I realize that not all my parenting decisions are mainstream. But never for one moment think that any of them are made lightly or without a lot of research.
I am a nurse, I had to study science at varsity. I like research and good logical reasoning. So when I make a decision it always takes pros and cons into account and looks at risk. The thing with most medical decisions is that there is risk no matter what you do. One just has to decide which risk you are willing to live with.
As some of you know Titus and I were struggling a bit with breast feeding. On Thursday we saw a Lactation consultant. She was lovely and spent 3 hours with us. I think we have the hang of feeding with bigger boobs now. Still hurts at times but definitely better than it was.
Titus had a little blister on his lip that started on Tuesday. I thought it was maybe because he latched wrong. Then it opened and was yellow and more appeared so we decided to go to the GP on Thursday afternoon.
She thinks it is Impetigo and needs antibiotics but because he is only 11 days old she does not want to give it without some guidance. So she refers us to Blaauwberg hospital to see the Paed on call in the ward.
So we went to the Paed ward and saw a Dr who rubbed Yme and I up the wrong way. Granted I had my hippy pants on and I have pink hair but gosh this woman was condescending. She is VERY medical and seems to be a worse case scenario kind of person.
She was worried that the lesions/ulcers were septic and that she thought he had a risk of being septic inside and wanted to admit him and put him on IV antibiotics and do 5 million tests. She said it could be lots of things including herpes ( which he could only get if I had vaginal herpses at birth – i nearly smacked her for that one) She was also questioning my choices about birth. She kept saying he was prem. He was born at 37+5 so close to 38 weeks and weighed 3.41kg – hardly prem. She questioned if I had vax’ed him yet, and actually I do give the BCG and birth stuff I just wait a week or 2 and seeing as he is at home it is okay. I think she thought I was some person that refused all medication without thinking or knowing why I did things. She had a whole fight with me about Vit K and asked if I had heard about Haemoragic Disease of the newborn, I have read more than most on Vit K, research papers and all sorts, I have spoke to people and again made an informed decision.
He is slightly yellow but my Dad ( a prof of family medicine) had seen him on the weekend and the midwife was keeping an eye on him, she implied that because we had not had him checked we were neglectful and his liver was prem blah blah blah.
So anyway I am on a medical insurance policy and Liberty does not answer phones after 5pm so we could not get authorization for admission and they wanted us to pay R6000 deposit to get him admitted. Hahaha ja right.
Anyway I phoned dad and sent him pictures (which I should have done first but did not want to take advantage of him being a Dr all the time) and he said straight away that it is Impetigo and that with a antibiotic injection and then oral antibiotics and topical cream he should be fine, Yme and I chatted to him about the risk of it being a general sepsis and we were happy that with no other signs, no fever, no lethargy, feeding well, weeing and pooing well and being alert and happy that it was unlikely that he was septic and that for tonight we did not want him admitted.
She wanted us to go to the government hospital with an 11 day old baby and sit and wait with all those germs, the risk to him seems greater to me than waiting one night and phoning the medical aid in the morning. I am also not convinced I want him admitted at all.
She wanted us to sign that we were refusing treatment, which I said we were not we were saying that on the clinical signs that night we did not want to go to a government hospital and that if he got sicker we would obviously take him in. She tried all sort of scare tactics but really she just came across to me as young and neurotic, like she tests for everything and over treats. I understand she wants to be careful but part of being a Dr is knowing when to panic and when to trust your gut and follow the clinical signs. She said we had to sign that we take responsibility for refusing her treatment, we made it clear that we ALWAYS take responsibility for him, that it is our responsibility alone.
I trust my dad and I also think that life is about making decisions based on the info you have on hand and then later if new stuff happens then you reassess and see if you need to do something different. I am so the wrong person to try the I am the Dr and therefore God thing on.
She did give us the antibiotic injection and a script for the oral antibiotic that my dad suggested even though she at first wanted to not give it just to make a point that if we did not do it her way it was no way. Anyway we got his billiruben checked to make her feel better and we got the antibiotics injection and the oral stuff for tonight.
He was fine overnight. It is not easy being a parent.
( as a note a friend @cazpi has had a baby at Blaauberg Paed ward does not like the Dr we saw today too, she also says she is neurotic and over treats, so that made me feel better that is was not just me that did not like her. She really really got my back up)
Yesterday we got an appointment with a Dr that works with a friend Suzanne’s Paed, her guy was full – but she has seen this Dr too and liked him so I felt happy going to someone that was recommended.
I was very honest and said i was there for a second opinion as i really had not liked the Dr the night before, but that if there was any reason i was happy for him to be admitted i just did not think that the symptoms last night warranted spending the night in a government hospital or paying R6000 for their bed.
Anyway so he looked at Titus and did a much more detailed examination. She just seemed to panic and wanted to order a million tests and admit him. He was happy that on the clinical signs we carry on with the oral antibiotics. The fact that he had no fever, he was feeding well, he had no tachycardia or lethargy or anything else that might suggest an internal infection. He did not think that admission was necessary and said we should see a huge improvement in 3-4days.
He did repeat the biiliruben just to check as she had not ordered the test that splits the level, there is congugated and uncongugated and then a total. The total does not actually tell you if the dangerous one is high. He also did some tests to see if there was any signs of internal infection. The tracked down the Billiruben test from the night before and if was 205 which is not actually a problem at all and does not need light which she said he needed.
Anyway we did all the bloods and also he changed the antibiotics from a huge dose that was really hard to give a tiny baby 3 times a day to a smaller does 4 times a day. We get it in with LOTS of screaming.
I was very impressed with his manner, he actually interacted with Titus and treated him and a person and was kind to him, this other woman was offish to me and showed no warmth at all. I think we rubbed each other up the wrong way from the start. She is obviously not comfortable with people that do anything but what they are told or totally to the book.
Yesterday afternoon I got an email from Dr Theart who i saw him that morning, he said the Billi is slightly higher than the day before but still not high enough for lights, and the dangerous one is low. If still yellow on Monday maybe we recheck. But all the other tests were clear, No internal infection and NO septic baby. Look i know it might have been a risk in her mind but there have to be clinical signs to support your decision. There was no need to threaten me that he would be dead in 2 days. I think what got to me was that I was just saying that based on the signs last night we made a decision for last night, we were not making a final decision on his treatment, we would watch and see and in the morning reassess. To me her clinical examination skills are poor and she just relies on tests to make a decision and not on being a Dr with good skills at diagnosing. Being a clinical nurse specialist and assessing patients and having to make diagnoses myself and watching highly skilled Drs I know what constitutes a good assessment.
it felt good to know that we were right in trusting our gut. I am glad i did have my dad to discuss it with, you do for a moment doubt yourself if someone says your baby is going to die. It would have been horrible not to have that backup. I spoke to my Dad tonight and he is a profession and lecturer and teaches students how to do just what she failed to do, how to be good clinitian and learn how to look for patterns and look for groups of signs and learn how to make decisons. He suggested that I write her a carefuly worded letter expalining what happened since we saw her and explain without being nasty and getting her back up the things that we did not like. I am not sure that it will do any good, it is not going to change her, but he thought the feedback and the chance to reflect on what she did was worth writing it.
What do you think, would you write to her?
So R3000 later he is fine. I had a moment at the path lab when my card was declined that i had a small panic. We don’t have that extra in a month. I will have to go and put all the bits together to pay that bill in the 24 hours we have. I then put my last R20 in the car with the petrol light on and had a little sob in the car. I think it was the built up emotion of worry and fighting and proving we were right. But we are home, we have more than most and thanks to my amazing parents and my full freezer of food my mom cooked for me when she visited a few weeks ago we will be fine. I can ask them if we battle, they are amazing, it just takes the wind out of your sails when you skate so close to the edge with money. And to think how much of it was because some woman panicked. BUT still better than the bill if he was admitted for nothing.
Then my awesome friend @cazpi came in the afternoon and I managed to chat and get it all out. She even read to the Pinklets while I washed the dishes that had piled up.
His face today – much improved