Sunday, February 12, 2012

The Moribund: times when it is too late

This is mom saying goodbye to dad. 

There is an expectation in the community that is not balanced. Actually, there are several of them. Today I am going to share stories with you I have seen in practice as a resident and as an attending that are important for you to know.

1) Your loved one will get better
 Infection is a time race between the infecting organism (a parasite) and the host (your loved one).
It is a race of time between when the host immune system will beat the organism, or the other way around.

Sometimes the organism wins.

I have to intubate patients anywhere in the hospital who are in trouble. I was called once, while about five months' pregnant, to intubate a three year old in the Pediatric Intensive Care Unit. This kid was toxic. When infection spreads fast and far enough, the coagulation (clotting) mechanism is overwhelmed.  This is a late finding in the battle, and is not good. Blood comes out every poke hole in the skin, in the mucus membranes, everywhere. I intubated him. And even though I was in and the sats were up, he coded. I watched the PICU team code this child a half hour and give it up. I saw them go to the hall and tell the parents that their boy had died. I heard the scream.

I will never forget that scream for as long as I live. It was agony voiced.

The mistake that these parents did, is that for whatever reason, medical care was not sought until the infection had the upper hand. There is a race of time. When the bacteria or whatever is about to win does not give enough time for the medicines and therapy to work.

Any temperature over 101.5F is a fever. I know there are lots of parents out there that hate to go to the doctor. You have to take time off work, and it can be the middle of the night. But I think most parents should know that A) this is YOUR kid and B) YOUR kid is sick and you need to do something about it.
I don't care if the authorities are going to deport you back to someplace you worked hard to escape and you are here illegally. I don't care if you believe in antibiotics or not. If you are not trained in the medical field, you are going to miss some important signs and symptoms of illness if you do not have a trained person on your side. Give them a call as soon as possible. Ask them what to do. 

This is NOT GIVING UP POWER! This is using an important resource that is available at this time on Earth. Be sure you know when and where to use it.

2) The doctor is always right

I can't begin to tell you how many stupid doctors are out there. I diagnosed my own mother's cause of kidney failure. Her protein in her urine and blood was high when she had had nausea and barely eaten for six months. I asked for serum electrophoresis to make sure it was not Multiple Myeloma, which presents like that. I was close. It was a different antibody and was Goodpasture's syndrome. 

My niece around kindergarten had bloody diarrhea. This was not good. The doctor said it was the flu. That's what they said about my mom. My sister kept taking her back. Sure enough, full blown e. coli. Very severe. Almost died. My sister trusted her intuition and kept going. She has saved the life of my mother three times and her daughter once because of that.

Your intuition is as right as the doctor

Listen to it, if you are a child, a parent, a friend. When there is a conflict with what the doctor says, and your heart, always listen to your heart. For after all, you will have to live with your heart and the result of this decision for the rest of your life.

3) Natural is better

Primitive Mommy posted about 'was your birth plan respected?'

She and the entire birthing rights community has it backward. All births are special. Yes. Are all births normal? They are not.

If Nature was to rule, we would have to accept Natural Selection at work. That would mean, acceptance of death and injury to the infant/mother in childbirth.

People die. They always have. In less advanced societies. And historically. People die while giving birth.

There is only so much a midwife can do. I work with them. Sometimes they have to call the doctor. And we have to operate. This is called a 'crash section'. You do not want to be that.

Let me explain. A crash section means we rush to save the life of the baby and/or the mother.
Under good circumstances it takes less than five minutes to take a child out of the womb with adequate dissection of the bladder off the uterus to protect it. In lay terms, we 'make room' to get the baby out.
In a crash that child is out in less than a minute.

If you are faced with the prospect of a c-section, wouldn't you rather  have it be under non-Crash circumstances so they can take care of 'everything else' down there? I would.

And for those of you wary of epidurals and anesthesia in childbirth, here are the facts:

Onset and placement of epidural: fifteen minutes if mom holds still and has normal palpable anatomy of spine

Onset and placement of spinal: ten minutes if mom is not fat or thrashing

Onset of general anesthesia: less than one minute.

That's right. If you go through labor with no epidural, and crash, guess what? You are going to sleep. The event you are hyper-focused on will take place while you are unconscious and your spouse nowhere in sight. And you put your child at risk due to the general anesthesia that is in your bloodstream. They are born 'asleep' and have to 'wake up' in addition to going through a traumatic birth that made you need a c-section.

Bring your birthing balls and candles all you want. We honor your birth plans as much as possible. BUT, when birth starts to be anything other than routine, your Labor team will start to give suggestions. Try pitocin. Take an epidural. Why? Because these have helped us to avoid doing c-sections in the past with mothers whose labor patterns were like yours.

Healthy mom plus healthy baby. Isn't that both of our goals?

4) Our loved one is a FIGHTER!

I am sorry. When more than one organ system starts to go, in the ICU we call that circling the drain. Add any more organ systems (on a ventilator, with pressors to help the blood pressure and the heart, and add hepatic failure) and the chances of recovery are next to nothing.

This is the time to accept.

We did a take back on a patient with Hepatitis C with a large brain tumor who was bleeding into the wound. There had been a heart attack in the past. And coma with the hepatitis c. Why put your loved one through all that? Why spend your copayments and your loved one's insurance to stave off the inevitable? Give them comfort. Give them care. But don't try for heroics.

Last week a pulmonologist had a patient who was hypoxemic and and endotracheal tube of 7.0 mm diameter in. He wanted a tube of 8.0 mm, or at least 7.5 mm, so his bronchoscope could fit.
I got a partner to help me do it. Sats were 80% and weight was BMI of 80. I had said no to the doc but my partner said yes. I got the soft exchange catheter. We stick it in one tube, slide the old one out, slide a new one in back over it. Mine did not have good ability to ventilate, but it could. The partner wanted better. They went back to the stockroom and got the fat yellow one. Guess what? In shoving it down, the mucosa bled. Although the exhange was 'successful' all the pulmonologist saw in the airway was blood.
I think of situations like this as 'giving them their chance'. I think that sometimes we should not be so generous in doing so. This patient died the next day. The low oxygen sats took their toll on the kidney, and it failed. Patient was too unstable for dialysis.

5) They are THEM and we are US

That is not true. My fearful Bradley method mother in labor with the piercings, tattoo, dark as Priscilla Presley hair and husband from Portland had couplet contractions. They were two contractions close together with not much rest in between. She knew enough that this was not normal, listened to her body and knew herself, saw the big picture, and listened to her labor nurse and got an epidural. She was concerned that once her water broke she was going to have pain she could not tolerate any more. That is what made her decide. And after she did, she was glad.

I told her 'healthy mom, healthy baby', 'enjoy your labor', and  'at each step of the way, we make an informed choice'. Baby does not read the book on natural labor.

When the nurse left the room, I shared, "I gave you Reiki. I am a Reiki Master" It was a total disconnect for them. Their jaws dropped as they were struggling to understand. I had to rephrase it, 'I may not look like it now, BUT I AM ONE OF YOU! I can't tell anyone here now, but I want you to know I am working so that one day I can.'

Do you KNOW how many doctors and nurses have published about Reiki and Intuitive Medicine and Energetic Medicine? There are a LOT. Meredith Kendall. Mona Lisa Shultz. Caroline Myss. Many many big names. Look at Dr. Oz! Deepak Chopra...There is a movement. And for every one of them there are hundreds of healers like me who are afraid to talk.

Dad touched my arm and thanked me for what I did. I felt the Reiki coming back. They were healers too. That newborn was going to be lucky to have them.

Friday, I was at Starbucks with a Mormon coworker to discuss politics at work. We are both single parents and can't afford to follow the lead of others who had left over the disagreements. While we were talking, my first patient I gave Reiki to openly in the hospital was there. Evan. She was a nutritionist who told me to get off soy. And I did Reiki on her postpartum. I blogged about it. Well she said, 'You were the one that did Ray-i-ki on me' right in front of the Mormon. I was glad she did well, and would have loved to talk more, but I couldn't. Not with him. But she looked great and the child was a little crystal child. I could feel it.

Things are moving up towards enlightenment and ascension in the practice of Medicine. Give it time. Until then, please leave your expectations at the door and go into the medical center with an open heart. And listen to it!


Reiki Doc