Tuesday, November 25, 2014

Briella's cleft surgery

Last Friday, Briella had her cleft surgery. I was hoping that this surgery could be performed in Australia shortly after our move, but when we knew it could take several months to organise, and when our doctors here were prepared to do the surgery before our move, we decided it was in her best interests to have the surgery done sooner rather than later. Knowing this would mean one (hopefully) last hospitalisation in the public system here in Hong Kong, I was a bit apprehensive but hopefully - for some areas of Briella's care, I've found that (slow) progress has been made in the system since a few years ago. The public system one last time did not fail to disappoint us and as a result, will (actually for the first time) be receiving a formal complaint from us. This is a summary of the last week or so. 

Last Thursday, we were admitted bright and early for Briella's pre-op checks.  The ward has been recently renovated and was more spacious than a few years ago with a decent cupboard for each bed rather than the tiny lockers they used to have. They still only have plastic chairs however, with no bedding provided for parents who are required to stay the night. They also don't have enough curtains for each bed, as it is "against policy" for the curtains to be closed except for if a procedure is being done.

On the cards for the day we needed to have an ear/hearing assessment with the ENT to decide whether or not she needed grommets (ear tubes), then just a quick check with both the surgeon and the anesthetist. The hearing tests were surprisingly good - a few months ago, Briella had fluid in each ear and hearing loss as a result. On Thursday, however, there was no fluid! As a result, when we had the surgery, they did not insert grommets. On one hand, I was thinking maybe they should just as a precaution - but after the cleft repair, the ears should theoretically drain easier - so there was no need adding an unnecessary procedure. 

After a quick check by the surgeon and anesthetist, we were free to go home for the night. Unlike Maddy, they were happy to not draw blood from Briella before the surgery - which I was thankful for as my girls have difficult veins and I didn't see the point in inflicting any unnecessary trauma! Also unlike Maddy, Briella ended up being the last surgery of the day rather than the first (estimated around 1pm). At first, I was concerned about it, but in some ways it ended up being a good thing.

On Friday morning, we were able to feed Briella her breakfast and then one last drink of milk - then she was allowed clear fluids (including apple juice) until 11am. She was actually surprisingly content until 1pm which is when the surgery was meant to begin - so if it had've been on time it would have been a really easy morning! Unfortunately however, they weren't ready for her until closer to 2:30pm and after close to an hour and a half of crying and screaming, Briella had completely crashed.

As Briella was sleeping when they were ready for surgery, I just dropped her off and left - unlike Maddy who I stayed with as they gave her the gas to put her to sleep. I told the anesthetist that we wanted to be there when she woke up and they said ok, and asked us to wait outside in about an hour or so. The surgery was expected to take between 2-3 hours. 

Bernard and I wandered for an hour before going back to wait outside the operating theatre. There is no "waiting room" for parents or carers, only chairs in a busy corridor. We were waiting and waiting, and then at around 5:15 (2 hrs and 45 minutes after I'd dropped off Briella) the surgeon came out. He advised us that the surgery was a success. I asked if we could go and see Briella and he said they were going to be moving her to recovery shortly and they would contact us then, we should just continue to wait where we were. 

This is where it all started to fall apart - it was taking ages and ages, so we were worrying that maybe something was going wrong or taking longer than they expected. Finally, 45 minutes later (around 6pm), we decided we should press the intercom button to ask after her. 

When the ward manager answered the door, we asked him where Briella was. He said "I don't know, she's not here, no one is left on this floor. Maybe they moved her to recovery on the third floor. We have lifts inside so don't need to come out, that's why you didn't see her". For Bernard, that wasn't good enough and he insisted that the ward manager found out exactly where she was and when we could see her. He made a few calls and finally let us know "They already woke her up and moved her to PICU. She's in PICU now". 

We were both very angry and upset. First of all, they had told us we could be there in recovery when she woke up. Not only had they not followed through with this, but they then moved her to PICU without informing us about ANYTHING. Bernard right there and then decided he was going to file a formal complaint so he stayed trying to get names of people involved and why this situation happened. I just wanted to be with Briella so I left to run up to PICU - which is in a completely different building to the operating theatres. 

When Bernard was talking to the ward manager, the ward manager ended up calling the surgeon on his phone and letting Bernard talk to the surgeon directly. The surgeon said he was surprised we were not notified, that this was an isolated incident and that it goes against normal protocols. He also later told us that the reason we were not informed was that their primary concern was getting Briella into PICU as soon as possible so her breathing could be monitored there. 

When I finally arrived at PICU (around 6:15), they would not let me in as they were in the middle of taking blood from Briella. I told them I wanted to be there for it but they would not allow me in until the procedure was over. I was allowed in around 6:30 (she'd probably been awake for an hour or so by that stage) and as soon as Briella saw me, her little face crumpled up and she started sobbing. She had done so much sobbing that day that she didn't even have a voice left. It was one of the most pitiful things I've ever seen...

The whole time in PICU felt like one big fight. They weren't going to let me hold Briella and I told them "she's my daughter, if I want to hold her, I will hold her. I was allowed to hold her sister in the recovery room after her cleft surgery - I don't see why I shouldn't be allowed to hold Briella in PICU now - particularly if she is crying and needs comfort!" I had words with so many of the nurses there - none who were apologetic for their lack of communication and disregard for our wishes - even though they did acknowledge that we should have been informed rather than having to hunt down our daughter. The visiting hours in the PICU are the same as in the NICU - only 12-1pm and 3-8pm. So when Briella fell asleep just before 8pm, we went home for the evening. 

I only told a few people about what happened to us after the surgery - I was so upset about the whole situation that I just didn't want to "go there" again. One of the people I told was a mother of a little boy with special needs, and so much for our situation being an isolated incident, almost the exact same thing happened with her only a few months ago, when her then 7 week old had surgery. It makes me so angry that we are not the only people to have had this experience, and if I know another person with a similar experience there, how many more people has this happened to?  It also makes me mad that all the staff we talked to about it seemed to say it was rare for that to happen. Is it just coincidence that I know possibly the one other person who had the same "isolated incident" as us?

The next morning, there was no way I was going to go until noon without seeing Briella. I just don't think that is healthy for a young child to be isolated after a surgery which is in and of itself, a traumatic experience. They need to have family around, a familiar face, someone who will care if they are sad or need a hug - and from what I've seen of NICU and PICU, it is not the nurses' job to make the kids feel happy, safe and secure. Nurses can never do all that for each child in the hospital. 

Bernard called the hospital around 8:30 on Saturday morning and found out that Briella was stable over night and would probably be transferred to the surgical ward around 2pm. They also reminded him on the phone that we would not be allowed in until noon. That did not stop me from going up to the hospital around 9:30. 

At the PICU, I rang the bell and told them that I felt Briella needed to be with family more than she needed to be there - particularly as we knew she was stable and would be leaving PICU that day anyway. I told them "I will be with her one way or another, either you can let me in, you can transfer her to the surgical ward now, or I will discharge her against medical advice". It again turned into a big conversation with a doctor there in which I accused them of not having the patients' best interests in heart, only caring about their physical needs and not their emotional needs, and placing the convenience of their staff above the needs of the patients. I also told her that I didn't care about their policies, I only cared about the needs of my daughter - and that their policies were wrong and wouldn't be accepted in any other first world country. I also told her that I knew the staff yesterday lied to me when they said that our situation was an isolated incident - and if they would lie to me, how could I trust them with caring for my daughter? It did feel good to get all that off my chest! 

As it was doctors rounds right then, they would not let me in but another very kind nurse told me that Briella was sleeping and calm. She also told me that they would let me in if she was crying at all. With two hours still until visiting hours, I didn't really know what to expect but I did plan to make a nuisance of myself in the mean time! After only about 30 minutes, they invited me in and then transferred her by 11am to the surgical ward.

The surgical ward was not comfortable but it was much better than PICU as someone must be with the child 24 hours a day. After our experience with Maddy, we found that I coped better with the day times and Bernard coped better with the night times so we planned that I would be there for most of Saturday and Bernard would take over in the evening. I found surgical ward to be not too bad - although it's not comfortable and it's impossible to rest there. Even Briella wasn't sleeping well and she was soooo sad looking! We were able to start feeding her fluids and as I knew her discharge would be based on when she was able to drink a certain amount, I made it my main goal to feed her as much as I could. It's not easy as she's not used to drinking without a bottle (although we did start to practice with her a few weeks ago) - and her mouth is hurting too, and she's just generally miserable so not terribly hungry. 

Bernard said the night was rough and uncomfortable and the nurses kept waking Briella up for various though. Neither of them got a lot of rest. I wanted to be at the hospital early on Sunday morning to beg the doctor for home leave (or even mention discharge against medical advice again). When I was on my way up, Briella's IV started to have problems so they took her into a treatment room, kicked Bernard out and got to work attempting to save it. A little while later, they handed her back to Bernard with vomit all over her, drenched with sweat and with a nappy that looked like she'd lost bowel control :( When I think of how much fluids she lost attempting to save an IV that was giving her 20mL of liquid an hour, it makes me mad! By that stage, she was borderline in her fluid intake and I understand them wanting to save the line, but it was removed completely only 7 hours later (140mL later) and the experience probably cost her more fluid than that! Makes me mad... 

The doctor came around not long after I was up there and he initially said that Briella wouldn't be discharged that day - she wasn't taking enough fluid. I asked him for home leave, just for the night, so that we would be able to actually rest. He in turn told me if I could get her to drink 500mL by 6pm, that we could be actually discharged that day! So the race was on...

After the trauma of the IV, Briella wasn't exactly up for drinking anything at all so the morning was pretty tough. By noon, I was thinking we might not make it and we'd need to spend another night in the ward - but in the afternoon we got on a roll and finally got down to needing to get her to drink 50mL in 30 min and we just made it! So we fed like crazy and made it, so were discharged on Sunday evening and have been recovering at home. 

The past couple of days at home have not been terribly easy - Briella is still uncomfortable and is still not feeding great. On top of that, she's pretty congested - some from the surgery and some I think from a little cold that's going around. She's waking a lot more at night and sleeping restlessly - but every day is a step forward. We still don't have our tickets back to Australia yet as the surgeon wants us to wait until the one week check up on Friday before saying when she is fit to fly. We are so glad to have this surgery over and done with and to be on the road to recovery now, and the road to being in Australia and hopefully on to a medical system which doesn't give us as much heartache as the one here!

Thursday, November 13, 2014

Working towards cleft surgery

Last week on Monday, I took Briella up to the hospital for her pre-op consultation with the anesthetist. Because Briella (and Maddy) are higher risk for anesthesia, there is only one anesthetist in the whole of Hong Kong Island that they would allow to do the surgery. She is great - we've had her since Maddy was born, first met her in the NICU when Maddy was tiny. I trust her and honestly, anesthetists are in many ways the most important people in surgery when it comes to rare kids or kids with difficult airways! The only problem is that this doctor does not do outpatient clinics, so to consult with her, we need to be admitted to the hospital and wait for us to fit us in.

It must have been a busy day for her - we were admitted before 9am, and didn't see anyone for the entire day. At least now, I am prepared for that so we took lots of food and lots of things to do (the hospital doesn't feed the parents so we are on our own!) I did start to get worried when it was getting close to 5pm, so I went back to read what this stage was like with Maddy (I re-read these three posts in particular - first, second, third). Maybe that was a mistake because that was an awful experience!

It was just 5pm and immediately after reading the above posts that a nurse came to talk to me. Mind you, this is after 8 hours at the hospital, in which time we saw no doctor at all. She said "I'm sorry but I'm not sure if the doctor will be coming around tonight. Would you like to take home leave and come back at 9am tomorrow?" I told her "I would NOT like to do that, I have already been here for 8 hours and have not even seen one doctor. My time is valuable as well and I cannot just give up days without even being able to see a doctor at all. I am extremely busy this week and I will need to see the doctor today." I think before, when Maddy was born, I wouldn't have been assertive enough to say that - I would just get upset and angry. Now I am more able to firmly but politely say what I need to say. After about 15 minutes, the nurse came back to me and said "Ok the doctor will come tonight, but I don't know how late it will be". Even staying until late at night seemed preferable than coming back for another full day so I was happy with that. 

A while later, our surgeon came around. I'd seen him recently so he didn't really check Briella out much. He did let me know that they would be trying to book November 21st for her surgery date, but it would be subject to availability. 

It was about 6:30 when the anesthetist showed up. She looked Briella over and gave us the green light. Briella's airways are stable (but still small), her oxygen levels are good, and the MRI of her spine showed no complications for surgery. So with that green light, all that was left was to wait for the call from the hospital.

When I hadn't heard back yesterday (9 days before the potential surgery), I decided to email the doctor. He'd put in all the requests but hadn't heard back yet. With our move coming up quickly, so much is revolving around getting this surgery done. 

As we are renting, we needed to give our landlord 2 months notice - so we already need to vacate our apartment by Christmas eve. The movers are coming on the 20th to pack up all our stuff. We still don't know if we will have Christmas in Hong Kong or Australia, as the surgeon has said we shouldn't travel for around 4 weeks after surgery.

Today the surgeon got back to me and he was able to book the surgery for the 21st, so in 8 days, Briella will be having her cleft repair. I'm not expecting it to be easy or fun - she will have some time afterwards in the PICU which is right across the hall from the NICU and that always brings up bad memories. While she is there, we will have to abide by their ridiculous visiting hours and policies. Hopefully she has no complications and is only there for a minimal amount of time. After that, she will be sent to the pediatric surgical ward for a few days. That also was quite rough with Maddy. Unlike PICU, parents are not only allowed - but they are expected to be there 24/7. Parents are the ones who will do all the care and feeding for their child. That would be fine if parents were catered for, but they are not. There is minimal space and only a plastic chair to sit or sleep on. No blankets or pillows. It's not easy to look after a child recovering from surgery when we are not able to look after ourselves! In addition, after the surgery, Briella will not be able to have a bottle any more. She currently almost always will fall asleep with a feed, and while she's getting better at cup feeding (we practice every day), she's not really ready to give up the bottle completely.

All that said, I do think it's in Briella's best interests to have the surgery now. If we waited to do it in Australia, it could be months later - and the later the surgery is, the more likely it is to have negative impact on her speech.

My mum will be coming next Wednesday to be around for a week and a half while we are in the hospital. Please keep us in your thoughts and prayers over this time. I will continue to update as we go through this :)

(And since I haven't added any pics lately, here are some random pictures from September)