Archive for February, 2011

And now, a short break

No pun intended.

Gabriel didn’t sleep much at all the first night home.  He doesn’t sleep on his back, and he’s been sleeping in a crib for the last two years, so now that he’s downstairs on the couch and sleeping spreadeagled on his back, it’s not particularly conducive to rest.  Someone has to be there for him, which at night usually means Jeanette or myself.  Since Gabriel didn’t sleep, neither did we.  Well, okay, one of us didn’t.  One of us slept down on the couch with Gabriel, or on the Luv Sac that Kevin and Dianna Field brought us, God bless them and their posterity forever, and the other got to sleep in bed.

Mostly, Jeanette takes the night shift, because she’s tougher than I am.  She says it’s because I work all day, and she can take a nap, and this is a great attempt at spinning the situation, but we both know she’s full of it.  She’s not going to take any nap.  My work is mostly sedentary.  I’m actually the guy that should be taking the hard shift at night, but I can’t do it.  She can get 4 or 5 hours of often-interrupted sleep and still be fresh and productive the next day.  Me?  No.  Not so much.

So Jeanette didn’t sleep much the first couple days, then I spelled her and that night Gabriel slept 4 hours straight for the first time.  Karma, that’s what it is.

Mundanities.  Gabriel was on heavy Lortab for the first couple of days, and he hated it intensely.  It tastes so bitter that you can’t hide it in juice or milk, so he has to take it straight. The only way to get him to do that is for one person to hold him down, pinning his arms and squeezing his mouth open, and the other person squirts the stuff in his mouth and blows on his face, which causes and involuntary swallow.  And then he screams.  And then you can let him go.  It’s fun for the whole family.  We ‘ve gotten good at it, but the first couple times, dang, that was one sticky mess for nothing.

After the first couple days, though, somewhat out of fatigue, we stopped giving him Lortab and just gave him periodic doses of Motrin and Tylenol – DO NOT GIVE LORTAB AND TYLENOL TOGETHER (Lortab contains acetaminophen already) – because those tasted okay and could be hidden in juice.  After four days, we stopped that, even, and for the last three days he’s been drug free, except last night, when he wouldn’t settle down at night so we Lortabbed him again.  Today, so far, he’s been great.

He can’t move around, so toys have to be brought to him.  He throws them, then cannot reach them.  Anyone have solutions to this?  Or is this just one of those things we have to deal with?  We haven’t really got a lot of stationary toys.

He doesn’t eat.  As in, he eats, but about half to a third of what he used to.  Now I know he’s not expending a lot of energy, so that doesn’t worry us a lot, but I thought I’d mention it.  He’ll eat candy and fruit, but not a lot of protein, and he drinks a lot.  Which means, drumroll, that he pees.

The first couple of days, he didn’t poop.  They told us this probably would happen because of the narcotics they gave him in the hospital.  Then when he did, it hurt him.  Be aware of that, those of you that are going to go through this.  He still peed, though, and that’s a serious problem.  He’s got a squarish hole in his fiberglass pants that allows a diaper to be affixed to him.  I say “afffixed”, because the diaper next his skin is a size 1 crammed up into the hole to try to stop the pee from getting onto the padding of the cast.  Then you wrap the whole thing up in a size six, which is too big ordinarily for Gwen, our nine year old.

But you can’t cover everything.  It’s now been one week since he got the cast, and it stinks to high Heaven.  I mean, it smells so bad that you can’t tell if he’s messed his diaper just by smelling.  There is no way to wash the cast.  Baking soda is our first attempt at stench control, and it’s not had much effect.  We’ll try lemon oil tonight, but please, if you have suggestions, we’d love to hear them.

The rest of him smells, too.  We can’t wash him.  Moving him a lot hurts, so we try not to do it, except to pick him up every couple of days to change his shirt and clean all the crumbs out from under his spot.  We’ll pretty soon have to washcloth him over all the area we can get to, but that’s not very much, and I fear what will have happened is that a full four-course meal will have gone down the top of his cast, which is belled outward to give his torso some movement capability.  In a couple weeks, I bet we can hang him by the bar between his knees and let some of that stuff fall out, but he’s still tender, so that’s not an option now.

But people, he’s doing really well.  he plays with us, and we are having a great time inventing games to keep him occupied.  Jeanette played hide and seek with him the other day.  Gabriel would put J’s cell phone up to his eyes to cover them, then count one, two, thirteen, sixteen…ready!  Jeanette puts a couch cushion up between them, and Gabriel pulls that down and yells “found you!”  So if you can play hide-and-seek while lying in one spot on your back, then life is pretty good.

We can’t do much around the house, so we’re grateful for meals and vacuums and friends and all the rest.  And Thursday, Nicholas took the first shift, and Jeanette and I slept in the same bed for the first time in a week.  Small blessings, gratefully received.

The madness continues. And intensifies.

I write a lot of fiction.  It’s fun.  But fiction, as the adage goes, has the disadvantage of having to be realistic.  Reality has no such constraint.

We talked with the American Fork Hospital billing people a couple of times this week.  And honestly, you can’t make this stuff up.

They called us Tuesday, wanting to talk to us about payment arrangements.  We were expecting their call.  They asked us the usual questions about how much we could pay every month (we don’t know) and whether we were going to apply for Medicaid (we are not), etc.  We told them we were going to be paying for everything ourselves.

That pleased them.  The gal said “you get a 25% discount for paying in cash.  You also get a 15% discount for paying within five days.”  That pleased us.  We asked, “so, is that 5 days from the day we get the final bill, or five days from Friday?”

“That’s five days from Friday.”

Now, get this, people.  We checked in on Friday after 11pm.  We count that hour as a day, apparently.  Then we have Saturday, Sunday, and Monday was a holiday.  This was Tuesday.  It was five days right that minute.

“So we have to pay you today?” we asked.

“Well, <reluctantly> I guess I could let you have until Friday.”

“What’s the final bill?”

“I don’t know.  It’s still being prepared.”

“So even if I wanted to pay you today, I couldn’t.  When will you have the bill ready?”

“Probably by Friday.  Maybe not, but probably.  Definitely not before then.”

And Jeanette laughed into the phone.  This didn’t faze whoever this was.  Apparently patent absurdity is so normal that they can’t even hear it any more.  We asked them what happens if the bill isn’t ready by Friday.  Did we lose our discount?

VERY reluctantly, they said, “I guess I could extend it to Monday.”

“So, if you don’t have the bill on Friday, you can extend the time to pay until Monday?”

“Yeah.  I guess I could do that.”  As if she were granting us a great favor.

Now, at this point I should have said “No, no.  I don’t want any favors.  I’ll pay you Friday.  I’ll make a number up, and put it on a check, and deliver it to you, and you can give me my discount.  If it’s not enough, I guess that will teach you to get you bill together faster, or develop a billing procedure that makes some sort of rational sense.”  But I didn’t.  Alas.

So here’s where we are.  They’ll knock 25% of our bill off even if we have to pay in three installments over the next couple of months, interest-free.  They will also take monthly payments, but in that case they’ll add 8% annual simple interest.  And it will take them more than a week to get their bill together.

This is not because everything is billed separately.  The radiologist will bill us separately for the x-rays (2 thereof).  The ambulance will bill us separately.  THE ER DOCTOR will bill us separately.  The hospital cannot, in under a week, figure out what to bill for inserting a line and administering saline and morphine, and splinting Gabriel’s leg.

People have asked me why I’m taking so much time blogging about all this.  Well, this is the reason.  I think most people haven’t the vaguest clue how completely cocked up the entire medical system is, and I’m not, in the main, talking about the medical part, which is complicated but that’s because bodies are.  The billing part is far, far more screwed up than any other piece of the system, and it is on this that I’ll focus more attention as we go along here.

They see several hundred people a month in the ER.  Yet they cannot produce a bill in less than a week for a procedure they perform HUNDREDS OF TIMES A YEAR , even if we take out all the other moving parts.  This is roughly like a restaurant taking a week and a half to send you a bill for a hamburger, even if they don’t have to bill you for taking up table space, for the waitress, or for drinks and fries.

It’s not stupid.  It’s worse than that.  It’s evil.

I was, in fairness, warned.  But I didn’t believe it could be as bad as people said.  And it isn’t.  It’s worse.

Have you stopped beating your children?

It’s incredibly offensive to be accused of child abuse after nineteen years as a parent with not one trip to the emergency room.  We’ve been parents now for a total of 82 child years, and we have three broken bones (this makes four) and four stitches.  Total.  We have bikes and trampolines and skateboards and ripstiks and skates and our kids play basketball and do all the stuff kids do.  They almost never get hurt.  We’re not the most careful of parents; we’re just very lucky and/or very blessed, whichever you like.

But the one thing you can’t say about our parenting is that we abuse our children.  We make them work, and do not believe in the Nintendo DS, so THEY think they’re abused, but by no possible adult definition of abuse are we committing any.

Bad news for us, then, when Gabriel’s injury happened to be consistent with having been abused.  The break, as I noted here, is not a typical one for that bone.  The break ran along the bone diagonally, not across, as would be consistent with a blow.  This break is more like what you get when you put torque on it, as in when you grab and twist, rather than strike.  Striking is what you’d expect from normal play.  The femur is a very strong bone.  It supports a lot of weight and is quite hard to fracture.  Gabriel, being 2, has fairly soft bones at this point, but even still this would have to have been something unusually violent to cause the break.

The Primary Children’s Hospital sees as much abuse as any medical facility in the world, I would think, and they are fairly attuned to it.  By “attuned”, I believe I mean, “they see every injury as potentially an abusive situation”.  And on its face, I don’t have any quibble with that.  I’m no more in favor of child abuse than anyone else.  On the other hand, being the father of eight children, and being the oldest of seven, I’ve seen my share of spanking, whacking, tossing, and forcibly restraining done by parents to their children.  I’ve done some.  Like many other things, how you do them is far more important than what you’re doing.

Three different nurses/doctors were involved on our abuse investigation at Primary.  The first one was apparently (I’m translating for my wife, who was the one on site) just asking questions about what happened.  As I previously mentioned, we don’t know.  This is not, perhaps, the most defensible position to be in.  It is perfectly possible to construct a negligence charge, or worse, out of what we know about the injury, because we just don’t know anything.  We weren’t, strictly speaking, there at the time.  I personally was in another city 40 miles away.  Jeanette was one room away, not looking at the incident, which she couldn’t have seen from where she was anyhow.

Note to those that aren’t parents: it is not only impossible to watch your children every second of the day, it is wildly undesirable, for you and for them.  Modern society seems to believe that an adult’s personal hedonistic fulfillment is the purpose of life, and simultaneously that every child has the right to expect constant, round-the-clock vigilance over his well-being.  The only way these two things are compatible is if there are no children at all, or if your aim is Brave New World.  Having had my share of discussions with possibly well-meaning but certainly ignorant non-parents on this subject, I can tell you that I think both of those outcomes are fervently desired by large chunks of the population.

Therefore, being a parent, I am under constant suspicion of wrongdoing.  All parents are.  We are unlicensed childcare providers.  We serve food from uninspected and unlicensed kitchens.  We drive our children around in unsafe vehicles, and again, we have no special training in child transport.  Seriously, think about it.  We are bus drivers with no CDL.  We are restaurateurs with no licensing or education.  We provide day care in overcrowded and unsafe environments that would never pass any state inspection.  If we were constantly watching OTHER people’s children in this manner, we’d be in jail.

It is a good thing that Jeanette was the one that was at Primary instead of me, because by 3 or 4 am “pleasant” was no longer an available emotional state for me.  I’d have been hauled off in handcuffs for challenging the doctor to a duel.  She asked all the usual questions about what happened, then said she’d need to do a full body scan.  She prodded and poked everywhere on Gabriel she could get her fingers, which by this point (by ANY point – Gabriel does not like to be poked) he really appreciated, as you can imagine.  Nobody found anything, because there was nothing to find.  He has a couple of bruises.  That’s about it.  Can I swear that he’s never broken anything before, and we didn’t think it was a big deal?  No.  I can’t.  I seriously doubt it, because we do pay very close attention to our children’s physical health, but I couldn’t swear to it.  Kids get hurt.  I WANT them to get hurt.  It’s part of being a real person.  If they spend all their time playing only games where no physical injury is possible, we kick them out and tell them to go ride bikes or jump on the trampoline.

They were talking about full-body x-rays and turning him over to see his back.  Jeanette flatly refused this.  The child has a broken femur, BREATHING is a chore for him because of the pain he’s in, and you want to turn him over on his back?  Which one of us is the abuser here?  Thankfully, I was in bed 35 miles away.  Jeanette is much more restrained in her response to this sort of thing.

After the first nurse left, Jeanette texted my sister “that nurse has just gone to call DCFS”.  She clearly did not believe a word Jeanette said.  By the time we got the third doctor, a Dr. Campbell, apparently they had pretty much given up the abuse idea.  Dr. Campbell not only contradicted what the first two nurses had said repeatedly, which was that this injury was very rare, but herself constructed a plausible way for it to have happened.  Maybe the staff is trained in investigative technique, so that they send in a stream of people to ask identical questions, hoping for contradictory responses.  Maybe they intentionally disbelieve everything you tell them, hoping for a giveaway reaction.  If so, they’re very good.

A word to the wise, then, for you parents in similar circumstances.  You are going to be suspected.  You are the enemy.  The child is of paramount importance (this is self-evidently stupid, but it’s the default position for our society), and you are only a caretaker that can be removed at whim.  Do not treat this lightly.  The system can and will take your children from you with little provocation.  When you go to the hospital, and you will, at some point, have to go, understand that you’re going to have to go in armored and vigilant.  Tell the truth, but volunteer no speculation.  Insist on being treated fairly and with respect (except for this one part of the experience, I doubt you’ll have any trouble with that).  If a particular investigative line threatens the health of your child, as when the nurse wanted to roll Gabriel over to look at his back, refuse politely and don’t back down.

If you are an abuser, God help you.  You’re going to get caught.  Get help before that happens.

For us, we passed through the gauntlet and survived.  This time.

Getting on the train

Okay, so we did the whole hospital thing for the first time.  It’s going to be incredibly expensive, this is certain, but it’s also going to be substantially more expensive than it has to be, because of the way the entire process works.  Once you board the train, you cannot get off without serious belligerence.  This results in a whole host of procedures and expenses that would ordinarily be optional – and often opted out of – that are instead all-but-compulsory.  Here are some examples from our recent experience:

  • We started the process at the ER in American Fork Hospital.  We knew before we got there that Gabriel’s leg was broken, or very likely broken, and would need to be casted.  We explained this to the staff there.  But even though AF Hospital CANNOT TREAT a child this young for an injury of that type, they admitted him anyway.
  • The first thing they did there was give him morphine for pain.  This they did through an IV inserted in his hand.  Once they gave him morphine, however, he was under a kind of treatment that necessitated his being transported by ambulance to the facility where he could actually be treated.  This was never explained to us until approximately the time the ambulance pulled up.  Even then, there were no options given.  He was going to be given the second-most expensive taxi ride in the universe, and there was nothing we could do about it.
  • Everything that happens, from the minute you walk in the door, costs money.  The needles are one use, and sterile, and expensive.  The line for the IV, the hanging of the bag, the bag itself, the liquid in the bag, all of this stuff is disposable, meaning that it is going to be paid for by you.  Everything they touch you with, except, I guess, the stethoscope and the gurney, you are buying.  No one explains this.  Ever.  Well, no, I take that back.  I bet they ARE going to explain it to me when the bill shows up.
  • In a restaurant, when they ask me if I want more food, I know that they’re charging me money for it if I say yes.  That’s true in the hospital, too, only they don’t ask.  They bring in juice, and that’s going on the tab.  They bring in graham crackers, and those are going on the tab, whether my son eats them or not.  These are the most expensive crackers and juice in creation.

I could go on, but this serves as an illustration.  We do not have medical insurance.  I am self-employed, in the main, and I’m going to be writing a check for everything we buy.  I explained this several times.  It made absolutely no difference to the treatment we got.  Now, in one sense, this is very egalitarian and fair.  Everyone that comes onto the car lot gets a Ferrari, no matter what, and whether he has the means to buy a Ferrari or not.

Unfortunately, what this means is that we are spending a Ferrari’s worth of care on people that don’t need it, and don’t even want it.  This is true for everyone, whether they have insurance or not.  I get to see it up close and personal, because I’m going to be counting the pennies myself, but even if you have Cadillac insurance, like my mother’s, for instance (she’s a public school teacher), the money is still being spent, only in her case it’s being spent invisibly, because someone else ends up writing the check.  Ultimately, and so, so ironically, ME, because her medical care is paid for by my income and property tax.

When I complained to my mother about the railroad job I had just gotten, she said “come on.  I’m sure the nurses and doctors aren’t sitting around thinking up ways to bankrupt people.”  And I agreed.  They aren’t.  They don’t get any benefit from doing so, and in fact I must say again that I found them almost universally kind and considerate to us, very professional, and highly skilled.  But they do a fine job of bankrupting us anyway, and they do it because they are trained to.

Like this: I asked my sister, the Primary Children’s Hospital Surgical Tech, how many meetings she’d been to discussing the costs of the procedures they used, and how to weigh the necessity of those procedures against the financial strain it would cause the patient.  She said she had never had such a meeting.  No, wait.  She LAUGHED, then said she’d never been to such a meeting.  Then I asked her how many meetings she’d been to where they explained to her in no uncertain terms that if anyone ever sued the hospital because they failed to perform a test and later a complication developed, that they’d be fired and never work in the medical field again.  And she said, “two a week.”

So the medical staff has a gigantic downside to NOT ordering tests, and no downside at all to ordering them.  What are they going to do?

This is the genesis of the railroad.  AF Hospital staff surely know that they can’t treat my son the minute he comes in the door.  But if they say that, and I take him away, and he dies, I could perhaps sue them for negligence.  So they admit him, knowing that the simple process of doing so is going to cost me $6,000 to $10,000 that I already told them I probably couldn’t pay.  Perhaps a hospital lawyer could figure out where I do and do not have grounds for a suit, but the 11pm shift nurse at admitting cannot.  She has to err on the side of covering the hospital’s butt, even if it means ramming a stick up mine.

This opens up a can of ethical worms that this post isn’t going to address.  But we’re going to get there.  Stick around.

Lessons to Learn

On Friday, at 2pm or thereabouts, my son broke his leg.

Sounds so innocuous, so simple, to say it that way.  But what a maelstrom of events was set in motion, what repercussions there are from that one accidental moment of bad fortune.

First, my son Gabriel is two.  Two and a little.  He’s a very happy, very active two-year-old with five brothers and two sisters, and he was romping about with them like he always does, chasing them around on a day off from school coming into the President’s Day holiday weekend.  I was at work, preparing for my annual Twelfth Night Charity Ball, to be held that evening.  My wife was home, baking cakes for the same event.  She was in the kitchen (that’s where you do that stuff), and heard Gabriel fall, and start screaming the “I’m hurt” scream.

If you’re a parent, you know what I’m talking about.  There are different cries for different circumstances.  There’s the “I’m tired” cry, and the “that was really frustrating” cry and the “my brother is a dork” cry, and my favorite, the “you won’t let me do that because you hate me” cry.  But then there’s the “I’m hurt” cry, and nothing brings a parent running faster than that one.

Problem with it is that for a two-year-old, there’s no discrimination about deployment of that cry.  It only comes out when they get hurt, but the level of hurt is irrelevant.  Everything  from “hangnail” to “my arm has be severed” gets about the same level of cry, so you learn to react a bit slower after a while, because it’s pretty much always a hangnail.  Clarification: FATHERS learn to react a little slower.  Mothers, in my experience, are wired to respond to all instances of that cry as if an actual emergency were occurring.

So she got there pretty fast.  Max was screaming and grabbing his knee.  Not unusual.  He didn’t seem to want to be held – also not necessarily unusual – but he settled down on the couch and started watching TV.  After a bit he fell asleep.  It was about nap time anyway.

Meanwhile the preparations for the charity event that evening went on unabated.  Kids went places, cakes got baked, Max was sleeping.  The babysitter came over a couple hours later and we went off to the ball.  From such innocent mistakes come the phrase “hindsight is 20/20.”

The event itself was disappointing, but that’s a subject for another time.  It was fun, though, and we stayed all the way to the end, being the hosts.  Eventually Jeanette left as we were cleaning up.  Half an hour later I arrived home, at about 10:30.  We were unpacking, and the babysitter was gone (no reported problems), and I heard Gabriel cry.  Not a sustained cry, more of a whimper, but to me, it was a clear signal that something was wrong.  I know this kid.  He doesn’t whimper like that.

So I went over to where he was sitting on the couch, and pulled the blanket off him, and made to pick him up, and he screamed again, a serious cry.  This was a pain cry, but that should have been over hours ago.  When I looked at his legs, I could see that the left one was swollen about double, and in a place where there was really only one possible cause.  It was the upper leg, about halfway between the knee and the hip.  I took one look at it and called Jeanette and said, “this is a broken leg.”

We have eight children.  Our kids are tough, and lucky.  In the nineteen years we have had children, we have never been to the emergency room.  Read that again.  NEVER.  Not one of our children has ever had an injury serious enough for us to visit the ER  We’ve been to InstaCare a couple of times.  Two broken arms (cracked, not broken through), one set of four stitches.  And that right there is the sum total of our entire medical experience as parents.  I’ve actually never seen a broken leg before, not in person.  But there was no question.  There’s nothing to sprain there.  The leg was busted, and I knew it.

But even if you know, you have to go to the hospital and have them do the requisite x-rays.  It was too late to go to InstaCare by this point (see “hindsight”, above), so we were forced to go to the American Fork Hospital ER.  This was a mistake, but that mistake will be explored in the next post.  It’s only moderately relevant to this account.

The hospital is not very far away, only about 10 minutes.  We took the van, because the first problem we ran into was transport.  We couldn’t possibly put him into a carseat.  He screamed even when we went over bumps.  In the end, I picked him up and held him, bracing his leg as best I could, feeling his little body tremble because of the pain.

Here we made another mistake.  My sister Allison is a surgical tech at Primary Children’s Hospital.  I knew she’d know what the story was, what we should do, but it was by now well after 11:30, and she was surely sleeping, having herself attended Twelfth Night and having spent most of the day making some fairly amazing cookies for the event.  I didn’t want to bother her.  Jeanette did call her, but the number we called turned out to be a text-only number, so nobody answered.  Ten minutes later, Allison texted back, but by then the phone was in Jeanette’s coat pocket and we didn’t see it.  Alas.

We couldn’t wait, once we were there, because it was clear that he was in a good deal of pain and we needed to see the extent of the damage to the leg.  Unfortunately, the ER staff – who were exceptionally kind and gentle – decided that they could not get a good x-ray of the leg without moving him so much that morphine was essential.  So they started a line and gave him fluids, followed by some morphine for the pain.  With that, we boarded the medical train, though we didn’t know it at the time.  That was fateful, and we’ve learned lessons since that we hope to share down the road here.

He calmed down a bit and even drifted off to sleep once the morphine kicked in, and we got the x-rays done, though of course he didn’t sleep through that.  I got to hold him for the bulk of this time, and that was a blessing for both of us.  Mom could do all the other stuff that needed to be done, and I could focus on Gabriel, which is the reverse of how things normally work at the Clan.  I fell asleep on the gurney a couple of times while we waited for the results – it was, after all, pushing 1 at this point, and when they came back, they showed exactly what we thought; he had broken the femur bone.  It was a shear break, meaning that the line of break went down along the bone at an angle, instead of straight across.  It’s an uncommon type of break, but consistent with what we thought had happened.  It’s also consistent with abuse, we discovered.  That had later consequences.

Here we got the first understanding of what the process would consist of from this point forward.  We had told the ER people that we had no insurance, and that we’d be paying for everything ourselves.  This, however, had absolutely no impact on any decision that was made, up to that point or later.  Once you board the train, you get to stay on it until the end, unless you get very belligerent.  This has obvious consequences, which I’ll explore another time, but the x-ray results discussion was the first time we understood what had happened to us.

American Fork Hospital does not treat children of that age.  They are not equipped to handle 2-year-olds.  Therefore, the child would have to be transferred to Primary Children’s Hospital in Salt Lake City.  More, because he had now been given morphine and had a line installed, he would not be permitted to go by car; he would have to be transported by ambulance.

After some rather painful consultation, Jeanette and I decided that she would go with Gabriel to Primary, and I’d go home to the other seven children and two guests, and make sure everyone was good, and get people set up for the day in the morning, and come be with her in the morning after my dress rehearsal for a play I’m doing that opened a week later.  Meanwhile, I consulted with my sister, who by now was awake and working the phones, and learned a few things.

One, she approved of the personnel that were on duty there to receive Gabriel.  She knew and liked the attending nurse. Two, we were in for a surgery, complete with an anesthesiologist.  There is no good way to set this sort of fracture, or to cast it, with the child awake.  So that meant operating room time.  She had good confidence in the surgical staff, but she was also pretty sure that the actual surgery wouldn’t take place until roughly 11 the next morning, after which there would be a few hours of observation while the child came out from under anesthesia.  This was not going to be an in-and-out.  It would take all day Saturday.

But what was there to do?  So Jeanette bundled Gabriel into the ambulance and off they went, and I went to my car and drove home alone.  We were a bit frustrated about the difficulties we were facing and the expense we were incurring, mostly because some of them could have been avoided had we known what the procedures would be.  But we didn’t.  We’ve never been to the emergency room before.  We had no idea that once we got there, we would have essentially no options about what would happen to us.

Once Jeanette reached Primary, a couple of things happened.  First, we already knew who the attending nurse would be, and that was great, because she was everything that Allison said she would be.  But second was the other nurse(s), whose job it was to accuse Jeanette of child abuse.  Well, essentially.  This was the part where it was a very good thing that I was not there.  I don’t take well to being accused of abuse, especially when we have over 80 combined child-years in our house and never a single trip to the ER.  Nevertheless, after threatening full-body scans and all the rest, giving Jeanette the look that says “we haven’t found the evidence yet, but we’re going to, it’s just a matter of time,” a sane and rational nurse took over and basically said, “we’re not going to do those scans.  Nobody has called DCFS yet, and I don’t think that’s necessary.”  I suspect this nurse of having been reached by my sister, God bless her, but regardless, Jeanette was grateful.  It was about 5am, and she had had no sleep.

Unfortunately, she didn’t get any, either.  Gabriel was dozing on and off, but here there was a serious problem.  The morphine settled him so he could rest, but he never sleeps on his back.  He sleeps on his side.  When he falls asleep on his back, he twitches as his nervous system tries to get him to roll over and be comfortable.  This time, when his body twitched, it hurt him, and he would cry.  No, shriek is a better word.  This happened about every two minutes for several hours.

Another complication that might be of use to anyone that finds himself in this position: cell phone coverage.  Jeanette’s phone worked fine in the ambulance, but once she reached the room in the trauma ward she lost coverage.  Our texts and calls went nowhere.  She, for her part, figured it was the middle of the night and everyone was asleep, so she never checked her phone for bars, of which she had none.  So here we were trying to get some kind of update on when they would do surgery, what was going on, and we got no response.  Finally my sister – you gotta love this gal – got hold of the surgery schedule for the morning and found that Gabriel was down for 11am.  This let me finally go to sleep about 2.  Apparently only Verizon and (in places) AT&T have coverage there.  I had it in surgery waiting, but only sporadically in trauma.  Jeanette, on T-Mobile, had nothing anywhere.  Word to the wise.

About noon, Gabriel finally went into surgery.  I was on my way there, and tried to call for an update, because now I had the room number, but Jeanette had followed Gabriel up to surgical waiting and was therefore out of range again.  But the staff there had been courteous enough to send word to the security orderly to tell me where to go.  Again, they are really very good there, and took marvelous care of us.

After an hour or so, Gabriel was out of surgery and his leg was set.  He was still out when we went to see him, and woke up only gradually over the next few hours.  He was in a spica cast, which for those curious, is a set of fiberglass pants that go from the ankle of the affected leg all the way up to the chest, with the other leg encased to the knee, and a bar welded to both legs to keep them about 18″ apart.  They cut a squarish hole in them into which one can insert a diaper, with a larger diaper to cover the whole thing.  And that’s it.  No sitting up.  No real lying down, because of the way the cast is molded.  For six weeks.

They told us  – the one doctor was especially good about this – what we could and could not do with this thing.  Specifically, that we were not to pick him up by the bar.  Except, we really could.  They ahd to tell us not to, but honestly, he said, you couldn’t get the bar off with a sledge hammer, so do whatever we liked with it.  They were very practical.  The cast will stink, whatever you do.  Don’t stress it, just get used to it.  Don’t get it wet.  Since the cast essentially doubles your child’s weight, you’re not going anywhere with him.  When you start feeding him, make sure you cover the top of the cast at the chest, because if you don’t, food will go down it and start to stink, not to mention itch and be uncomfortable.  Some of that will happen whatever you do, but do your best to prevent it.  Etc.

Once we found some sports on TV, even if it was only golf, Gabriel started perking up a bit.  He drank some juice, had a graham cracker.  One last hurdle was the carseat for home transport.  No carseat will work – the legs are just too wide in the spica cast.  So what they gave us instead was like a cargo harness, and we laid Gabriel on his side and buckled him in through the harness lying down.  We got Lortab from the pharmacy, and finally, at about 5pm, drove home.

It’s hard to describe what we felt like driving home.  Gabriel would whimper, and we’d do our best to help him be comfortable.  We were talking about the financial atomic bomb this would drop on us, we not having insurance.  We had only started looking at the logistical difficulties this would cause, with six other children at home and no other driver with a license.  For six weeks, essentially, we have a disabled child.  He can’t go anywhere, and has to be tended by someone at all times.  We can’t even use our regular babysitters, because he’s so heavy now that we need someone that can carry him out if the worst happens while we’re gone.  And so on.  Things we probably haven’t even thought of yet.

But as we think of them, I’ll try to write about them.