Hydrocephalus

I am so mad about something that happened yesterday. I began my career in pediatric neurology/neurosurgery and have seen my fair share of hydrocephalus emergencies over the years. Currently I have a patient who I see who is s/p myelomeningocele at birth, untreated hydrocephalus, Chiari II malformation. The social situation is extremely complex, CPS was involved with the family before the baby was even born, and the mother is currently inpatient herself due to a medical issue that arose soon after the baby was born. Yesterday I go to see the baby- he's normally calm, alert and interactive. The neighbor who was watching him said he'd been screaming all day and wouldn't settle. He cried the entire time I was there and had all the signs of worsening hydrocephalus- fontanelle is tense, head circumference is up, no up-gaze, vomiting with every bottle. After speaking with the on-call Neurosurgery Resident, it was decided that he needed to be seen. His VS were ok so my initial idea was to just have Dad come home and drive him in. Come to find out, Dad- despite having a car- is not a licensed driver and there wasn't anyone to bring him in. The neighbor he was with had let him scream for 7 hours and vomit with every feed without so much as calling anyone (despite having been told the signs of hydrocephalus multiple times) and the baby had also sustained a skull fracture/bleed last week. There was NO WAY I was going to leave and just hope that someone with a car would eventually show up to drive them to the hospital, so I called 911 and sent him in via EMS. His primary Neurosurgeon initially felt- based on the clinical picture as I reported it- that the time to treat his hydrocephalus had probably come. THEN, the On-Call Attending (who is apparently a little full of himself according to my former colleagues) goes and says "After talking to Dad, what we're mainly dealing with is overreaction on the part of the visiting nurse." I was so rip-roaring mad when I heard that.

First of all, Dad had left him with the neighbor at 8am so had no idea what he looked like when I was there at 3pm. This baby had all the classic signs of hydrocephalus. They keep wanting to say that his increased head circumference is just normal growth but he's gone from the 12th to the 18th to the 23rd to now the 50th percentile and his weight is only in the 30th percentile. Do I have X-ray vision? I can't see what's going on inside the baby's head. Am I supposed to just do nothing with a baby who's showing all the signs of hydrocephalus who's got a caregiver who's let him scream and vomit for 7 hours under the assumption that the Neurosurgeon will probably not want to treat? Who will get blamed in that instance when the baby is dead in the crib the next morning? They did end up admitting him but it aggravates me beyond belief when surgeons are so dismissive. I forgot how aggravating they are to deal with, I mostly deal with PCPs and Oncologists now and they are very responsive to me.

Happy freaking nurses' week.