I work in a pediatric ER and I am so sick of all the crazy parents out there. Just the other day I had this little 26 day old come in with a known seizure disorder on phenobarb. Baby was d/c'd from NICU the day before and had a seizure at home... so what do the parents do? Rush the kid to the ER for a "STAT phenobarb level and want to immediatly 'give her a po bolus' of phenobarb." UGH, had to explain to them that giving her a "po bolus" will make her stop breathing! So, we draw the phenobarb level, they won't let us draw anything else because they state the baby is anemic and that drawing another 10th of a teaspoon of blood will push her over the edge (even though we can't draw a CBC to see if she really IS anemic).
So we draw the Level and are waiting for results now, every 5 minutes they come out and ask if the results are back, meanwhile they have "bolused" the kid without our concent--although not as much as they would have if we hand't said something, because they know better since the dad's a pharmacist and the mom is supposedly medically inclined somehow. So we're waiting for the level and the kid has a seizure in the ER, great, just what we need. Baby's pink so we're setting up a little O2 and suction and the sat probe falls off the kids toe, mom freaks, throws her portable O2 tank on the bed dad starts yelling "she's getting dusky" And meanwhile we put the probe back on, the kid's fine. I keep saying, she's fine, she's pink... mom's yelling "I'm losing my child!" UGH, drama.
So then MD orders ativan, which I was soo happy about so that we can prevent this kid from having another seizure and having the parents freak again (asked them if they'd witnessed seizures before, they said yes "at least 6"... but only in the NICU). I go in to push the ativan and they ask, once again, if the level's back, I state that I will check the minute I'm done pushing the med. But no, they won't let me touch the baby until I check. I had had enough at this point, I kinda blow out of the room, I know I shouldn't have, sit down at the computer and nope, not back yet. Mom starts crying at this point, telling me to not be upset. I apologize, push the ativan and leave.
Another nurse does most of the care after this point, thank goodness, because I wasn't sure if I couldn't take much more of these poeple. I try to educate that the kid will have seizures, she has a seizure disorder, but parents are too freaked to listen.
(There were at least 4 other very demanding families there that night, the MD almost lost it too.)
MAN, this was probably the most unwilling, demanding, dramatic family I've ever dealt with. I barely kept it together. I'm kinda ashamed with myself for losing it like I did. But, even the Doctor went into the room and told the parents we were trying to care for their child, but they were making it difficult. How do you get over these families? I just keep my finger's crossed and hope that these people don't come back when I'm on (isn't that horrible). Anyhow, just needed to vent. thanks.
So I've been reflecting a lot on this family since my first post and I think I've figured it out. I know these parents were anxious and upset that their baby was back in the hospital, they had every right to be demanding and so forth. It was just all of the circumstances in the ED that night. Multiple traumas, multiple demanding families (the attending--director of the peds ed-- even said he just wanted 1 family to work with him), and being short staffed made it an extremely stressful night. I'd go into this room to provide care and end up being "reminded" numerous times to check for labs, etc, etc, etc. And then when the kid seized it just escalated things even more, partially I think because the "stat P.O. bolus of phenobarb" didn't work, even though it should have per the dad. Oh well, I guess it helps show the parents the kid will have seizures, and as long as they're self-limiting, they can observe her, make sure she doesn't aspirate or anything like that, and she'll make it through. I have not seen them back even though it has been a few weeks, so maybe that one visit helped them accept that this baby will have seizures, and that this is OK. I dunno, just a thought.
Just wanted to say thanks again for everyone's understanding. I love working peds, wouldn't change that for anything. The smiles and "high fives" and most of all the hugs are worth it!
The family I spoke of in this thread has returned to our ER twice now. I was present with the third visit. We were extremely busy, and I was running with a PICU admit an Onc admit, so I didn't get the patient (thank goodness). However, the nurse that did kept saying she thought the mom had munchausens (sp?) by proxy. (Not a possibility, since we saw the baby have a seizure on the first visit, plus known disorder diagnosed at birth.) She spent about 45 min with the family explaining everything and said she was avoiding going into the room because of how difficult the family was. Luckily, the family wasn't demanding formula, blood levels, etc, like they were with their first visit. But still, this seasoned nurse with 30+ years experience in the ER and PICU was having a difficult time with this family as well.
It made me feel better, I knew I wasn't the only one, which was great. Anyhoo, just thought I'd add that.
As the mother of a preemie, I can only imagine how horrified the parents were at bringing their baby home and having the baby have a seizure. The first two nights after I brought my baby home I didn't sleep and I was terrified she would stop breathing, b/c all I kept hearing was she was high risk for SIDS, etc.
Are the parents over-reacting? Somewhat, I would agree with you. However, education is the key to helping them understand what is going on.
I remember when I first started visiting my baby in the NICU, everytime an alarm went off I freaked..until they showed me how to read the monitors, and I was able to focus on my baby instead of the monitors.
See if there is a NICU support group for parents for babies who have been born too early or have ongoing issues when they are released. I know I could not have made it through without them.
being a mother of 3, i know how irrational parents can seem when it comes to their kids. the saying is true - it's different when its yours. you are sooo bonded to those little ones, that health decisions take on much more weight, and crises seem so much more frightening.
and, being a nurse, i know that not all doctors & nurses are competent simply because they are employed by a hospital, and just because a doctor orders it, doesn't mean its necessary or appropriate. therefore, i have difficulty trusting medcial professionals i do not know - - pair that with a specialty i don't have much experience with, and it makes for one nervous mom!
i understand how the op would be frustrated with those parents. they did interfere. but, i also wonder how it would have gone if someone had taken the time to ask questions and educate them.
i tend to give people the benefit of the doubt when they do strange things like that. or perhaps i should say, things that seem strange to me. perhaps the focus in the nicu was the phenobarb level, maybe anemia was discussed. i know it is a common issue. they hadn't had long to get used to her disorder, so they would be freaked the first few times it happened, i know i would - and i'm a nurse.
did anyone ask them why they didn't want the ativan given? did anyone try to explain the treatment plan for seizures in the er and how it differs from what they were accustomed to in nicu. did anyone explain that the lab has to spin the blood down first, yada yada yada... or whatever the case is?
i know with bili results (for jaundice in newborns), since i have started preparing parents by telling them the lab has to spin the blood down first, and that it usually takes about an hour to get the results back, that far fewer are bugging me about the results too soon.
when i have nervous moms in the nicu who jump every time the monitor beeps, i teach them a little about false alarms and tell them that they aren't allowed to get worried unless i get worried. "when you see me running across the room to your baby, then you can worry." we all have a laugh, and they calm down. a well-timed joke can go along way when calming parents' fears. it makes them consider their behavior from the perspective of the bigger picture.
anyhow, maybe all these parents needed was for someone to sit down after the crisis was over and explain what managing their child's siezures would be like day to day. giving them a mental picture of what to expect and what things to be concerned about would have probably gone a long way toward their mindset and the behavior that stems from it.
last but not least, i'd much rather deal with parents who seem to care too much, than those who don't seem to care at all.
analee23
115 Posts
So I've been reflecting a lot on this family since my first post and I think I've figured it out. I know these parents were anxious and upset that their baby was back in the hospital, they had every right to be demanding and so forth. It was just all of the circumstances in the ED that night. Multiple traumas, multiple demanding families (the attending--director of the peds ed-- even said he just wanted 1 family to work with him), and being short staffed made it an extremely stressful night. I'd go into this room to provide care and end up being "reminded" numerous times to check for labs, etc, etc, etc. And then when the kid seized it just escalated things even more, partially I think because the "stat P.O. bolus of phenobarb" didn't work, even though it should have per the dad. Oh well, I guess it helps show the parents the kid will have seizures, and as long as they're self-limiting, they can observe her, make sure she doesn't aspirate or anything like that, and she'll make it through. I have not seen them back even though it has been a few weeks, so maybe that one visit helped them accept that this baby will have seizures, and that this is OK. I dunno, just a thought.
Just wanted to say thanks again for everyone's understanding. I love working peds, wouldn't change that for anything. The smiles and "high fives" and most of all the hugs are worth it!