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Tuesday, July 20, 2010

Discharge Day...

Wednesday, July 13th: We're getting the hell outta here!

Niki got her blood transfusion a little late -- 12:20am to be exact. Once the transfusion started, the nurse stayed with us for the first 15-30 minutes to watch for signs of Niki having an allergic reaction to the blood. After that time period, the nurse asked us to try our best to monitor Niki throughout the course of the infusion to make sure she stayed reaction-free. John and I were exhausted, but we tried our best to stay awake. The good news is she didn't have a reaction to the blood they used. And I'm thankful to whomever her donor was. This whole experience makes me want to coordinate another blood drive. :)

Please excuse the "yellow pictures" we took these shots in the dark.

Unfortunately, it took a while for the blood bank to find an exact "marker match" for Niki's B+ blood. She had to get her infusion before she was due for her next factor dose. This meant that her next factor dose was going to be pushed back because it would take four hours for the transfusion to finish. So, the nurse ended up giving Niki's factor dose a little after 4am once the blood transfusion was done. I honestly thought this meant that Niki wouldn't be discharged on time (maybe a day late) since her 36-hour factor regimen was now off schedule. didn't.  The doctors decided that it would be okay to give her final dose of factor at the regular scheduled time -- 8am. It was a little too early for my taste, but the Resident reassured me that Hematology cleared it. At least it meant that we could go home!

As for the weekend, the plan was to keep Niki's port accessed so I could administer her factor doses. (You can leave a needle in for about a week.)

Discharge was a breeze once morning rounds were completed. The Resident discussed Niki's plan with John and I, the nurse went over the paper work, and Niki was set to be released at 9:30. it turned out there was yet another silly delay. The Resident forgot to put the "discharge to home" order in the computer so even though we all knew Niki was supposed to go home (well to Dr. Awesome's office first, then home), the nurse couldn't legally let us leave until the Resident entered the order.

Yep, yet another "computer issue".

Unfortunately, the Resident wasn't answering any of the pages the nurse sent. So, after waiting around for hours, the nurse was finally able to get in touch of the Resident during multi-disciplinary rounds. And the order was finally placed in the computer. The good news is Niki didn't seem to notice because she was too busy playing Nurse K (the former hemophilia nurse I wrote about). We finally left the hospital at around 12:00.

Niki's nurses and doctors were awesome, but it felt really good to get the hell out of there.

After we left the hospital, we stopped by Dr. Awesome's office to meet with Nurse Richard. He gave John and I a mini educational session in order to prepare for Friday's dummy teaching on "Chester". (More on "him" later.) John was leaving for Vegas on Thursday, July 15th so he was going to miss the first teaching. The purpose of the visit was really to give us both a joint "crash course" before the first official training commenced. Nurse Richard also helped smooth out the confusion regarding the correct Heparin dose for Niki's port, topical anesthetics LMX vs. EMLA (she should have gotten EMLA, but she was discharged with LMX instead), and why Niki had Ferrous Sulfate supplements included her bag of discharge medications. The Attending MD told us that Niki had anemia before the transfusion, but no one explained to us that the infusion wouldn't be enough to correct it. I know what iron supplements are used for, but I was a little surprised that no one went over this very important information before Niki was discharged. Nurse Richard was just as surprised that no one told us about the supplements or her official diagnosis. (I swear, it's good I work in health care sometimes.) Niki's nurse is the best!

Apparently, Niki has developed microcytic anemia. Which is odd to me because even though Niki's a milk-a-holic, she still eats a very balanced diet. We even give her Pediasure for good measure. Even odder still, her hemoglobin and hematocrit were all normal just last month! So, I'm still slightly convinced that the anemia has something to do with her prolonged intake of antibiotics. Either way, Niki is on a milk restriction and she's going to be taking nasty iron drops for a while. (Here is an interesting article on bleeding disorders and anemia in case you're interested.)

After we left Dr. Awesome's office, John and I decided to take Niki to the famous Fentons Creamery to celebrate her successful surgery. The last time we (John and I) went to Fentons was to celebrate Niki's impending discharge from the NICU. We always vowed to take Niki there when she was old enough to enjoy ice cream. And what's a better day than "Discharge Day" to indulge in some deliciousness?

She made a mess of herself, but it was an absolutely perfect way to kick off the good times that we can look forward to from here on out. :)

 Turkey Bacon melt for me. Yum!
I wanted the famous Banana Special, but John said no. He knew that we wouldn't be able to finish all that ice cream so we decided on going the Banana Jr. instead. (A mini version of the Banana Special.)

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