Saturday, November 11, 2006

CONS

The mother was complaining, accusing the hospital of giving her baby an infection. In a way, she was right. Her baby, a twin born at 31 weeks gestation, developed a coagulase negative staph (CONS) infection at the age of ten days. CONS are bacteria that live on our skin and other parts of the environment. They cause no harm to us, but to premature babies with poor immune systems they can cause a real infection. In fact, they are the most common cause of late onset infections in the NICU.

I have mixed feelings about CONS and blaming hospital workers for transmitting CONS infections. I don't just want to say, oh well, infections happen, because there are measures we can take to try to decrease the rate of such infections, like good hand washing, and I think we need to keep trying to improve in this area. On the other hand, even with our best efforts some babies get CONS infections. I don't think any hospital has totally eradicted it from their NICU. Also, it's possible that the mother or another visitor transmitted the CONS bacteria to the baby.

The mother kept complaining and said that she should transfer the baby to the hospital across town, where her aunt works and where "they know how to take care of babies." Finally, our nurse had had enough. She asked the mother where she received her prenatal care, knowing that mother had very limited prenatal care, and knowing that she had used marijuana during her pregnancy. When asked why she hadn't gone for more prenatal care, the mother sputtered a bit and said it was because she had planned to abort the babies, but when the father went to jail she decided to have them. (We couldn't figure out that reasoning either, but hey, whatever blows your hair back.)

We know that we're supposed to be nice to parents of NICU babies, even when they are critical of us. We know that hospitals should offer good customer service. We know that having your baby in an NICU can be stressful and make you say things you might not otherwise say. But if there is one thing we have trouble tolerating, when we're doing our best to optimize these kids' outcomes, it's taking crap from a mother who didn't even care enough about them to get decent prenatal care. After all, we're only human, too.

16 Comments:

Anonymous Anonymous said...

but neodoc,you don't get it,it's 'all about her' she probably doesn't care the poor little guy is sick,(or maybe she does,just a little) her main concern is to keep your and your staffs' attention on 'her' wants and needs.her babies obviously don't figure into her own twisted equation.why else would she have so woefully neglected her prenatal care? nope,nope,nope,it's all about her and her "poor pitiful me" mindset.her attitude qualifies for my new descriptive acronym "WABOS" what a bunch of ----

5:15 PM  
Anonymous Anonymous said...

In my experience this kind of 'tude is all about power. This mom has none, you have a lot, or at least compared to her you do. The health care setting is one place where she knows she has RIGHTS and therefore she can jack you around. Passive aggressive behavior, like the nurse asking about her prenatal care, is the only possible response for me most of the time. I find it tough to come up with any compassion for a mom who can't manage to get prenatal care. Especially when she can manage to get $75 fingernails.

7:16 PM  
Anonymous topher said...

Hi Neonatal Doc,

I subscribe to your feed which makes me one of the most silent of readers, reading each entry and clicking to the next post from the blogosphere. It also means I read everything that you write and I keep waiting for you to run out of single-word-titles to aptly describe the entries. Regardless, I'm out of the shell to tell you that I love the writing. Keep it up.

11:15 PM  
Blogger Flea said...

ND,

I'm not sure you have to take crap from anybody, except for patients themselves whose lives you are saving. You are upholding the highest standard of professionalism in your care: Why not defend yourselves against nastiness? Good for your nurse!

best,

Flea

7:06 AM  
Anonymous Anonymous said...

I disagree with you about 'having to be nice even when they are rude'. Why should we docs be nice if a parent with an IQ of 30 is trying to blame everything that is wrong with their baby on the hospital?
I am always nice to my patients, but if they act out/misbehave, I am extremely firm with them...and I have noticed it works in most situations.
If the mother wants to ship the baby across town, I tell them I will be more than happy to tranfer the baby. In almost all cases, these are just empty threats. And if they leave, all the better. I dont want to deal with parent tantrums.
It boils my blood to see these good for nothing parents who survive on my tax dollars talking through their rear end.
They didnt think twice before smoking, snorting, boozing and prostituting themselves when they were pregnant, but now suddenly everything is the doctors/nurses fault!

11:44 AM  
Blogger Dream Mom said...

I can totally understand your frustration with patients like this who don't get any prenatal care, don't take care of themselves and everything else that comes with their lifestyle.

When confronted with situations like these, I try to separate the issues too. As for the infections, there are certainly procedures that can be put in place to minimize staph infections. I guess, what I am thinking about is MRSA, a common hospital based staph infection. My frustration in them, lies in putting all of the responsibility on the patients. One example that comes to mind, is when I am at Big Academic Medical Center and the sign flashes on the television for patients and caregivers to wash their hands to prevent infection. The reality is that most of the docs, nurses and hospital staff enter the room and do not wash their hands. Furthermore, I have seen many a nurse and a nurse's aid, change Dear Son's diaper, who has MRSA and place it on the tray that is most commonly used for lunch, and think nothing of it. Or they will place the diaper/stool on the counter, where I need to wash out his syringes, or they'll place anything dirty in the sink. Same thing. I also have seen many a worker, assume that since they are using hospital gloves, there is never a reason for soap and water to touch their hands.

Ironically, this same hospital, requires anyone entering the play room, to use the hand santizer near the door, and you are not allowed admission without it. Furthemore, you have to be buzzed in, and the staff will watch you use the hand sanitizer. All toys that leave the play room are santized before coming back in. This is the highest standard of any department or room in the entire Big Academic Medical Center. If the hospital were run as well as the play room, we'd have a lot less MRSA.

Now then, I can totally relate to the frustration of patients like that and make no excuses for them nor do I condone their behavior.

I do think it's important to analyze, from a hospital perspective, what can be done and what procedures can be put in place to minimize infections, especially when you have a patient population as such, who would have very few reasons not to sue.

12:00 PM  
Anonymous vartabedian said...

I'm with Flea. We're raised as physicians to believe that we're supposed to take abuse on the chin. The doctor patient relationship is just that, a relationship. And relationships go two ways. While we always need to be sensitive to the issues of our parents we need to be comfortable with the relationships we get into.

12:32 PM  
Anonymous Anonymous said...

I love the debates your blog generates ND. Keep it up!!

4:48 PM  
Blogger NoEmptyArmsHere said...

I love seeing all the diaglogue these entries create but with one exception. Why does a certain/certain anons seem to equate so many ignorant things to IQ?
Are they, themselves deficient enough in that area that they need to stoop to insulting the disabled community?

7:28 PM  
Blogger neonataldoc said...

Thanks, everyone; I'm a bit surprised, but pleased, that most of the comments are supportive. Interestingly enough, this episode was just one part of what has, for the most part, been a good relationship with the family.

DM, I, too, see people at the hospital not wash their hands, even people who should know better. It's frustrating. Topher, thanks for the kind words. I plan to use one word titles for at least the first year of my blog, for no particular reason.

9:00 PM  
Blogger karrvakarela said...

Hi Neonatal Doc,

This isn't related to the post but I had a question I was hoping you could answer: you once mentioned that you took a year off after the residency to practise general pediatrics and then started your neonatalogy fellowship. How easy is it to get a neonatology fellowship once you're out of residency and in general/hospital practise for a couple of years?

Thanks!

12:21 AM  
Blogger WendyLou said...

I don't think you need to take abuse from parents. I took plenty and it did me no good, and gave the parents more license to abuse. I think it lets people thing that behavior is acceptable.

Often times, it to too painful to be angry at your self, so you take it out on others.

Along the lines of Dream Mom....

At our NICU, parents/visitors were required to scrub for 3 minutes. There was a timer and everything. We had to gown as well.

One neo scrubbed when he arrived. He brought in a visting doc, adn I heard him direct that doc to the scrub sink, as that doc was headed into the patient area. He said "Hey, we have germs too." The other 2 did not.

I never saw a nurse scrub when begining her shift or returning from a break.

If you left the NICU, you had to re-scrub. If you used the bathroom in the NICU, no rescrub required.

I had to scrub with IV in place, even though my post partum nurse had scrubbed my hands in my room to help me.

I know this because DD's bed was very close the the scrub sinks, so while sitting in the easy chair, I could monitor the comings and goings of the NICU. (We were at the end of the hall.)

12:33 PM  
Blogger neonataldoc said...

Karvvakarela, I didn't have trouble getting a fellowship. In general, I think there are more fellowship openings than there are applicants.

4:39 PM  
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