<p>Hypothetical conversation between Nadya and the discharge planning team (totally ficticious, for purposes of illustration…)</p>
<p>Ms. Suleman- 4 of the babies are stable, have gained 18 oz and are developing adequate suckling skills, allowing us to remove their feeding tubes. They no longer meet criteria for continued inpatient care. They are to be discharged. Have you contacted Medicaid (medical) to arrange for insurance coverage for them? Oh, you were getting your nails done, I see. They will do best being fed on breast milk, supplemented with special formula. Have you been pumping and storing breast milk? Oh, you were on the Dr. Phil show… I see. They will require special cribs with appropriate cardiac monitors and oxygen saturation monitors as they are at risk for breathing issues, heart decelleration and SIDS. Have you arranged to rent the cribs? Oh, you haven’t contacted Medicaid yet. I see. Have you arranged to have your home checked out to assure adequate wiring and power supplies for the cribs, monitors, etc? Oh, you were at your lawyers all day. I see. Have you been trained on how to monitor their breathing, suckling, eye care and vision, hearing, G.I. development, expected weight gain, etc? Have you been trained on how to recognize symptoms of RSV or other emergency situations? Have you arranged for clothes, diapers, bottles, bottle warmers, carseats, eye and hand protection, etc. Oh, you were in wardrobe? I see. When will the special cribs be delivered? Do they fit in your home? What will you do if you and your mother have to bring one or more of the babies emergently to the hospital? Who will watch the other chidren? Oh, Gloria Allred is on your speed dial? I see.</p>
<p>Well, we happen to have a wonderful temporary foster care arrangement with state of the art preemie beds, monitors, trained staff, all approved by the state and covered under medicaid (medical). Oh, I forgot-- you haven’t set up their insurance yet. I see. Well, perhaps we can get an emergency approval, as they no longer meet criteria for inpatient care and need to be discharged. Were you aware that when you request disability services, they require a home visit to assess the needs and supplies? Oh you didnt know that? I see. Did you know they need a 1 week minimum time for scheduling? So you think that all the babies need is unconditional love? Oh, I see…</p>
<p>*** Oh I forgot-- their skin is delicate and they are still healing from removal of feeding tubes. Have you been trained in wound care? Oh, you will put a dab of your nail adhesive on the wound. I see…</p>