Monday, June 2, 2014

Week 5-7 Of Life: Our Journey To Palliative Care

This past week was National Palliative Care Week.  Palliative care sounds like a scary thing, and it is, but the services, support and care, palliative care providers provide for their families is unexplainable.  So, I thought it would be a fitting time to share our story of how we become apart of palliative care.
(due to my horrible memory, there may be a few blanks)
January 3rd, 2012, at 5 weeks and 5 days of age, Lyla was booked in to have an overnight oximetry and a barium swallow at the WCH.  Anyone who is unfamiliar with an oximetry, it is non invasive test that measures the oxygen saturation levels in the body, and a barium test watches a swallow (while drinking) under x-ray.  As soon as we arrived to the ward, we were told we were in for 2 nights, which was news to us, and just as quick as we arrived and started to get settled, Lyla had her first 'code blue', followed by another 2 that night; we became quite familiar with the Medical Emergency Team.  And needless to say, everyone in the ward was freaked out; the nurses moved Lyla and myself to the room directly in front of their desk, put her on oxygen and gave her a 1:1 nurse, who literally sat next to Lyla all night.  I was even told not to touch or pick up Lyla incase that set her off in to a blue episode again!  The following day, slowly started our week from hell, with the help from a very smug, inconsiderate, inappropriate, condescending and just all round asshole of a doctor ("Dr M."), he cut Lyla's feed amounts in half and put her on continuous feeds, incase all of this was reflux related (ha!).  Eventually we were moved to PICU, as Lyla's needs became too much for ward nurses to handle.
We came in for an oximetry, but we ended up in intensive care.  This was all new to us, yes we had spent a couple of weeks in hospital when Lyla was a newborn, but we had been at home for 4 weeks, 4 amazing (and slightly scary) weeks where we tried not to think about her unknown future and go about our new life as normal as possible.  It was overwhelming, but we had an amazing nurse in PICU, called Kate, and she was exactly the kind of person I needed around me, happy, helpful, caring; if I wasn't around Lyla she was there holding her and I knew she was safe.  I still think about her, she was the one person I could say inspired me to want to become a nurse.  I wanted to do for others what she was doing for us. 
Our time in PICU was not how I envisioned and it kept going from one extreme to another.  It went back to day 1 of life; to try and find a diagnosis for Lyla, to try understand why she was like she was.  They were no longer focused on the issue we came in for - respiratory.  To Dr M. she was science experiment, he thought it was exciting, coming in to see us with a bounce in his step, an inappropriate joke about the situation and then a laugh.  We met with a number of doctors and specialists over the first couple of days; general medicine, respiratory, pulmonary, neurology, genetics, ENT.  It was decided to take Lyla to have a laryngotracheobronchoscopy (camera down airway) to check for any obstructions in her airways that could be causing her to have these blue spells, after the scope she would have a MRI scan; all done under general anaesthetic.  It was scary, this was her first anaesthetic, despite everything she underwent when she was born. Thankfully she came back with no issues from the anaesthetic and no growths or obstructions in her airways; instead she had a continuous airway spasm.  The MRI showed possible 'bilateral open opercular syndrome', only Lyla's neurologist knew what it was at the time; a malformation of her brain that would affect face and throat muscles.
After raised concerns about possible seizure activity Lyla had an EEG done whilst in PICU, normally they attach sticky monitors to the head, but for a more accurate reading the monitors had tiny needles that went into the scalp.  Thankfully there were no recorded seizure like activities.  But things were not looking good for Lyla, it was blue episode, after blue episode, after blue episode; everyone knows what continuous lack of oxygen can do to the brain, and the biggest fear of ours and the doctors was she would have one of these episodes and not recover. 
We (myself, Daniel, my parents and his parents) had a big multidisciplinary meeting one morning with all the specialists we met with over the stay, to discuss what had been found and what we would do next.  Luckily by this stage Dr M. was on leave, so we had a lovely new doctor to lead everything.  It seemed the ONLY option we had to help Lyla was to take her to surgery straight away to have a tracheostomy inserted to protect her airway.  We didn't want this.  After a very long meeting, lots of discussion and lots of tears, we begged (almost) to let Lyla come home.  We didn't know what to expect, but I was prepared for Lyla to come home and die, as was everyone else.  The doctors were happy for discharge, but we couldn't leave without oxygen and because of our decision we were put in contact with palliative care.
 This was scary, palliative care was for people who were just about to die, so I thought.  Her name was Julie, she was very sympathetic to our situation explaining what she does and what P.C. do for families; it was a lot more than what I thought.  Julie sat down with myself and Daniel along with our parents and we discussed what our goals were for Lyla and many other heartbreaking things no parent should need to think or talk about.  Julie said we should make a resuscitation plan before being discharged, incase something was to happen with Lyla and we would have, in writing, how far we were willing to intervene.  We told Julie we didn't want Lyla on 24 hour continuous oxygen and feeds (like what was wanted by doctors), as this would be impacting on our quality of life with Lyla.  After these meetings Lyla was taken off all supports and monitoring and we were left in charge of her care, doing what we would normally do at home. 
Later that day we had a nice distraction as my grandpa had organised to have Brenton Sanderson come in to visit us.  I wasn't too familiar with Brenton, but he was the new AFL coach for the Adelaide Crows; everyone in our family is a Crows supporter except for Dan and myself, we're Geelong supporters, but Brenton was an ex Geelong player and assistant coach, so Dan was happy. He came in for an hour or so, we told him all about Lyla, had some photos and everyone had a nice chat with him about football.

Our final day in PICU was 'exciting', we were looking forward to getting out of this place.  We were given rundowns on how to use our new feeding pump and home oxygen, then came the time to fill out the resuscitation plan.  Thankfully Kate talked us through all levels of intervention and physically showed us what machines were used, so we knew what to expect if we were ever in the position.  Dan and I met with the leading doctor and Julie, we made our decision for resuscitation, much to their surprise, they didn't think we were making the right choice, but it was OUR choice.  There was then some discussion between the two, that the coroner should be advised 'to avert the need for involvement in unlikely event of death less than 24 hours post discharge'.  That was rough. 
Then it was time to leave.  It took a couple of days to finally relax back into our life, but I still had in the  back of my head with every episode she had at home that this would be the last one.  
The weeks and months after our discharge our family told us of some of the things Dr M. said to them while we were not around.  It started with Dr M. running into a support nurse we had with us during our PICU stay, and he was wanting to know why Lyla had been discharged, this was weeks later, he believed she should still be in.  Then more recently our parents told us Dr M. told them the best thing to do for Lyla was to let her starve to death.  The thought of a medical professional saying something like that to a family makes me physically sick, but thankfully this doctor no longer works at the WCH. 
(thats Kate in the background)
We are still under palliative care, we do not require as frequent support from them like we once did, but they are always there if we need them, for literally anything; in fact Julie is coming to visit us tomorrow, so we can fill her in to what has been happening over the last few months and weeks, and Julie hasn't seen Lyla in a year! 

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