125) I screwed it up

October 6th is E’s EOT date, so we have less than 4 months to go. We’re in the proverbial home stretch, and I did my first big medication screwup this week. We’ve missed a couple of doses – it happens, but this was something different. E receives his methotrexate on Wednesday, and gets 4 x 2.5mg pills for a total dose of 10mg. Normally, we pick up our prescriptions from the pharmacy at SickKids. At our last visit, I forgot to ask for a refill of this particular medication, so we got a prescription from E’s nurse practitioner, and filled it at a pharmacy near home. Unbeknownst to me, they gave us 10mg instead of the 2.5mg ones. On Wednesday, when it was time for his methotrexate, I dosed him with 4 x 10mg pills. Since the pills were the larger dose, I should have only just used one.

The 10mg pills were the exact same size & shape as the 2.5mg ones, so there wasn’t a visual cue that something was different. There were only 4 pills in the bottle & that didn't strike me as strange because pharmacies are restricting the amount of pills that are given out due to COVID. The pharmacy we picked up the pills from was the same chain, and should have had access to E’s medication history. They should have attached a visible note, or given a verbal message at pickup to let us know that the dosage had changed. I accept some of the blame, because I did not look at the dosage on the bottle before administering them to him, but when you’ve been doing something for the 2+ years we’ve been in maintenance, you start to go on autopilot a little bit.

So, this Friday morning, when I randomly had the epiphany that I’d over-dosed my son on Wednesday, I called E’s nurse practitioner at our satellite clinic. She called the oncology department at SickKids, and called me back a little bit later. They said not to worry; early on in treatment their methotrexate doses are much much higher than what he accidentally received this week. The most likely thing that will happen is that his counts will plunge. They said to watch for abnormal behaviours, vomiting, diarrhea, or bleeding. We are to bring him in for an unscheduled CBC next week to check his blood. He's seemed absolutely fine so far, I haven't noticed any side effects or changes, but I feel terrible. I feel like an idiot, and a moron. I'm both angry, and disappointed with myself. I feel like I let him down, because I'm the adult, and I'm supposed to make sure things like this don't happen.

124) Threes

Today was a bloodwork day for E. We received a phone call from E’s nurse practitioner yesterday, and apparently, today was going to be a busy day, so all appointments were being scheduled rather than their regular informal show up whenever you like policy.

They still have a one-parent-per-patient policy in place, and I drew the short straw, so we packed up, and left the house a bit before 10 am, arriving at the hospital a few minutes before our 10:30 am appointment time.

There are plexiglass booths through the main doors, where you are asked why you’re at the hospital today, and if you have any cough or fever. I was handed a mask & a sticker, and I was on my way to the 7^th floor.

On 7, we were ushered straight into the clinic room. E’s nurse practitioner, registered nurse, and child life specialist were all there today. Because of the one-parent-per-patient policy, I hadn’t seen any of them since early March. My wife took E to his satellite appointment in April, and I took E to his May appointment, but it was a lumbar puncture at SickKids. It’s always nice to see those three ladies.

E was given a once-over by his nurse practitioner, and then we were ready for port access. Well, upon taking off his shirt, we discovered that, surprise, he wasn’t wearing an EMLA patch. He was wearing one at home, and I dug around in his shirt to see if it had gotten stuck to the fabric. Nope. We asked him about it and he said “I took it off”. We asked him where it was, he said “at home”. Sure enough, the next time I was on my phone, a message had come in from my wife saying that she had found the EMLA patch on the floor at the house. They have a fast-acting numbing cream, and that was applied in place of the EMLA patch, but it set us back 15-20 minutes while we waited for it to do its work.

The previous two times E needed bloodwork done, we had problems with his port. He’s almost always required a saline flush before there was blood return. At both his April & May appointments, he needed a clot buster called tissue plasminogen activator (TPA) before we could get blood return, so I had a feeling going in that something like this might happen again. Yup. After he was accessed, his port must have been flushed 6 times, and there was nothing coming back. Around 11:40 am, they administered the TPA, and we were moved over to an empty room to wait it out.

Fast forward to two hours later, we were brought back to the clinic, and it was again attempted to get blood return from E’s port. The TPA sort of worked. The plunger was easier to push in on the flush, but when trying to draw blood back out, it came out in only a trickle. It was better than before, when there was zero blood return, but it didn’t work anything like it should. There was enough in the vial to do the rest of the blood tests & it was finally time to go.

Getting back to the car, there were a couple of dents in the back bumper, and it looks as though someone hit it when trying to back out of a spot. No sorry note, no contact info, they hit it and drove away. Things like that are difficult for me because of the nature of my personality. I tend to get stuck thinking on something, and have problems shrugging it off. With everything going on it the world at the moment with pandemics & social injustice, this really isn’t that important. There are bigger fish to fry.