second transitional year program interview here in Milwaukee at St. Joseph’s Hospital. He said that the interview went well, was pretty relaxed, and went by pretty quickly. He got home early after his interview, so he was able to go with me to an appointment at the hospital for Isaac to try to help with his nursing in speech and sucking therapy. There was a nutritionist and a feeding specialist who both work with babies who met with us and watching Isaac suck on a pacifier, eat from a bottle, and nurse. They were both really nice, and after watching him they said that he was efficient and he had a good sucking and breathing pattern, and they didn’t know why he was having trouble with the nursing. They didn’t really have any more suggestions for us, other than the fact that they said we should supplement with formula as needed so that he could have 4 to 5 ounces to eat at each feeding. They told us a nice little way to know how much a baby needs to eat: take the baby’s weight and convert it to kilograms, and that is about how many ounces they should have at each feeding. Isaac was a little over 4 kilograms, so we have been giving him breastmilk and formula since then, because I have only been pumping about 2 ounces at a time. (I’m sure you all really needed to know that – oh well). So, I have continued to pump since then, and I plan to do so until we leave town. Then he will at least get the breastmilk until he is six weeks old. One thing that sure has been nice this last week is that since Isaac has been eating from a bottle, Grandma Faun has been getting up with him to feed him at night so I can sleep. That sure has been nice to be able to get my rest at night so I can keep up with things in the daytime. Thanks, Grandma!

On Wednesday Kolby had preschool and then he had his swim lesson that night, and Grandma went with so she could watch him swim. Today I signed Kolby and Eli up for the winter session of preschool and swim lessons. Eli will be going with Kolby three days a week to preschool, which I think both of them will really enjoy, and both boys will be taking their swim lessons on Wednesday nights. It will work really well because Kolby and Eli will be in different classes, but their classes will be held at either corner of one end of the pool, so I will be able to go sit in the middle of the two classes and watch them both do their lessons, but we won’t have to go out two nights in a row. I think that will work out really well.

On Thursday we had a fun Thanksgiving day. In the morning Michael got up early and went to play football with the other guys from church, and he said he made a couple touchdowns. Michael roasted a turkey, and Grandma and I made a lemon jello salad with bananas that my great grandma, Grandma Moore, used to make; a fruit salad with marshmallows that my other great grandma, Mamaw, used to make; a layered green salad with peas, swiss cheese, and red onions that my mom makes; funeral potatoes, and deviled eggs. We decorated the table with a new tablecloth and we used the china. It was fun.

On Friday morning I took Kolby to preschool and when we got there, there was a sign on the door saying that preschool was cancelled due to the holiday and a lack of attendance. So I took him with me to the DMV because I needed to renew my license before we leave town (and the paperwork that they sent in the mail listed the holidays that the DMV would be closed, and only listed Thanksgiving but not the day after Thanksgiving), but when I got there they were closed too for the holiday. Kind of wasted my whole morning, but oh well. That night the Hedgecocks came over and the boys played together and we got to play a card game, which was fun. It was nice to see them again after a while.

And then on Saturday we got a lot of errands run and that evening after dinner we took a little trip to Cabellas. It is a hunting and fishing store, and Grandma told us that they have the best licorice that she has ever had (although once we got the licorice there, she said that the stuff they sell at the Cabellas in Utah was better than here). But it was a fun little activity (and nice to get the whole family out of the house). It’s not only a store, but they also have giant fish tanks with trout and catfish and other fish, and lots of animals (stuffed) – all sorts of animals from the forest, and a little section with African animals. It was a really big store – we didn’t even have time to see the upstairs before it closed since it was pretty late when we got there. But the kids had fun – that was our first activity with the entire family out of our house since Isaac was born.

Sunday was kind of crazy. I woke up at 7:30 in the morning to Michael yelling for help. I guess Michael was helping Kolby and Eli brush their teeth before church and Camden walked into the bathroom and fell and hit his mouth on the edge of the bathtub. We know that cuts in the mouth bleed a lot, but his was bleeding more than any other injury any of our children have had in the past. After we got it to stop bleeding and got him calmed down, Michael took the older boys to church. I noticed that one of Camden’s teeth looked like it was pushed back a little further than the other ones, and I called the pediatrician’s office to see if we needed to worry about that, or if it didn’t matter because it was just a baby tooth. The doctor on call suggested taking him into the hospital to have it checked out just in case there was root damage to the tooth. So Grandma stayed with Isaac while I took Camden to the emergency room. They told us that his tooth cut almost all the way through his top lip when he fell, but that they rarely do stitches in the mouth because the mouth heals on it’s own so quickly and because of the bacteria there is a high risk of infection when they do stitches inside the mouth, so they will only do that if it is a serious cut, like a really forked tongue or something. And they felt the tooth and said that it didn’t wiggle at all, so they weren’t concerned about that. So I don’t know if his tooth did move, or if it was already a little further back than the others and I had never noticed it before. So Camden is fine now – but he still has a big fat lip. Hopefully that will go away soon. After we got home from the hospital we decided to try to catch the second half of church. I wasn’t planning on taking Isaac this week, but Kolby gave a talk in primary, so Grandma and I wanted to be there to see that. He did really well, it was very cute. Then that night after dinner we had the Wellses, the Kearls, and the Hymases over for dessert. It was fun to get together with all of them before we leave.

This week has been crazy busy so far, and I think it will just continue to be really busy until we leave. Yesterday I had to get all the errands run that needed to be done because I knew we would not have a car today because we had to take it in to have the breaks and rotors replaced. So yesterday morning I took Kolby to school, got stamps at the library, went to the DMV and renewed my driver’s license, went home to call the doctor’s office to get Isaac’s medicine refilled, went back and picked up Kolby from school, signed the boys up for preschool and swimming lessons for the winter session when we return in February, went and got ink for the printer, picked up some diapers at the store, and then went to pick up Isaac’s medicine. When I got home and helped Grandma to finish feeding the kids lunch and put them all down for their naps, Grandma said that my visiting teacher had come while I was gone. I totally spaced the appointment she had set to come visit with me. Ooops! It seems like with so much going on I can’t manage to remember everything that I need to. I was thinking that my visiting teacher is going to think I am a forgetful person, but I’m really not usually like that (but maybe now that I have four little kids I am going to turn into a forgetful person – hopefully not, hopefully I will feel less forgetful after a few months when things calm down a bit and we get into some kind of regular routine).

So, last night we did have some fun. After running a few errands we went to the McDonalds down in West Allis and let the boys play in the big play area there. It is a two-story indoor playground with tunnels to climb through and two big slides, and it was especially fun because Camden went up in the play area for the first time. The first time he went up with Kolby and Kolby helped him through the tunnels to the slide. Then Michael and I each took a turn climbing up and helping him get up to the slides. The boys really enjoyed that.

And this week we have a lot planned. Tomorrow Michael leaves for his first dermatology interview in Temple, Texas with Texas A&M. He has a dinner with the residents Wednesday night and then the interview on Thursday. On Wednesday we also have a doctor’s check-up for Camden and Eli’s flu shot. Then on Thursday I am taking Isaac to Children’s Hospital to have him circumcision done (they didn’t get it done before he was discharge from the NICU, so this was the earliest time that we could get an appointment for him). And then on Friday I have my 6-week check-up after having the baby. And then we will be leaving early in the morning on Saturday. Our friends, Faith and Tyce, were so nice to say they would take us to the airport. Our family is getting so big, that we will need to take two cars to get to the airport now – with our family, my Grandma, a driver, and all our luggage for a two-month trip there is no way we could fit into one car. I don’t even know how we are going to pack for this trip, but I guess I’d better figure that out pretty soon. Well, Isaac was asleep and he keeps flailing his arms about and waking himself up – I guess I’d better go swaddle him so he can stay asleep.

Oh, here is the talk that Kolby gave in church on Sunday: (I helped him a bit with the beginning and end of the talk, but he came up with all the things he was thankful for all on his own).

“I have faith in Jesus Christ. I have blessings in my life. I am thankful for my blessings. I am thankful for Jesus Christ and Heavenly Father. I am thankful for my brothers. I am thankful for the temple and the church. I am thankful for our Christmas tree. I am thankful for my whole family. I am thankful for my grandma. I am thankful for my friends. I am thankful for my manta. I am thankful for songs. And I am thankful for our food and our clothes. I show that I am thankful in my prayers to Heavenly Father and Jesus. In the name of Jesus Christ, Amen.”