Wednesday, May 26, 2010

Trauma Part 1

Joseph with his foam support. We affectionately call it "Sponge Bob"

Joseph after getting home from a long day in the ER. We both were there in our pajamas as we didn't have time to change before heading over.

Yesterday morning I was sitting at the computer when I heard Joseph scream, "Mom there is so much blood!" I hate those words, they are never good! He came running up the stairs holding his finger out. The tip was covered in blood and dripping profusely. I jumped up carried him downstairs, grabbed a clean cloth, and shouted to Charley. I really didn't look too closely at his finger as it was apparent he needed the ER right away. She came running, I told her I was taking Joseph to the ER. She didn't even bat an eye. She just said no problem Mom. (Its pretty sad when she thinks this is just another normal day!). I called Ronny who had just left for work and told him to turn around and come home as Joseph had just seriously cut his finger and he needed to come home to be with the other kids while we were at the hospital. On the way I asked him what had happened. He had been wrapping the cord of the blinds in Sam's room around his finger and pulling his finger out. He said usually the cord just loosened up and his finger came out. This time though the cord took his finger right off.

Thankfully the hospital is only 5 minutes away and happens to be a new Primary Children's endorsed hospital. We walked in and were greeted by the sign in lady and an older women who immediately came over and tried to soothe Joseph while I checked him in. We were immediately taken to triage where I got my first real look at his finger. The nurse looked at me and asked if I had brought the missing portion in as well. The top 1/2 inch of his finger was gone and the white portion sticking out that I originally thought was his finger nail was actually his bone sticking out. I grabbed my phone and called Ronny and told him to find the missing piece, wrap it and bring it to the hospital ASAP. I also told him to take the kids next door while I prayed our neighbor was home and could take them indefinitely. At this point, knowing how bad this was I wasn't sure if they were going to transport Joseph to Salt Lake or be able to take care of him there.

Ronny arrived at the hospital just as the doctor came in and he cleaned and prepped the missing portion of his finger and cleaned and dressed his finger. Up to this point Joseph was upset and terrified but still able to be consoled. The doctor then said they would need to give him an IV and Joseph freaked out! It took Ronny and I and another nurse to hold him down. Once the IV was in they pushed morphine and an anti nausea medicine. The nurse looked at me and asked if she should go get some more for me. I was doing great up until this point. Thankfully Ronny was there so that I could pull myself together. It took me a few minutes but I didn't pass out or lose my stomach. (Quite an achievement after seeing his finger I assure you!) They then took him to x-ray to confirm the bone was still intact, it was.

The doctor came back and told us he was calling in a specialist from Salt Lake who would come and reattach Joseph's finger. We said great but didn't realize it was going to take him 3 hours to get there. GRRRRRRR! When the doctor arrived and examined Joseph's finger he told us there were a few problems. The way the finger was severed it exposed the bone and killed the blood vessels that provided blood supply to the top of that bone. This left us with 3 options. To save that portion of the bone he could connect his finger to his abdomen for the next month while more tissue grew to cover the bone that could provide blood supply, 2. Fuse his first and second finger together with the first at an arc to do the same thing, 3. File off the bone until enough tissue that was left could be skin grafted to cover the bone and provide the blood supply. Knowing how active Joseph is and knowing he is a 7 year old boy the first two options would probably result in him tearing more tissue and bringing us back to the third option eventually so we opted for option three which turns out to be the most recommended and chosen option.

At this point the surgeon asked if we would like to put Joseph in a papoose board. I have had experience with this and knew this would traumatize him more than just holding him still. They pushed in more morphine before starting and I calmly gave Joseph the choice. He could hold really still while the doctor gave him the lidocaine shots and worked on his finger, or they could tie him to a board to keep him still. He tried to negotiate for just putting him to sleep. I explained he would have to go to the OR for that and would probably end up staying the night and Mom and Dad couldn't come with him if that was what he wanted. He chose to have me hold him and lay still. Joseph did a GREAT job! He laid perfectly still although being totally terrified (that made two of us!). I held a sheet between the doctor and his face and the two of just hunkered down while the surgeon and nurses did their thing. Ronny joined us when they started the shots but watched most of the procedure.

When the surgeon said file his bone, he really meant cut his bone. He ended up taking about 1/3 of an inch to 1/2 an inch off the top of his finger. Then he removed all the inner tissue of the tip of his finger and reattached it to what was left of his finger. His finger will be about 1/2 inch shorter than it was before but he will have a nail bed that will probably grow a little crooked. In the end Joseph really did amazing. He didn't move an inch. After that they gave him antibiotics through his IV and then proceeded to splint his arm. The splint goes from under his elbow up and over his arm and hand and then back down and around the elbow again. His arm is completely immobilized for the next month. He is prohibited from any physical activity that would jostle his hand. To this little boy, that is pretty much everything!

The doctor informed us that once the morphine and other drugs Joseph was given wear off, Joseph would have a really tough time with pain. He cautioned the next 24-48 hours would be the worst of it. We are seeing that now!


Stacey said...

Oh my gosh, I still can't believe it. I freaked my boys out by telling them yesterday. Rees is bummed that he probably won't be able to do much with Joseph when we see you...oh well. Hang in there! I still wonder how I'm going to react to some serious wound. Are you a RN yet? Gees - you should be!

enSTYLEpedia said...

So crazy! I'm so sorry you're having to deal with a child in pain...there is nothing worse or more wearing, it sucks not being able to do anything. I hope it gets better- thinking of you.