Tuesday, February 28, 2006


This morning I came to work to find one of our tiny babies struggling to breathe. She had extubated herself last evening and the neonatologist on call - in the hospital - had left her off the ventilator to see if she would do okay on her own, which was a very reasonable decision given the baby's condition. Unfortunately, he (the neonatologist) didn't follow up with her. He did not order a blood gas (a blood test to see the amount of carbon dioxide, oxygen, and acid in the blood), and even cancelled a previously scheduled blood gas for the morning. To make matters worse, the nurse called him at 6 a.m. reporting the baby's increased work of breathing, and he didn't get out of bed to come check her. Badly done, sir, badly done. I checked a blood gas when I arrived, only to find her carbon dioxide level sky high, so I put here back on the ventilator, and she's doing fine now. ( I don't write this to make me sound like a hero; it was pretty routine stuff I did.)

The neonatologist on call was a moonlighter at our hospital who normally works elsewhere. He's a smart guy, board certified, knows his stuff. He certainly is bright enough that he could have properly taken care of the baby - if he had been there. But it really frosted me that he let the baby get like that.

Doctors can screw up in different ways. They can be very busy and overlook something; they can be faced with a difficult decision and make the wrong judgement, while trying their best; and they can be lazy. I think many people can understand mistakes of the first kinds, although they don't want them to happen with their own baby, but this lazy thing is hard to take. There is no excuse for this doctor not coming to check the baby when notified of the harder breathing. We weren't so busy that he was exhausted and couldn't make it out of bed. He simply was lazy.

Don't get me wrong. I'm no saint and, like other doctors, have made my share of mistakes. But someone once said that 90% of life is simply showing up, or something like that, and we should at least be able to do that.


Blogger wunderkind said...

i hear ya - and agree.

9:34 PM  
Blogger Dream Mom said...

That's precisely why I never leave my son at a hospital unattended. I don't know if the mother was there with the child, or could be there, but the reason that you stay with your child is so that you can report when they are having distress. I would have been persistent and asked to see someone when no one failed to show.

You posted recently about Money. One of the reasons we don't mind our children's physicians earning the money that they do is because they have a responsibility to our child and will usually take good care of them even when we are not there.

When you don't have a personal physician, it's easy for people to get lazy or busy. Frustrating.

10:31 PM  
Blogger Flea said...

It was Woody Allen who said the line about showing up.

Love your blog.

I added you to my blogroll.

Where all da pediatrians at, yo!


10:58 AM  
Anonymous Anonymous said...

I agree with Dream Mom, parents can`t be absent, they must be there as much as possible too. At least twice I noticed my son having breathing trouble long before the neonatalogists did.

2:18 PM  
Blogger jennmit said...

Shame on the nurse for not bugging his butt out of bed! It's part of his/her responsibility to advocate for the patients and do what's needed even if you step on toes. The doctor may have erroneouly believed the problem wasn't that bad since he didn't get a followup phone call.

1:38 PM  
Blogger jennmit said...

Also, if the parents are aware of the problem, this breakdown has just destoyed their faith in their baby's quality of care.

1:40 PM  
Blogger neonataldoc said...

Thanks all. If one of my kids were hospitalized, I think one of their parents would be there 24 hours a day.

2:00 PM  
Blogger That Girl said...

Just wanted to point out that even being at a child's bedside is a luxury for poor parents. Especially children in long-term care.
And the collection agencies that collect for medical bills will be the first to suggest that you should have contacted them from the hospital bedside to make payment arrangements. As if beside phone calls were free.
I say this as a mom who has already used up her FMLA for the next 10 months (and of course my company ran out my vacation and sick days for maternity leave).
I live in fear that my son will be hospitalized before i can earn more sick or vacation days.

9:50 AM  
Blogger Rajat said...

Nice post...used to work as Neonatal Resident myself...one important thing is: did you report this back to the resident and made sure that he realised his mistake and was a clinical incident reported...he might be moonlighting elsewhere doing the same to other babies.


4:44 PM  
Blogger diary of a premmy mum said...

knew there was a reason why i let my anxiety be known :D To make sure lazy ass doctors don't forget who the important babies are!

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