Tuesday, August 19, 2008

Logical Consequences

I've been thinking about this for a while now. When our children make a choice, there is a logical consequence to their action. We try to use this philosophy in discipline, to help educate them to do better in the future and understand the breadth of their decision. Like most parenting methods, sometimes it works, sometimes it doesn't. But, the majority of the time it is effective.

At times, it seems they will never fully grasp the concept of personal responsibility. These moments are some of the most frustrating for me, as a parent. The times when you've brought attention to the same behavior for the fifteenth time that day and you want to run, screaming like a banshee down the street in your pajamas, leaving the neighbors to wonder what it was that drove that young mother down the street to the brink of insanity. Or, perhaps just nodding in silent agreement.

This past two weeks, this is precisely the feeling I've had regarding the healthcare providers responsible for Jack's care out of state. While his surgeon is fantastic, experienced, gentle, and truly not unlike an artist in his manipulation of the spine and careful application of the cast, the follow-up care is rudimentary, crude, and at this point has crossed the line into negligent.

I don't respond well to injury to a child - in particular, injury to MY child. A group of moms I know refer to this as being a "mama bear." We are ferociously protective of our young. So, when we first discovered the sore under his cast, I began to get angry. Every day, when he would hold his arms up to us, begging for comfort, screaming that it hurt, I grew angrier. Over time, the injury grew worse. Once we got a visual of the injury, it became apparent that this was not a pressure sore. This was not a rubbing spot, such as the ones that we deal with on his hip bones. THIS was negligent. THIS was careless. This was done by someone. Whether it was the saw creating this abrasion or the sharp edge of the fiberglass, we may never know. However, it was done while he was still outstretched. There was no way to get down under the cast for it to have happened any other way.

Today, nineteen days later, here is a nearly one inch by one quarter inch rectangular piece of skin gone from his body. The depth is enough to rest the pad of your finger beneath the surface. For nineteen days he has been in pain, at the hand of someone who did not do their job adequately. Were it an accident, had we been told about it and had it been addressed, this would be a non-issue. I cannot fathom how someone would have NOT seen this injury when he was outstretched.

The parties in question have consistently caused difficulty for Jack. He has returned to the room with unpadded edges, haphazardly taped in place. He has experienced repeated irritation from tape placed directly on his skin. He has a significant cavern in his rib cage, two inches up from the edge, due to improper placement of the mushroom cut-out. He has had two separate incidents where his abdomen was either cut or rubbed by fiberglass, leaving open wounds struggling to heal while pressed against the edge of a (necessarily) snug cast. He is in a beautifully corrective cast right now that was so poorly trimmed in the front, it presses against his esophagus when he is seated. Windows are not padded. Large pieces are missed, causing it to press deep into his bladder when he's seated. It is, to say the least, inadequate.

"Well, tell someone," right? We have. When we draw attention to the problems, they are (sometimes) fixed. We press, "He has to live in this for 8 weeks." They reply with a flippant, "I KNOW he has to live in it for EIGHT WEEKS!" Okay - then FIX IT!

The battle for proper post-cast care is ongoing. The first time we were told this we were new to the hospital. They hadn't done many of these - were still learning the ropes, they said. What is the excuse now, six months later? Four casts now and this staff cannot get it right. We are told they are over-worked. We are told they have to be in charge of the ER and the OR and the clinic and will get to us when they can. Last time we sat for hour upon hour, then had to carry him down to the clinic and sit in the waiting room. He was groggy and out of it from the anesthesia. He could not stand on his own. He was still bleeding from his IV site and inconsolable. And we had to sit in a waiting room with kids who were ready to have an arm cast removed and return to the pool, happily playing, while our boy was miserable. Somehow, when they don't do their job right the first time, we are the ones who pay the price. There is no logical consequence. There is no lesson that is learned. And, I am running down the street in my mind right now, at wits end. I don't know what the end result will be. I don't know if anything will change. I am ever so slightly afraid to rock the boat and compromise his care. We clearly aren't in there when they're doing this and I don't know that I can trust them to perform this task again. I've contemplated telling them to just let us do the padding, but that would leave him with raw edges and an unpadded cast - subject to injury from fiberglass - for at least an hour. And, we don't have a cast saw in the room. Every time this has happened in the past, we've hoped that maybe next time it will be better. It isn't. It's worse.

We are sad and miss Shriners and their amazing ortho tech. She was motherly and kind. She carefully padded every edge with perfection. She would be the perfect partner for our current surgeon. Second to her is our local Children's hospital. They were kind enough to fit us in yesterday, for an emergency repair (third total repair in the same cast, three facilities). With precision they trimmed the area, re-padded and re-taped, and for the first time in nineteen days our boy had a bit of comfort - or perhaps just hope. This time he didn't even cry when they started the saw (usually an invitation for hysterics). We explained to him over and over that we promised we were going to make his side all better. I think, for the first time in weeks, he had hope that it was almost over. So, even though it was still raw and bleeding, he smiled and whispered his little, "Thank you," to the tech.

We are reaching the end of our ability to cope. The trauma of him being taken from our arms is excruciating - for us and him. While he does have the Versed, which is supposed to be a sedative and amnesiac, it doesn't work completely. For nearly two weeks he screams in his sleep. He will reach his arms out at night, pleading, "Hold you, Daddy. Hold you!" When they take him back, he is in hysterics and it never fails that another nurse has to come and hold our thrashing boy. Perhaps his memory is foggy, but it is there - embedded in his mind that Daddy left him time and time again. When John is home, he has to hold him and walk around. The psychological trauma is compounding and it is having a lasting effect on the way he interacts with adults. Recently, a therapist brought to light for us that it has also influenced his interaction with children now.

But, once again, I ask the question, "What choice do we have?"

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