Tuesday, October 11, 2011

Um, I Think You Might Be Wrong...

I got home and took a minute to look at Aaron's discharge paperwork.  Um, I think they got it wrong, or more specifically, the resident got it wrong.  Not that it's a big deal.  It's certainly not a critical mistake.  But he listed aspiration pneumonia, (or in his words, viral pneumonia) as his diagnosis.  Sorry, that's not it.  And I told you.

Yep, it's the beginning of the school year.  This particular resident will, I'm sure, learn to look at previous records before making a decision, especially in a complex case.  But he hasn't yet, or at least he didn't go tell his attending that he'd goofed.

I'm not a radiologist.  I'm not a doctor, or even a nurse.  (Maybe I shouldn't say "even."  I know some pretty incredible nurses.)  My medical training consists of a basic EMT course taken seven years ago and Aaron's School of Medicine.  That said, I have been there for nearly every one of his 90 inpatient days over the past 15 months.  (I hit a wall a couple times and went home for one night during two longer stays.)  And I've seen each of his chest x-rays.  There's been more than just a couple.

This is NOT Aaron's lungs, but the
patchiness is similar to what we
always see on his.
So when the chest x-ray from Thursday night looked just like the one on Wednesday, which looked just like almost all of his previous ones (except when he had pneumonia, that was scary), I looked at it and went, "Yep, that's my kiddo."  Now, for almost anyone else, an x-ray like his would say, "we need to do something."  His says, "yep, that's Aaron."  One of Aaron's challenges is atelectasis, or collapsed lung.  It's not collapsed like a balloon, just some of the little alveoli don't like to open.  And sometimes they take turns being the open or closed ones.  But his lungs always look just a little cloudy, and usually in about the same places.

Normal Lungs
So I was surprised to hear the resident announce a diagnosis of viral pneumonia.  After rounds, I asked him why he made that decision.  He then went into viral vs bacterial pneumonia, probably figuring I was asking why we weren't putting my baby on antibiotics to clear stuff up.  No, I was asking if he'd found something I had overlooked.  When I asked him about viral pneumonia vs atelectasis, he agreed that they often looked very much the same.  I suggested he look back at the previous x-rays because I was just going off my memory.  I guess either he didn't, or he didn't want to find Dr. C (the attending) and tell her he made a mistake.  Because there it was on the discharge papers.

Now of course, the fun has continued here at home.  He's still not well.  It is probably a virus.  But I don't think his vent settings were supporting him well enough either.  He did pretty well on our trip to Shriner's yesterday, but still needing more oxygen.  But by last night, I was getting really antsy again.  I even told William that if it were not for our appointment with the trach/vent clinic on Wednesday, I'd be taking him in now.  But there we meet with ENT, pulmonology, respiratory, and special needs all at once.

This morning wasn't much better.  In fact, just regular suctioning had him desatting to low 80's & high 70's and me going quite high on his oxygen to bring him back up.  So I called up to PCMC and got the home vent coordinator up there.  Now, I don't think this woman really forgets anything, but if she did, she's the kind of person you'd say had forgotten more about a subject than most others know.  She agreed that his trouble probably wasn't pneumonia, but insufficient vent settings and probably the weather changes.  Like I said, she doesn't forget and she knows my kid.  So we've increased the settings in anticipation of tomorrow's appointment, and guess what!  He's doing better already.

Yeah, I think I know my kid.  And once that resident learns to listen, he'll make a great doctor.  He's just young, and I guess I'm starting to feel old.

Side note:  We're on our last set of casts!  On the 24th, Aaron gets braces, and they're cute, thin ones, not the big clunky ones of my generation.  He's also up to 17 pounds, 14 ounces!  How's that for failure to thrive!!

1 comment:

  1. You are a very perceptive Mama! I'm the mama of an Aaron also but I have no idea what his lungs look like! Your boy is blessed to be so loved.