I've been a nurse for a long time. How I got their was purely due to practical issues. I could support my baby on $4.20 and hour as an R.N. or on $1.60 an hour as a photographer/dark room technician. I chose the easy road, i.e., the $4.20/hr. (It's hard to believe that RN's ever made an hourly wage like that.) There have been many times I've regretted that decision as the artist in me suffered a slow, painful death over the years but I was able to provide for my birth children. Now that I'm old and make more than $4.20 an hour and am once again pursuing my art I realize had I not entered the world of medicine I would have NEVER adopted the last 3 munchkins as I would not have had the knowledge to deal with their medical complexities or the fortitude to survive the confusion of the medical profession. That would have been a great loss. On the other hand it has exposed me to the good the bad and the ugly of a complex system that i could have done without. Medical error in hospitals is so rampant it causes approximately 98,000 deaths a year in the U.S. As a nurse I have to maintain training on prevention of medical error in order to renew my license every other year. No surprise. Today is a good example. Wee one has been coughing for 3 weeks. I finally took her to the pediatrician 6 days ago as the saline nose drops, Benadryl, Motrin yada, yada, yada, etc was getting us no where. Sinusitis. Since her nose smells like something crawled in it and died she was placed on a high dose of an antibiotic for 14 days. Last night she spiked a temp of 104. This changes things. I bring her to the ER today and tell doc number one I will be happy to continue to call it a virus and/or sinusitis and go home AFTER he does a chest x-ray and tells me she does not have pneumonia. He agrees but tells me he would like to see her on 3 times the dose of inhaled steroids she is currently taking, a steroid nasal spray and to continue on her rescue med via nebulizer as I have been doing for the chronic cough. He will write the prescriptions but also wants her seen in pulmonolgy. He leaves. After 4 hours, a urine specimen and chest xray, doc number two comes in to tell us we can go home but "try to keep a handle on that fever." I might add that while we are in the ER she has had no fever as it is meat locker cold in the room we are in and the exact words of doctor number two as he walks in to bid us good bye were, "DAMN! It's cold in here!" He tells me her urinalysis was normal and the chest x-ray was "ok." Call me an RN but something in "ok" prompted me to ask if it was NORMAL? Well, no..."not exactly".... "it showed perihilar thickening bilaterally." He felt it was lung changes due to a virus but not to use her nebulizer as it might make her jittery (hard to tell the nebulizer jitters from her seizing last night) ....since she is "not wheezing just coughing." As an old (yes, literally) pediatric pulmonolgy nurse i can tell you all orders for rescue meds are written by pediatric pulmonologists to be used for "cough or wheeze" as everyone who knows anything about pediatric asthma knows many asthmatics do not wheeze...they just cough...and cough...and cough....and cough. Perihilar thickening on x-ray is also a dead give-away for chronic moderate to severe asthma. We are shipped out of the ER by doc number two with NO prescriptions but an assurance that he will call once the radiologist reads the film if the radiologist sees a problem. OMG. You mean the radiologist never even looked at the chest x-ray? Then I remember it's Sunday and he is probably golfing. So we leave not knowing much more than we did when we went in and now here we sit at home with the temp creeping past 103. Three weeks without sleep is wearing us both out. Bilateral perihilar thickening is ticking me off. A sudden 104 temp after 3 weeks of illness is freaking me out and I don't freak easily. Since statistics show that death from asthma is about the same percentage whether your asthma is mild. moderate or severe I will pursue this with our pediatrician tomorrow. I will request a pulmonolgy referral and discuss increasing her inhaled steroids and adding a nasal spray since studies have also shown (as doc number one was fully aware) how beautiful the combination of these two drugs work in controlling chronic asthma. I always tell my friends, loved ones and patients to NEVER enter the hospital without an advocate at your side if you are not knowledgeable yourself. It simply makes good sense. Even when you are knowledgeable , though, you have far too many moments of asking your self, what the @%*# just happened? In today's situation...nothing.