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.

Pain

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.

Twice.

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.