Wednesday, June 14, 2006

Reaction

It was just a small cut, a couple of millimeters long, on the tip of the baby's earlobe. At first glance it looked like the tip of a scissors had nicked it, but on closer inspection it appeared a fingernail or needle might have scooped out a little bit of flesh. It will probably heal without leaving too much of a scar.

Mother was livid. She examined her baby head to toe every day and knew that something had happened to the ear. Mom used colorful language and threatened bad things if anything else happened to her child. It didn't help that no one would fess up to doing it, so we don't know exactly what happened. It also didn't help that my partner on duty at the time, when called to see the baby, heard the mother complaining and took 45 minutes to actually go into the room and evaluate the cut. My partner then made matters worse by minimizing the whole thing, telling the mother it was really nothing and unimportant. Eventually, one of the baby's primary nurses and the nurse manager talked mom down.

There was a time earlier in my career when I would have been a little ticked at mom for that kind of a reaction. We deal with some pretty tough stuff sometimes in the NICU. Accidents will happen, and in the big picture we have done a whole lot more good for her 24 weeker than harm. But now I see it a little differently. For one thing, I know that when it's your own kid nothing, especially in a hospital, is unimportant. Also, I know that mom was probably mad not just about the cut, but about everything. She was mad because her baby was extremely premature and had been on a ventilator the past seven weeks; she was mad because her baby couldn't be at home and it was a pain trying to visit her while she also cared for her two toddlers; and she was probably mad because dad was in jail and although she was doing her best to keep him informed and the family together, it just wasn't easy to do so.

Life can be rough. I'll keep working on her baby's ventilator thing, but I don't know any cure for those other problems.

14 Comments:

Blogger Flea said...

I'm not sure you guys have any alternative to these situations apart from responding immediately and apologizing profusely.

I got a call yesterday from a dad, a gastroenterologist), who was in the hospital in Boston where his second child was born. It seems the baby's knee was cut with a scissors. It took the resident 2 hours to get there. Dad was apeshit and wanted to know if a tetanus shot was needed.

It seems like a little thing, and it is - it's just so easy to say and do the right thing, that there's no excuse not to do so.

best,

Flea

5:02 PM  
Blogger Kristina said...

As a parent, acknowledgement goes a LONG way. Heck, in dealing with *anyone*, this is true. People settle down when they feel heard.

7:32 PM  
Blogger Fat Doctor said...

When Son was in NICU, he had a minor reaction to the tape holding his NG tube in place. I went berserk. It wasn't the tape, trust me, but the whole situation. I just needed a venting moment.

10:30 PM  
Blogger Ex Utero said...

It's called taking it on the chin.

we screw up. We have to step up to the plate and say "yep one of my nurses/medical students/RTs or I... did that. We are so sorry... and we are going to do everything we can to make sure it doesn't happen again. Except that it will, to someone else's baby, someday...because the these things do. It's human error...and life especially premature life, isn't the perfect bundle of joy you thought it would be."

"I'm so sorry. Really. I am. But in the scheme of things, isn't this better than the alternative?"

OK that's not what I say, really, I'm more sensative than that, but you get the drift.

I was involved in this process once when a nurse in training snipped off the tip of a child's pinkie finger by mistake while trying to get a taped arm board off. It was a twin and there after (honestly) it was the only way we could tell them apart at bath time (other than reading their bracelets). They were the most adorable babies.

We did ban the use of scissors within the isollette in that unit after that episode.

10:20 AM  
Blogger That Girl said...

I had the opposite thing happen to me - they told me "Your son's line infiltrated. We called in plastic surgery but they said just put some cream on it."
So Im thinking - Called in plastic surgery, they are so over-protective, it's sweet. He using his hand (with a nice white bandange on it).
Then the next day I came in when the nurse was airing it out - i could see along the side of the large area (half-dollar sized) where his necrotized skin met the muscle and bone.
Im pretty sure I had a seizure.
I mean, "line infiltrate" sounds so inncuous, non? And of course, the "no big deal" attitude (perfectly natural in a NICU nurse) gave me the completely wrong impression.
On the other hand, the original nurse probably thought we were jerks for seeming not to care.
Im pretty sure no one ever completely wins in a NICU.
But Im glad you keep trying to reach for compassion.

11:28 AM  
Blogger Dream Mom said...

Sometimes, just acknowledging and apologizing go a long way. I had a situation a little over a year ago where a surgical nurse (who assisted with the g tube surgery) put in a too large feeding tube that blocked Dear Son's stomach opening and caused him to vomit for months. There were three separate hospitalizations-one was three weeks long and the last one was 32 days long and cost over $200,000. When the issue was discovered (and it was defintely her fault because she was the only one we saw for the g tube clinic and the only one who changed his tube), she went beserk. Instead of apologizing for her error, she insisted that it must have been something that I had done, and tried to blame just about anyone else. Never mind the fact, that Dear Son nearly died over this error or the fact that they were thisclose to doing another surgery for a g-j-tube etc. I had to foot the bill and sit in the hospital for weeks plus miss a ton of work for all three hospitalizations and all of the days off school he missed until they could figure it out. I also had to manage all the medical bills. You can bet I was not pleased about what happened, let alone her reaction which was unprofessional.

All she had to say was that she had done her best and apologize and it would have gone a long, long way.

Needless to say, I never went back to that hospital for g tube clinic.

In the end, there were several other incidents involving her at the hospital where she had a similar reaction.

We are in the hospital a lot. I expect that mistakes do happen. All I need most of the time is an apology that they are truly sorry and an explanation.

4:30 PM  
Anonymous Anonymous said...

I think often parents go a bit crazy when this sort of thing happens because they have to trust completely in the hospital to care for their baby. It is hard for many parents to just drop their kid off with a babysitter for a few hours, it is much harder to hand your baby over to a hospital for weeks or more and having to trust that they will care for that baby as well as you want them to be cared for.

When my daughter was in the NICU I lost it on a nurse. She had just dealt with the baby next to my daughter and then came over to look at my daughter without washing hands or changing her gloves (baby next to mine was dealing with a lung infection and my daughter was ok, but I didn't want her to catch anything). Anyhow, the nurse acted like I was completely overreacting. Because of her attitude towards me, then I wondered how often stuff like this happened when I wasn't sitting right there. What if my baby ran into serious trouble? Would they pretend like it was no biggie? If they made mistakes would they be more concerned about covering them up or fixing them?

Thinking about it today (4 years later) still gets me steamed up. I wanted to protect my daughter from everything under the sun, but had to trust the hospital to do that instead as she needed their help. Honestly, all it would have taken to remedy the situation would be for the nurse to have said, "You are right, I am so sorry and it won't happen again."

By the way, my daughter made it out of the NICU without any additional issues or infections, so they overall did their jobs very well :)

6:50 PM  
Anonymous Anonymous said...

no matter if it you child or not, it is never right to take out your disappointment in the world on those helping said child...

7:13 PM  
Blogger La Lubu said...

It's true that the mother may be angry at other situations in her life also, but I think the intensity of her anger boiled down to this: treating the cut as if it was no big deal is another way of saying:

who gives a shit about your kid, lady? It's just gonna die anyway." (or "be a vegetable, disabled, retarded, etc." and hence, not matter.)

See, there is a hierarchy in this world, and those of us who don't graze the top of it are very aware of this. It's one thing to weather the slings and arrows yourself; it's quite another to see your own child's life devalued, especially in a most vulnerable time (and it doesn't get much more vulnerable than in the NICU.) The failure to apologize on the part whoever cut the child's ear is reprehensible.

8:17 PM  
Blogger neonataldoc said...

Thanks, everyone. I agree that the best thing to do in a situation like this is apologize eand try not to do it again, and not to minimize it.

Dream mom, I agree the nurse should have apologized. But maybe her reaction was a defense mechanism against the terrible guilt she would feel if she admitted she made such a huge mistake.

La luba, I appreciate your opinion but can't agree with you on this one. We don't think those terrible things about the babies in our NICU's. We really like them and feel bad when they do bad.

10:25 PM  
Blogger Ex Utero said...

NeoDoc,

I dedicated one of my episodes to you this week:

http://talesfromthewomb.blogspot.com/

10:46 AM  
Blogger La Lubu said...

neonataldoc, the point isn't that the staff feels that way towards any particular baby or her mother, but that there is an unintentional message being sent when any distancing techniques are used. Some people are particularly sensitized to distancing techniques because they've had a lifetime of having strangers consciously, obviously distancing themselves (example: sales clerks trying damn hard to avoid any actual touch when returning spare change). What I'm saying is: it's a perfectly rational reaction, when you look behind the surface.

I'm sure it wasn't the intention of my daughter's neonatologist to send any message of coldness towards me or her. In fact, I continually reminded myself that it was a psychological defense mechanism on his part to not use her name. At the same time, it was a daily struggle on my part not to lose my temper during rounds when every other baby in the pod was referred to by name, while my kid was "the baby". Every child had his/her name posted prominently on the isolette; my daughter was "the baby" for two months. It wasn't deliberate hostility---but yes, it was hostile. It was blunt.

And yes, there are staff that would think "what's the big deal about another scar? The kid's got plenty of them already." I went through that with my girl too. Granted, her abdomen does look like a road map---but that didn't mean she needed a botch job of stitching on her neck (really. worst effing stitches you've ever seen in your life. And to this day, I don't know what the hell they were doing up there anyway; she already had a PICC line. My hypothesis is that some student dropped a scalpel on her and had to fix the result---that's pretty much what it looks like. Gahh.)

7:08 PM  
Blogger fairscape said...

nd

my son is 22 years old at home in a persistant vegetative state on a ventilator

it still makes me angry when I see the scars on the bottom of his foot where some idiot pinched him so hard they broke the skin trying to stim him up instead of intubating him right away and putting a line in

the first thing they should teach a doctor is how to say I'm sorry because everybody makes mistakes, no one is infallible and every injured person deserves to hear those words

granted it may all be about outcome but a neonatal unit doesn't always have the best outcome as far as the patient is concerned so shouldn't the outcome of an intact family and their future positive medical interactions be high on the outcome list

most nicus are in teaching hospitals and it seems you are in a position to teach others

(ps. i have been an rn for over thirty years - i know how hard it is to say i'm sorry but as the parent of a nicu/picu/micu graduate i know how important it is)

6:13 PM  
Blogger Susan said...

I agree with many of the other posters that the lack of an admittance of the accident is part of the problem. As a parent of a cancer kid for over 3 years I have seen my share of minor mistakes. I know medical staff are human and will make mistakes.

My son had an 8 hour surgery and came out with a very large bruise on the back of his head. We saw it after a few days and asked about it. We were told it was simply because he was on the table so long. I have since met plenty of kids with the same surgery and none have a huge scar on the back of their heads where hair doesn't grow. So, I don't buy it. I think someone banged his head on the table. I don't care if they did. I wouldn't have been mad about that. I feel like they were not forthcoming with me and that is why it still bothers me from time to time.

8:59 AM  

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