The momumental screw-up... part 1

So we are home from Wolfson's Children's Hospital, where we endured a 4 day isolated stay that has left our poor Gracie looking and feeling like a human pin cushion- covered with prick marks, bruises, and bandaids. My poor sweet girl.

So let me give you the story- start to finish- of what really went down. Uncle Mack and Aunt Hyster did their best with second hand info, but I'm going to clear it all up so we can have a full picture of what exactly happened.

Rewind to a week ago- Sunday. Gracie is fighting a fever... it started out around 99 degrees. This is enough to warrant some concern, but 100.5 is our magic number. When Gracie reaches 100.5, we automatically head to the ER to have blood cultures taken and doses of antibiotic given. Anyway, she seemed ok despite the low grade fever, so we took a quick trip with Noni down to Gainesville to shop for a few hours. Gracie did well, but as time passed, she seemed to get more and more fussy. We headed for home and once we got there I took her temp and there it was 100.9. We packed Gracie up and Noni went with us to the ER (Shands at Lake Shore). We got in our room and waited for the inevitable needle stick which would provide not only a blood sample, but also an entry point for the IV antibiotics that would follow.

I'll give our nurse credit for trying, she did go for a vein in Gracie's arm with little success. Of course, Gracie squirmed and screamed her head off the entire time as the nurse wiggled the needle around looking for her vein. No go. On the other arm, she saw a big bruise we got from a previous draw which blew Gracie's vein over there. I think that by that time, she was nervous about sticking Gracie again and her judgement was not so clear. She suggested another method of blood capture- a heel prick, and we could give the antibiotic in a shot. Having just watched my baby writhe and scream in agony for a few minutes (which felt like an hour), I liked the idea of a quick stick and then a quick shot. WHatever would get us out of there the fastest. It never occured to me that I should question this method. I figured that if the nurse and doctor ok'd it, it must be a good alternative.

So she prepped Gracie's foot by cleaning it well with alcohol and chloroprep before giving her heel 2 pricks to make the blood flow more freely. Poor Gracie screamed again and kept screaming for next half hour as the nurse squeezed her foot and scraped the collection tube around her heel to collect enough blood for the sample. She had to get several tubes worth of blood, and this took a lot more time than anyone anticipated. By the time she filled the 3rd tube for the culture, the first 2 tubes (which were for a blood count and a metabolic panel) seemed to have clotted up. Fearing that the third tube would also clot, she called another nurse in to run it over to the lab. The second nurse saw the clotted samples and Gracie's still bleeding foot, and grabbed another 2 tubes and began squeezing Gracie's foot as well. I had noticed that she used hand cleaner when she first walked in, but I was distracted by my screaming baby and the discussion on the clotted tubes and I didn't pay much more attention to what she did. I was so paranoid that Gracie would have to be stuck yet again because of all of this mess. As Nurse 2 finished collecting the 2 new tubes, it was then that I noticed that her bare hands were covered in Gracie's blood. No gloves. I panicked, thinking only of the risk of contamination, and asked Nurse 1 if the 2 new tubes were for the the culture or the other tests. I was told they were for the other tests and then the nurses quickly took all of the tubes out of the room to send them to the lab before any clotting could occur. This was unusual because the blood for the culture is usually placed in the special culture bottle before being removed from the room... but with the entire process being out of the norm and my poor baby just absolutely terrified and screaming, I let it go and concentrated on calming Gracie down. In retrospect, I see the many red flags staring me in the face, but in the whirlwind of the moment, I was concentrating only on comforting my screaming daughter. The motherly instinct trumped my consciousness.

This was only the start of the screw-up...

On Wednesday evening while we were doing well and Gracie was fever-free and feeling better, we received a call from the folks at the ER telling us that Gracie's culture had grown something. I asked them to fax any and all results to our doctor at Nemours. I then called over to Nemours myself and asked them to page the on-call doc so that he could tell us what to do. He called back immediately and when I told him about the preliminary results of the culture, he told me to go ahead and pack up, that we were going to be admitted to Wolfson's for observation, a repeat culture, and a round of specific antibiotics. He asked me what kind of port or line Gracie had, and I told him that she had gotten her line removed at the beginning of the month. He asked how the culture was drawn, and I told him that they collected it from a heel prick. There was silence on the other end of the line, and then he asked me if I was serious. Ummm... this is clearly a bad sign. He told me that no one should EVER do an infection culture via heel prick due to the risk of contamination, but that we have to work under the assumption that the culture was correct and we needed to bring Gracie in. We packed up and loaded our poor girl in the car and headed to Jacksonville.

Upon arriving, we were ushered into the ER and we went through the normal registration and shown back to our little cubicle. Gracie endured 2 more pokes and then finally they were able to place an IV. They took another culture and hooked her up to the antibiotics while we waited for them to get us a room ready on the Oncology/Transplant floor. We finally made it our room at about 4 am and Jimmy got us settled in before heading back home in time to get maybe an hour of sleep before having to head to work. Gracie was restless and scared... and very annoyed to have the IV in her hand so it took some work to get her to sleep. We finally crashed about 6... although we were constantly disturbed by the many people coming in and out to check on this, or hook up that... etc. It was not fun for anyone, especially poor Gracie.

Stay tuned as the story unfolds in a future installment.