"ignore the story. see the soul. remember to love. you will never regret it" --- Seane Corn

"ignore the story. see the soul. remember to love. you will never regret it" --- Seane Corn
it's a jungle out there

Wednesday, September 8, 2010

Back to Work: Expired Patient Part I

Last night I was wishing for more time off. I like my job and all, but I like being home more.

Cuz I'm lazy

Anyway, I got to work and found I had an unusually light schedule. But who's complaining? Not moi.
In between patients I sat at the computer to catch up on work email.

One of the best things about my job is that I do not take it home with me. I may have told you this before. When I leave the office, it all gets left behind. In the 13 years I've been here, I think I've lost sleep over a patient only a handful of times. I am entirely not interested in worrying that I've missed something or made a mistake or fucked up with someone's kid. So I'm super thorough. I answer all the parents' questions. I tell them what to expect so they don't freak the fuck out at 2 am when their kid pukes or runs another fever. I don't leave messes for others to clean up. And I've never gotten burned. I cover my ass and I cover my patients' asses and I go home with a clear conscience knowing I've done my best.
And my best is pretty damn good.

So I'm reading up on the last 10 days of office email. I come across an expired patient notice. We get these notices a few times a month. Which may sound like a lot of dead kids but we have an enormous patient base. Sometimes it's a kid with serious chronic illness. Sometimes it's a drug overdose. Sometimes an accident. We are usually notified by way of obituaries, which rarely state cause of death. It's unusual that a kid dies while in our care
they don't die in the hospital
so most of the time it takes a while for us to find out what happened.

So. Email. Subject: expired patient. Brandon M.

Brandon M. Wait. He's my patient. He's only 13. He's Jack's age

Brandon was the first patient to really make an impact on me as a nurse practitioner. Amongst the many sore throats, ear infections and well babies, he was my first complicated kid. I started seeing him when he was only a few weeks old. He had a congenital heart condition that is not uncommon, and usually resolves on its own. His was pretty significant, though. The pediatric cardiologists suspected that it would need surgical repair at some point. I was a brand spankin new NP, and although I knew what to look for, I was afraid I wouldn't recognize the signs indicating he was deteriorating. But mom was on the ball and so was I. So when Brandon was 5 months old, we saw the signs that his little heart was tuckering out. I remember being so intimidated to call the cardiologist an tell him what was going on. I guess I handled it ok because later that day Brandon was on his way down to the medical center to get the hole in his heart repaired. About a week later, I saw him for post surgical follow up.

It's a tad disconcerting to see a 5 month old with a 4 inch sutured incision running down the middle of his chest.
The professional me looked at that tiny chest and thought easy peasy-all fixed up-good as new.
The 7-months-pregnant-with-Jack me looked at that tiny precious sewn up chest and was offended by the invasiveness and insult of it all.

Mom was concerned that Brandon wouldn't stop crying. Before his surgery, they had said if he was irritable or refusing his bottle, it could be a sign he was decompensating. He had never been an irritable baby, but since the surgery, he seemed worse.
I took one look at him and said what are they giving him for pain?

She looked at me like I had two heads. Pain? Ummm... nothing

Seriously? This baby's in PAIN.
How can peds cardiac surgeons forget that if you saw through a baby's sternum, he might be in pain afterwards?

They hadn't even recommended tylenol. Seriously.
I gave Baby Brandon a dose of tylenol in the office and instructed mom to give him more every 4 hours for a few days.

I called her later that evening.
Oh michelle thank you so much. He so much better. He's taking his bottle and smiling at me. Oh my god he was in PAIN.
Thank you so much for taking his pain away.


Today, I couldn't stop thinking about her.
When I saw the obit I thought drugs? No way.
Stepfather? Maybe.
Car accident? Hmmm..

I pulled his chart to see if there was any notation regarding cause of death. Under a copy of the obit was a copy of a short article from the local paper. Seems she was driving back from NJ a few friday nights ago and hit the divider. Brandon was thrown from the car, then hit by oncoming traffic. His 17 year old brother and 18 month old half brother were in the car as well.

The accident was under investigation. The reporter mentioned that
Brandon wasn't wearing his seatbelt.
At the time of the article, mom had been discharged from the hospital, but the siblings had yet to be released.

I don't know if they were injured or being held while CPS investigated mom for negligent homicide.
Godfuckingdammit. Can you imagine?

I couldn't feel my feet. My heart started to pound. I KNOW this mom. And I couldn't imagine what she must be going through.
I called the number listed in Brandon's chart. Straight to voice mail. I left a message.

On my lunch break I found my way to the address listed in his chart. No one was home. I scribbled a note on a blank prescription.
I was shaking and holding back tears as I got back into my car. My minivan.
The minivan in which my kids sometimes ride without their seatbelts.
Like when we're coming home late and they want to strech out and sleep, or when I'm sick of saying dammit put your seatbelt on.

I drove back to work and all I could think was I can't imagine

I felt sick. I felt sad. I felt scared.
And I thought it's like being on the beach in mexico and feeling how extraordinarily hot the sun is. It seems like you can actually feel your skin burning. Then you try to imagine how much hotter it would be on the sun.

The fear and sadness and sickness I felt was only the sun on my skin 93 million miles away.
Brandon's mom must be feeling like she's right on the sun's surface.

When I visit Hallie I feel the same way

I got back to the office and thought who am I kidding?
I don't leave my patients behind in the parking lot at the end of the day.
Their little hands leave indelible marks as they knead this crazy heart of mine so it can keep rising and feeding my soul.

I need to find Brandon's mom and give her a hug. Hopefully I'll see her soon with the baby.
And I will be following all seatbelt rules going forward.

There But for the Grace of God Go I.


P.S. I wrote this post in between patients and on my lunch and dinner breaks.
My 6:50 appointment was Christopher J. Brandon's baby brother.

I'll tell you about that tomorrow.


  1. Oy.

    Was just talking about this today, trying to explain to an ADA that it is not "lack of supervision" to take a shower when you have two young children in bed. A mother should not lose custody of her children for this.

    We are so quick to judge. Thank you for the judge-free space, of knowing bad things happen to good people for lousy reasons.

  2. I don't know what to say. You've said it for us, for all of us.

    I'm breathing now, grateful for you and your place in these people's lives who you've described -- grateful, too, for the humble way you teach us.

  3. I will be thinking of you, asking of what you believe in - I am sure the Lord Ganesha will remove any obstacle in your way, after all we both know that in more ways than the literary one he truly has your back - to light the way for you hoping that you will see and feel that your love and concern are as powerful as any pharmaceutical thing you can hand to them. My heart goes to the mother. What a hell this will be for her to live through.

  4. Ack. That's about all I have. xoxo

  5. I can't even imagine. No. I can't. And I feel sick even trying.

  6. Dammit.

    This is why I take care of old people. Though I have gotten attached to many over the years, their passing is rarely tragic.

    I prefer peaceful expected Death thankyouverymuch.


  7. Thank you for being brave and loving and abundant and picking up that phone.

  8. That's why I get so furious when I see THREE YEAR OLD kids without seat belts on, riding in the front seat of the car.

    Also, this "It's a tad disconcerting to see a 5 month old with a 4 inch sutured incision running down the middle of his chest. " reminds me of when Joey was barely 3 months old and he had a 7 or 8 inch incision stretching from the back of his neck up through the back part of his head up to behind his left ear. They removed a tumor called a plexiform neurofibroma. The stupid doctor said "He is only three months old and shouldn't be in too much pain anyway".

    I was LIVID.......I talked to the nurses and they made sure he got Tylenol with Codeine. My pediatrician offered something stronger but the Tylenol with Codeine was doing well..........

  9. I feel physically ill after reading this. I am so sorry. This is just so friggin' tragic.

  10. oh my god, i'm almost in tears. this may be one of the first few posts of yours I've read and it's heartbreaking. Thank you for all that you do in your work.


so... wadaya think?

Your fairy is called Columbine Icedancer
She is a bone chilling bringer of justice for the vulnerable.
She lives in mushroom fields and quiet meadows.
She is only seen when the bees swarm and the crickets chirrup.
She wears lilac and purple like columbine flowers. She has icy blue butterfly wings.