Friday, January 31, 2014

"Have You Examined the Patient!?"

Surgeons tend to get a bad rap amongst nurses.  Not necessarily in my institution necessarily (or consistently), but in life, in general. 

They can be known for bad bedside manners. They can be known for being short (in personality, not stature).  They can be known for talking down to all non-surgeon personelle. 

And then there are the rare but fine (oh so fine!)  moments, when one of them just says something utterly ridiculous that you can call them out on!

What was even sweeter about my interaction with a particular surgeon this week, was there were 3 of my collegues listening in on my phone conversation.  As I hung up, they all bust out laughing, and couldn't believe what they had heard.

So enough setting up the story...onto the good stuff!

I had been caring for a four year old girl who had cerebral palsy and several other medical problems. She was severely mentally and physically disabled, was completely non-verbal, can't fix or follow objects, and was definitely on the small side of the growth curve.  I know that's a lot of info, but it comes to be important in a bit.

She came in for pneumonia, but I noticed that she was malnourished, and recommended consulting Pediatric Surgery for a G-Tube for feedings. I was actually shocked that up until this point she had been fed by mouth for so long!

Looking through her chart, she had previously had a swallow study showing that she was aspirating (which was just as I suspected), so this further built my case for needing a GT.

I placed the call, told the surgeon why we were consulting, and he said he would go see the patient later in the day and get back to me.

Just as I was getting ready to leave work, I get a phone call. Reluctantly I picked up, and was so glad I did. 

The conversation went like this:

Surgeon:  "So I went and evaluated your patient.  I also talked with the mother for a bit, and we are not going to place a GT.  She doesn't need it."

Me:  "Umm, I'm sorry, why do you not think that she needs it.  She is malnourished, she has a swallow study showing that she aspirates, and given her underlying medical problems, none of this is going to change anytime soon."

Surgeon:  "Well the mother says that the patient is able to tell her when she is thirsty, and mom gives her water to drink.  She also says when she is hungry and she will get an apple and eat it. She's been doing this for the last four years, and while she may be on the smaller side, perhaps the mother isn't giving her enough nutrition which we can educate her on." 

Me:  (let me preface that I was BAFFLED at this response!) I simply stated "I understand that you had a conversation with the mother and were given that information, but did you examine the patient!?"

This took him back a bit, and he stumbled over a few words and then said, "Well, yes I saw her." 

More adamently I said, "This patient is completely non-verbal...why would we think that she is verbally telling her mother that she is hungry or thirsty!?  She is severely contracted and does not have purposeful movements, so why would we think she would say she wants an apple, reach for it, and then feed herself!?  I understand what the mother told you, but if you spent five minutes evaluating the actual patient, you would understand the reality very clearly."

*This was the point in which my co-workers were laughing b/c I was so in awe of his ridiculous reasoning that I was definitely firm, but remained very calm*

He didn't particularly like this (I'm assumming), because he got really quiet, then didn't really say too much. 

At the end of the conversation, I gently reminded him to go back to the patient, do a thorough evaluation, and then come to a conclusion on whether this child was safe to eat by mouth, and more importantly able to take in the appropriate nutrition that way. 

He agreed, and then said that he would talk to his attending and call me in the morning.

The next morning I get a text page from him saying "Discussed with attending. We will place GT in 4 weeks.  She will need imaging prior to that."

Short, sweet and to the point.

And yet such a sweet, sweet point made by me! 

Just another lesson learned in the importance of truly evaluating your patient. And yes, while parents are a wealth of information most times, sometimes they don't live in a full reality.  It takes our medical evaluation, studies, and judgement to help determine what is best for these patients.

Score one for the Nurse Practitioners...lesson learned for the Surgeons! 

Saturday, January 11, 2014

Exhaustion: PICU vs Pregnant!

Hi friends!  I know, I know...I've definitely fallen off the blog wagon. 

The holidays came and went so fast (don't they always), and now I'm still here thinking now's the time to jump back on.

But then work happens and it's been SO crazy lately!  Tons of sick kids equals tons of crazy busy shifts. Which leaves me just flat out exhausted on my days off.

Oh, that and the fact that I'm pregnant!!  Really, I think that's the major contributor the extreme exhaustion, but still...the job isn't completely innocent : )

For those of you that personally know me, you know this has been a very long journey to motherhood.  Four years of dreaming, planning, praying and hoping.  Four years of countless doctor appointments, about a trillion blood draws and medications, and a hormone imbalance and severe clotting disorder diagnosis later, and here we are!! 

So of course I had to start a pregnancy blog that I hope to continue onward and document our little one has he or she grows.
And when I sit down after a really long day in the PICU, I can either get on and blog about how I didn't sit, eat or pee for the last 12 hours, or I can relish in the fact that I'm pregnant and document that amazing journey.

Yeah, guess which one generally wins!?!? (if you're interested:

But regardless, I still love my first blog baby.  And I am still madly in love with the PICU.  So while I may not be as present, or have as many fun or funny stories, I'm not going anywhere. 

Just thought you should know.  Because really I know how patient you all are. And since most of my readers are either family or other nurses, I'm grateful that you just get it.

Shoot, my nursing and APN friends probably log on every great once and awhile thinking, "Oh my schedule is so crazy...I don't have time to read blogs!" only to find out, neither does the writer.  So at least we are on the same page ; )

I do have some stories in the back of my head that I want to share.  And I do have some topics that keep getting asked about (eg: DNP, picking grad schools, studying for boards, etc) that I want to address as well.

So stick with me and we'll get through this crazy, busy life slowly written blog post at a time.  And if you're in the PICU like me, you wouldn't want it any other way!  What's life without some busy, without some crazy!?!? That's PICU at its finest!