Another call from the school

It was 1.30pm, Weds, March 23rd, 2011. I was having a nap, thus is the luxury of being a housewife and domestic goddess, we need our beauty sleep you know!  I haven't been sleeping very well since the kids went back to school after a lovely week off for March break.  I had been to school earlier that morning, I go in Wednesday mornings to help sort the fruit for the healthy snack for school. It was plums today, and they all needed washing, all 500+ of them.  Sue and Zohra were drafted in as well to help, and a student on work placement helped us too. The job was done at just after 9 and the three of us then went to the library to help Mrs P, with the auditing of the AV equipment for school. It's amazing how many overhead projectors the school has! We worked through all the projectors that had been sent down to the library for audit. I question the need for this piece of antique equipment which must have been such a useful tool in years gone by and in it's hey day, lol. I remember learning how to use them the first time, in nursing college, that was more than 20 years ago. Seemed high tech then but today, it's almost archaic and basic low tech compared to the smart boards that most classes have now.

Back to the phone call, it was T, the school secretary, it was a call about Mitch.  My heart sank slightly. We've had 2 phone calls from school about Mitch in the past, and both times, Mitch had been involved in something that required his parents to be informed.  This time round, Mitch was unwell. He'd banged his head, was not feeling well, and they were going to call and ambulance for him. Heart now in mouth. They wanted me to come in.  They know that I don't have a car at the moment and was prepared to get the headmaster to come and get me. I said I would ask Sue to give me a lift in if she was free.

We get to school and the 1st response paramedic's SUV was parked outside. I get through the front doors and was greeted by the Vice Principal, she had a worried and slightly panicked look on her face. She gave me a quick summary of what had happened, I could see down the corridor, where Mitch was sat on the floor, leaning against the wall and a paramedic attending to him.He looked drained, I called out to him, he acknowledged my arrival in a quiet fashion. I asked him if he was ok, he said yes. Mrs P was there, Mrs McT( Mitch's home room teacher) and Mrs B, who was the first aider for the school. The paramedic had chest leads on Mitch, taking a clinical history at the same time as doing the vital signs, though he did not take his temperature.  All his vital signs were within normal limits. Blood sugar was done it was 6.6 mmols- fine. Mitch said he had eaten lunch. He also said his head was fine, did not hurt, and though still slightly nauseated, he had not vomited.

We all tried to get Mitch to tell us what happened, but he was slightly vague, said something about feeling very cold,  then feeling nauseated and dizzy, feeling the need to get indoors as the bell had signalled the end of break.  As he walked through the doors he fainted and hit his head on the door frame on his way down. He was out for several seconds.  I was told by the Vice Principal that Mitch had been feeling unwell whilst outside during the lunch break and had been seen to be sat on the snowy ground with a couple of girls beside him and then fainting and banging his head as the slid down to the ground. It was a cold day, at least -6C and it was snowing. Mitch unfortunately did not have his puffer jacket on, he just had a t-shirt and a hoodie on, no gloves or hat, clearly inappropriate clothing for an outdoor recess!  I touched Mitch's hand. I wanted to hug him really, but he was wired up.  He felt very cold. He had some blankets around him, but I could see he was trying hard not to shiver. I was trying hard not to panic myself and appear calm, I wasn't hysterical or anything, but I was worried about him. As a mother it was difficult to see my normally active and healthy son on the floor all wired up, looking drained of all colour and not responding normally. Then as a health professional wondering what was the cause of the 2 faints, for a normally healthy boy. Low blood sugar had been ruled out and therefore when the paramedic suggested that he be checked out at the hospital, even though Mitch did not want to go, I relented, wanting to be reassured that he was really ok.

So, Mitch had his first ride to a hospital in an ambulance on a patient's trolley, all wired up.  It's all computerised in the ambulance, no writing at all, the attending paramedic used a laptop attached to a mobile worktable to input all details. Apparently, they can transmit all ECG readings directly to a cardiologist if needed for consultation as they are attending to the patients. The ambulance has WiFi! This facility has been helpful as they are currently doing a trial for people experiencing MIs( Heart attacks), in order to know what drugs to administer according to the ECGs transmitted. One group is given tocolytics and clopidogrel and the other are given anticoagulants like heparin and enoxiparin.  Interesting, I think. I also think about my forthcoming start of work at McDonalds, and wonder if I am doing the right thing. LOL.

The ride to the hospital did not take long, even though the weather conditions were not great, snow covered roads normally follow a snowstorm,  the ploughs and gritters were out but it usually takes a few hours for them to take effect.  We belted up and arrived safely. Mitch was wheeled into ED, waited in a corridor, the triage nurse had handover from the paramedics. Mitch's temp was finally taken, it was 36.5C. Mitch's condition had improved during the ride, he was more communicative and warmed up a little. He got transferred to a wheelchair, we were told to get registered and following that, we would be seen in the ambulatory clinic, which would get us seen to quicker than if we were seen in the proper ED.

We got registered, then got told to get to the red zone, put his case notes in a box , sit on the blue chairs and wait to be seen by a Doctor.  A bit like the walk-in- centre with Doctors. After a while, Mitch got called and was taken to have an ECG done, by a nurse, who did not smile as she greeted us, nor told us her name. She did explain what she was about to do to Mitch.  Communication was lacking and she really did not converse with us at all. No interest in us whatsoever. All this time waiting and watching, had me thinking about the baccalaureate table I was supposed to be completing for the College of Nurses of Ontario to see if I could sit their nurses exam and then be granted a license to practice as a nurse. None of the nurses that dealt with us showed any of the competencies that I have had to read about that first entry level nurses have to have. I am not going to bore you with what these all are, there are nearly 100 competencies us nurses are meant to have. If you are a nurse in the UK, it's a bit like the scope of practice and codes of conduct.

As time passed, I knew Mitch was ok, all investigations were coming back normal so far but I was concerned if there are any underlying reasons for his faints. I racked my brain dead brain cells, thinking back to all that I was taught in my masters, and all my years of working in primary care, ED and in hospital. No bloods were taken. He was eventually seen by a doctor, and after a brief examination, we were referred to the Paediatricians. The hospital we were in did not have a separate Paeds ED. While we were waiting, Dave arrived, having left work about 2 hours ago, when I called him to tell him what had happened. We waited and waited. No one came to see if we were ok, no one offered us anything, not even a smile.

Eventually, after about an hour, a Paediatrician and a medical student came to see him. The Med student took history and examined Mitch, it was during the eye movement examination that I noticed that Mitchell had nystagmus on both eyes. I mentioned this to the student, who agreed with me.  Finally, the paediatrician returned, requested a urine sample, and sent us home to be followed up by our family doctor. We were all baffled as to why it had happened, and as a precaution, Mitch was to have investigations done by the GP and then to be referred back as needed. I am sure nothing is going to show, so why subject him to blood work?  I guess it's better to know for sure than to just rely on your own knowledge and instincts? Have I moved over to the realm of investigation for the sake of investigation, that the availability of tests are there, so get them done? Of course not, it's just not normal for 12 year olds to faint because of the cold. He was not hypotensive, hypothermic or hypoglycaemic, so why?
Mitch has an appointment with the GP at 10.10 am tomorrow..... watch this space for further news....

By the time we left the hospital, Mitch was almost back to normal. He was requesting we take him to school to get his school bag as he had a test the next day... we told him not to worry about that, that his teachers would understand but Mitch was adamant that he needed his books. Sue had had Jasmine after school for us and also cooked some dinner for us, which was so kind. We picked up his bag from school, which was open as the school gym gets rented out to several activities after school hours, and went to Sue and William's to get Jasmine and have some food.

4.5 hours in ED, not bad. Sue thought we'd been quick. I have not written anything about the red zone and there is a lot that I could write about, like how it was quite a weird set up, there were several patients hooked up to IV's and sitting and waiting in uncomfortable chairs in and uncomfortable environment. I wondered if I was in some kind of day case/walk-in/ minor illness place.  Privacy was lacking. I knew which patient was 14 weeks pregnant, with a retroverted uterus, and urinary retention, which patient had kidney stones, which patient had to have a full bladder to have a scan. Several patients had been there so long, looking unwell, tired, they were slumped over in those uncomfortable seats asleep. There were several that could have done with lying down. Most were waiting to be discharged.... priority to me, in that most uncomfortable place! There were not enough seats for everyone at times, and some of us had to stand whilst we waited.  The Canadians are such patient people, they waited and waited, no hospital staff approached us to tell us what was happening, but they all still just waited for their name to be called.  When Dave arrived at the red zone and asked reception where we were, he was told to look around for us as he didn't know who was in the department!!! Hahahahahaha or cry I say. Not going to carry on, health care is free and covers much up to a point, mustn't moan or groan. My son got seen, I should be grateful, and I am. Would I nurse in Canada?? Show them how it's supposed to be done??? Should I? Could I? Or would I be tearing my hair out? McDonald's first and then we'll see.

Oh, one last thing, in the cubicles all had couches with paper roll covering them, but no one cleaned them in between patients. The 1st cubicle Mitch was in also had a kidney dish with about 0.5cm of blood in it! Charming, lovely, and wow! I wonder when MRSA is going to hit here.