Castle Update: Pharmacy Foul-up & Flu Follow-up

Friday: Naval Hospital, when I called to inquire about LLGA's croup of Thursday evening, insisted I bring her in. Whee! Masked medical folks peered at her and recommended that we begin a course of Tamiflu.

The fine print is that Tamiflu is off-label (NOT recommended for those under 1 year) and her screening test was negative for flu A or B. They don't know about whether it crosses the blood/brain barrier and they think there's an increased risk of seizures. I cross-examined the pediatrician and med student that were in with us and the pediatrician assured me that the Chief of Pediatrics as well as the lead Infectious Disease doc had personally reviewed the case (including the crablets' propensity for seizure disorders) and still felt that it was advisable to begin.

The reality is that the Naval Hospital had the first case in San Diego and has been advised by the lab to expect "several" other confirmations. And, unlike the rest of the planet, it has stockpiles of the antivirals.

Dutifully, I go home and deliver the first dose.

Other than Charlie and Lucy taking turns (and occasionally in chorus) hacking, we got through the night.

Saturday:

Charlie belatedly rejects his orally-administered dose of Tamiflu.

Lucy does with a bit less tape-delay.

I check and C-boy's temp is elevated. So, in light of his nausea, I grab the suppositories that the Naval Hospital pharmacy dispensed with the Tamiflu on Wednesday. He protesteth the two of them, too.

Then I confirm that LLGA's temp is elevated, too. I reach for the trusty suppositories. Because she requires a smaller dosage I look more carefully at the tiny print. WHAT THE SAND?! Where the Rx label reads, "120 mg", the suppository itself says "650 mg."

For those that don't know, overdosing Acetimenophen can cause severe liver and kidney damage. Even better, there's not a lot of heads-up for the damage until you reach toxic levels.

Luckily, the CQ records dosing religiously (and a bit compulsively). It paid off when the Poison Control Center needed to know how much he'd taken of the meds since Wednesday. Charlie-boy, because I had alternated Motrin and Tylenol, was not endangered but the Poison Control Center was not amused and encouraged me to divert from panic and worry to FURY at the dispensing pharmacy.

Ever socially responsible, I begin the recommended action of alerting the pharmacy to the big goof.

I call the Pharamacy. The menu informs me it will be a 60 minute wait for a live person.

I call the Quarter Deck of the Hospital. I explain that I need a live person and am promptly transferred back to the same menu I'd already called, with the same 60 minute wait.

I call the Quarter Deck again and plead to be transferred to a live person. I'm told that, no, they cannot deliver a message the 100 yards or so that the QD lies from the Pharmacy. And, no Patient Relations aren't there on the Weekends. I'm advised to contact Pediatrics.

I call the Appointment Call Center and try my luck. The rep offers to pass the message onto the Pharmacy with my phone number. (Remember, I've got emesis times two to clean).

About a half-hour later, the call center gal calls and tells me that "Linda" (her real name) instructs that I "can just bring the suppositories back into the Pharmacy and they'll exchange them". Oh, and "Linda" wouldn't even take my number from the call center clerk. Clearly, "Linda" misses the point that they've potentially put other patients in peril. Oh, and "Linda" can sand herself.

Unfortunately for "Linda", the CQ is not new. I call (yes, the seventh phone conversation on someone else's mistake) the Quarter Deck. "Please put the OOD on the line."

"Ma'am?" croaked the fellow manning the Quarter Deck.

"I will speak to the Officer of the Day now."

"May I let her know who is calling?"

So the JG and I had a little telephone powwow. Something in my tone led her to start with my "sponsor's" information. Commander Combat Crab, I didn't use my maiden name.

And she was Horrified. Absolutely horrified about the mix-up, which yes is considered a "near miss" in patient endangerment. And that was before I calmly observed the utter lack of proactive response.

But then, I received two pediatric opinions from friends about how Tamiflu should NOT be given to Lucy.

So I called the call center again to put in a request to find out Charlie's lab results.

Then the phone rang with a *real* doctor. Sadly, not to address the Lucy issue but to verify what the Poison Control Center had said.

Then the nurse called. No, Lucy should NOT be on Tamiflu. She would go talk to the docs and call me back.

This gave me 20 minutes to have a good panic-cry.

The nurse called back and said she spoke in error. That the CDC had issued revised guidelines on Tuesday, that we were following them to the "t", and that the CDC had personnel on site. That the Naval Hospital is being more aggressive because they have plenty of the antiviral meds and that Chief of Peds had reiterated his confidence that the appropriate course of action was to treat her.

Then new information: that we probably wouldn't have Charlie's flu results until Monday or Tuesday -- not early enough to determine Lucy's course of Tamiflu, as expected.

No need to include further symptomatic detail in order to ask:
Are we having fun yet?