attending physician vs patient family - the rest of the stay......

It was one of the toughest and agony night for me…I woke up on hourly basis , auscultated his breathing sound and checking his pulse rate. By 5am on the nurse morning round, his HR had dropped to 100/min with SpO2 of 94%,  but his BP was at an uncomfortable reading of 88/60mmHg despite of his improvement clinically. The second check was 1 + hrs later after Xian inhalation and antibiotic medication; his SpO2 was better at 95%, and BP had increase to 94/56mmHg. I was still feeling discomfort about the reading but yet he was in better shape.

Boss did his Sunday round at 9:30am and we had a brief discussion, Xian SBP was over 100mmHg by then. Both of us agreed the Xian was in bad condition on arrival but improvement was noted. He agreed with the admission ordered and thought that we were at the right track of management. Xian had improved later that day with no fever but yet his tachycardic was stationary. Ving had visited us later that evening and brought us some supplement for our stay. I had a better sleep as Xian condition was better though his SpO2 was still at 95%. His cough was better less sputum was noted.

D3 and D4 was a challenge to both of us as I had to do morning shift. Ving was only able to visit us later in the afternoon after Yun returned from school.

I left Xian alone in the room at 7:50am. After 2 days of living with the drip he was able to go to toilet with it and managed his own routine. His condition had improved greatly with heart rate down to 80/min(his average was 70/min). SpO2 was stationary at 97% and his breathing sound had greatly improved. It was a busy day and when I grabbed a chance to check on Xian at 10am, I found him by himself at the basement waiting for his turn for sonography. He was cool and confident about his condition. He mixed his medication (syrup and powder) and took it by himself after his meal. The feeling of seeing your own child handling his own task is beyond words..

I fetched Xian lunch at noon and Ving had brought us dinner later in the evening. The ED was busy and I could only returned to Xian room at 8:30pm. Xian breathing sound was still noisy but limited only to the base of his lung. The struggle at that time was to complete a 5 days or 7 days parenteral antibiotic. I was too tired and slept throughout the night. I woke up at 5am and Xian reading was almost normal. His heart rate had returned to baseline and breathing sound was much better. The struggle began as his venocath was due and need to be replaced. This time, the struggle was less.

 I prepared his breakfast and left him for ED at 8am. He was very comfortable with the environment than; he had wanted badly to get discharge and go back to school. I had a short discussion later that morning with boss and agreed that to discharge him tomorrow morning. It was a busy day in ED and I rejoined him later that night. Ving had come again later in the evening to bring us dinner. Xian was happy with our decision to discharge him on D5. He had slept more than 12 hrs per day during his admission; he had a very severe condition and I thank the great one for his speedy recovery…We had a great chat and I told him that my fear during this period. He finally realized why I brought my surface pro with me when we leaved home 5 days ago; I had expected the worst….

On D5, after the final rocephine drip, I had brought him home at noon…..

I slept through the afternoon when we reached home. This was life of a patient’s family. It was not my first one and I knew it will not be the last…..

I continued Xian on 2 more days of oral antibiotic and was very anxious whenever he had a slight cough. He had recovered well after the medication……

attending physician vs family D1

It started 2 weeks ago when Xian had started to experience cough. It was mild initially and later the cough become bursting in nature. No fever was noted and he had noted with no sign of life influenza. I had given him some cough syrup and the cough was better later on. The cough was still non-productive but had been disturbing in the night.

D-5 days before the incident, Xian’s cough character had changed – episode become longer and the sound quality was different from before. I had started him on Augmentin syrup and after the completion of the 3 days course, the cough was stationary and I stopped the antibiotic. On D-1 days, he was noted with low grade fever. I had gone for my night shift and felt very uneasy about his fever. His spirit was ok but yet the cough did not improve.

When I arrived home, I did an auscultation again and found that Xian condition had worsen; there were bilateral basal crepitation with mild wheezing. He was also tachycardia which made me more uncomfortable. I had started him on azithromycin, antipyretics and and some cough syrup before I gone to sleep. I hoped that when I woke up with the fever subsiding, his heart rate would become better…and I was wrong.

After 4 hours of sleep, I woke up and found that Xian’s fever had subsided. He was still tachycardic. I hesitated for a few minutes and decided to take him to the hospital. Tachycardic was not a good sign. Baring in mind that he would be admitted, I grabbed all my gadget and took him to the hospital.

ED was crowded and I seen him myself. The initial vital sign was unsatisfactory, tachycardic, hypoxic(SpO2 93% on room air). The CXR was better than I excepted, some infiltration over rt lower lobe instead of a very large patch. Another struggle….but there is no alternative, to risky to do home care therapy as I don’t have an oximeter in the house. I signed the admission form and praised the great one that there was still a single room available. Single room had been hot cake and very difficult to get one nowadays.

I started him on rocephine and azithromycin as he was an ICU candidate; not much choice for me.

Although with all of the “I am in very bad condition” findings, Xian was still comfortable which worried me. This is the sign of "I could deteriorated fast anytime" without any sign of warning...

The most difficult part was inserting the branula; Xian is definitely a super needle phobia compare to my needle phobia. It took 4 persons to perform the task, he is now 168cm and 63kg instead of the kiddo few years back.

In less than a hour, I had managed to take him into the room. SpO2 had increase to 95% after inhalation but yet he was still tachycardic.

I was unable to sleep that night due to anxiety; I was there as an attending physician, nursing aide and also a family. Xian’s life was in my hand and at the mercy of the great one….

I had questioned myself many times if I made the right decision...should I referred him to a better setting and under care by a pediatrician or should I use another regimen of antibiotic. Questions which I was unable to answer...