Kernicterus, Medical Professionals and Judgement

Anonymous

There are some days that are burned into your memory.  You can remember these moments with such clarity. A moment for me was when doctors told me that my son would never walk and would never talk.  And, with that information, I knew he would never catch frogs in a pond, he’d never jump into  a lake in the middle of summer and he simply would not experience childhood the way I had always envisioned.  As soon as someone tells you that your child will not do these things, your world is crushed and you don’t want to believe any piece of it.  

Perhaps more painful than being told that your newborn child would not do many things, is the subsequent judgement that came from healthcare professionals.  Medical professionals who were supposed to help guide me with my son’s condition, instead blamed me for it.  These moments of judgement are also burned into my memory.

The condition my son experienced was severe hyperbilirubinemia – jaundice.  Yes, a lot of children have jaundice when they’re born and for many, their bilirubin level doesn’t reach high levels. But, for my son – and countless others, it reaches levels that threaten their lives. For some, if they survive, they are crippled with a wide variety of symptoms including cerebral palsy and serious hearing issues.  The condition – rarely diagnosed because of the legal ramifications of mismanaged jaundice – is called Kernicterus.  It can mean a lifetime of disability.

Knowing that your child has suffered a major medical emergency within the first few days of his or her life is one thing – but, knowing that it may have affected his or her development is beyond scary. It feels like you’re looking into the black abyss wondering what’s about to come next.  And, while you’re forever concerned about the well-being of your child and looking to medical professionals as a soothsayer or crystal ball reader, their judgement for what happened to your child is perhaps most devastating.

I had to take my son to a pulmonologist for a few weeks after he was born.  Sending him home with a monitor was perhaps, one of the most difficult experiences – especially since they said my son very well could have problems breathing.  It was, essentially, they only way they would release him – with a monitor. On one hand, it gave us peace of mind that it would go off in the middle of the night and we could administer CPR if he had stopped breathing.  For my husband, an Iraq combat veteran, the beeping of the machine sent him into a panic.  I would have to remind him that our son had pulled the leads off and  chances were he was just fine.

The monitor was certainly concerning – but, getting it removed by the pulmonologist came with an incredible amount of judgement. There I was, sitting in a little room with an 8 week old baby, worried because I needed my son to be okay – but, also was nervous that they would not take the monitor off of him. I sat there patiently, when the pulmonologist. Dr. Baker looks at the chart, then looks at my baby, then looks at the chart. “Oh, this was the baby with the bilirubin level of 44.”  

“Yes,” I replied. 

“I saw him when he was in the NICU” said Dr. Baker. 

“Yes,” I said – with no memory of him ever having visited my son or talking to me during our stint at the NICU. 

“How does a baby even get to a level like that?” he said, looking at me. 

“Yes, it was very high.” I said waiting for reassurance.  

The doctor looked my son up and down, then looked me up and down and said, “How did you not even notice the jaundice?  How could you let it go as high as it did?  I’ve never seen a case like this in all of my years as a doctor – like 30 years!”  He waited for me to respond, but I said nothing. He continued “I just don’t know how you could have let it go that high.”  And, with that he got up and left the room.  

He later returned to tell me that I could not remove the monitor because there was something “mysterious” in the readings and he needed more data. I left the office feeling crushed, feeling responsible, and still so concerned about my son’s well-being.

About a month later I returned and his physician assistant, (who I was very glad to see) removed the monitor and said my boy was very healthy.  There simply was no reason for the monitor to remain. There was nothing wrong with his breathing.

In hindsight and with a lot of therapy, I realize now that the doctor’s reaction was simply wrong.  I was not to blame for a rare issue – severe hyperbilirubinemia.  I also realize that the doctor’s reaction was simply not professional.  The point, however, is that medical professionals need to remember that what they say, how they react to serious emergencies like this has a significant emotional effect on the family of the individual.  In essence, we need medical professionals to be supportive and comforting.  Emotional support is often needed from medical professionals – particularly after traumatic events like severe hyperbilirubinemia.

To learn more about Kernicterus and mismanaged jaundice, please visit http://www.pic-k.org (Parents of Infants and Children with Kernicterus) and http://www.kernicterus.org

In the Shadows

rescue

They are in the shadows.

Babes are at risk.  (Jaundice can become toxic when not managed properly.)  Children live with no viable treatment options.  Research funds are needed.  Adults live in immense difficulty.  Families struggle to hold together fractured pieces of their lives.

…all because of jaundice.

There are those shaped by “the K word” and those who are threatened by it.

They live in the shadows.  Many babes are affected by jaundice, but not all escape it unscathed.  Here in the US, there is no reporting system for kernicterus.  Due to the negligent nature of the diagnosis and the ethical concerns that accompany it, it is not always diagnosed either.  How many are living with kernicterus and do not know it?  The effects of kernicterus take months and years to become apparent.  (Newborns don’t need wheelchairs.  They aren’t expected to walk or talk.  The movement disorders, sleep disorders, hearing loss, vision loss etc all become apparent as children miss milestones.  Without proper analysis, the k word is easily swept under the rug, misunderstood, mislabeled.

And what of those living with the milder effects?  Neurological hearing loss (that can only be discovered under sedation with a test that measures brain wave response to sound.)  How often is this misread as behavioral – smart children with unpredictable hearing and difficulty communicating?  Milder forms of kernicterus also seems to come with hyperactivity – how often is that mistaken for other disorders?

The truth is that the numbers of kernicterus are hidden in the shadows.

Our kids, those in picK are likely the tip of the iceberg, and our numbers grow weekly.  And the truth is – one case of kernicterus is one case too many.  The effects are just too catastrophic!

How do we rescue?  How do we make the change?  How do we illuminate?

How do we?

  1. On the front end, we turn the light on!  We spread the word – jaundice can do that, and it doesn’t have to!  TEST!  Prevention.
  2. For those living with the K word, we support the research that will lessen the load of that K.  Research for viable diagnostic tools and treatment options that can lessen the effects of the K…diminishing it’s effects.  Rescue.

Please partner with us in shining the light needed into these shadows to rescue those living with the K!

Preventable Tornado

Jaundice. It’s a word most parents are familiar with, but to my group…it sends chills down our spine.

We don’t joke about cute yellow babies, or pumpkins that are orange.

For us, jaundice was the strange weather that heralded a MASSIVE TORNADO in an innocent child’s newborn body, just days after coming home from the hospital.

Go ahead. Call me dramatic, but with a deeper understanding, you might agree. (AP Photo)

There has been wreckage.

My boy had multiple risk factors for more serious jaundice (hyperbilirubiemia).

Over 12 times, I asked doctors and nurses about his bruising, his early birth, his color and EVERY single time – they dismissed my concerns…this was on the phone, and face to face, and even in the ER when he lay dying in my arms at 9 days old.

The kid with the cut finger was rushed back while we waited hours.

The finger healed.

My son has an irreversible, virtually untreatable condition that has impaired his ability on a profound level to talk, walk, sit, stand, eat, use a toilet, hear, see, form enamel on his baby teeth, control his own movements, digest food, etc.

What jaundice did to my boy – it’s no small thing.  IT WAS A TORNADO.

Kernicterus

I had no idea.

None.

It was treated like a common cold.

They say it’s rare, and to some degree it is.  I don’t see 50 kids a day with it.  But to what degree is it rare?

NO ONE KNOWS.

NO ONE IS TRACKING KI.  There is no mandatory reporting of KI or higher bilirubin levels.

I’ve lived through this – I’ve seen the tremendous amount of negative pressure – pressure to smother the word – kernicterus.

Here’s why: IT’S PREVENTABLE.

You follow these steps, you use the technology and KI is avoidable.  But some people think it’s a fairy tale – that if it doesn’t happen to every baby that it can’t happen to any baby.

It CAN.

It does.

PICK, continues to receive new members on a weekly basis, around the globe, and right here in the US.

We believe that our members are the tip of the iceberg.  Why?

  1. Our group has an unusually high # of educated middle to upper class families.
  • KI DOESN’T DISCRIMINATE.
  • THESE FAMILIES HAPPEN TO FIND US BECAUSE THEY HAVE THE RESOURCES OR THE KIND DOC IN THEIR PATH TO FIND US.
  • NOT EVERYONE HAS THESE RESOURCES.
  1. The negative pressure in the medical community – the pressure to not “throw someone under the bus” by saying the word kernicterus is strong – and it prevents many children from getting the proper diagnosis.
  2. The milder kids are missing.  KI is a spectrum.  There are the more severe and those less affected.
  • IN CASES LIKE MY SON’S IT’S HARD TO KEEP A LID ON THE FACT THAT A BILIRUBIN OF 45.6 IS SURE TO CAUSE A BRAIN INJURY.
  • BUT WHAT OF THE OTHER CASES, WHERE JAUNDICE DIDN’T GET TO 45.6 BUT IT WAS HIGH AND/OR IT WENT ON FOR WEEKS?
  • WHAT IF YOU TAKE MY SON’S CONDITIONS AND THINK OF THE MILDER FORMS: THE HEARING LOSS THAT REQUIRES A SPECIALIZED MEASUREMENT OF BRAIN WAVES TO DETECT – THAT CAN OFTEN APPEAR LIKE A LEARNING DISABILITY, THE MOVEMENT DISORDER THAT IN MILDER FORMS CAN LOOK LIKE A LACK OF COORDINATION?
  • WHERE ARE THESE KIDS?  THEY ARE OUT THERE, BUT THEY RARELY MAKE IT TO OUR GROUP, BECAUSE IT’S MORE DIFFICULT FOR THE FAMILIES TO PUT THE PIECES TOGETHER.
  1. And then there is the sad reality: that there is no tracking of kernicterus because there are no real numbers on kernicterus.
  • WE’VE SPENT TIME PLEADING WITH AGENCIES TO GET OUT OF THIS UGLY CYCLE, AND THEY’VE RAISED TIED HANDS.  THESE HAVE BEEN HARD BLOWS.

So while estimates (derived from looking at Canada’s KI reports) come in at a minimum of 100 NEW cases of KI per year, keep in mind – these are kids that are actually at a level where they would receive the KI diagnosis.  How many more of the milder cases are happening? How many of them are being displaced under other diagnoses? ADHD? Autism? Developmental Delay?  We need the research to know

When a tornado comes, how do you put a price tag on the damage, on

Lives lost?

Homes lost?

Futures robbed?

Livelihoods destroyed?

Siblings scared?

The grief that carries from one day to the next?

A community altered?

What is the price on that?

How much more is the emotional price tag when the likelihood was foreseen?

tornado3.1

(Photo: Associated Press/Mike Gullett)

THE DAMAGE IS 100% AVOIDABLE.

WHAT IF THE AUTHORITIES DECIDED THEY DIDN’T WANT TO SOUND A SIREN?

Many fear the effects of fear, but when you can stop the object of your fear: What is to fear?

And here is the kicker. The cost of the test is minuscule.

You can never measure the catastrophic effects it has upon the families and the ripple effects upon the communities.  They are egregious!  But what you can measure – the healthcare cost? My son’s life care plan is

60 MILLION DOLLARS.

…All because someone did not perform the appropriate test (estimated to cost ONE dollar).

…because they thought their eyes could see the severity of his jaundice.

KI is a tornado…and it’s being allowed to go on with no siren.  No warning came for us.  If we had been told of the possible catastrophe, we would have sought shelter – it wasn’t a rain storm to watch on the porch.  It came in the night and forever took my son’s abilities.

AND THE MATH.

Let’s say that 100 kids a year in US develop KI.  Let’s say each of these cases has an economic impact of 30 million per child (1/2 the estimated cost to my son).

30 million dollars x 100 = a cost to the health care system of 3 BILLION DOLLARS or unnecessary cost, and of course this cost would be over the child’s lifetime, but you also need to realize that it happens EVERY year.

I’m not saying I know the cost of KI in terms of being able to hand you a number. Like I said, there is not positive pressure, or even a system to report it, but on the ground I can tell you – it falls under the tornado category. Although it doesn’t happen to every jaundiced baby, when it does, the cost is catastrophic beyond words.

What of these children’s futures?

What of the crippling effect it has on their entire family and network of friends who help shoulder their burdens,

What of the parents who struggle with depression and decreased ability to work through multiple hospitalizations of their child and the agony of their daily lives?
From the wreckage, I cry out to you: sound the siren!  It is only when the victims make the disaster known that change can come, and I tell you:

Please help us!

Please treat jaundice seriously.
Please spread the word that Jaundice CAN do THAT…
and IT DOESN’T HAVE TO.

Let’s turn the tide around.

Let’s minimize exposure.

Let’s prevent KI by bringing much needed awareness.

Let’s research KI to find the means of treating it.

Let’s pave the way to a cure.

LET’S BRING THE DAY THAT WILL #STOPKI!