Day In The Life

"Her blood pressure is 144/77." I told her mother.



"Is that high?" she asked.



"For a 12 year old girl who weighs 95 kg, that is high." I said.



"Wow, she weighs 95 kg?" her mom asked in surprise.



"95 kg..." I replied.... "Is two hundred and nine pounds." I wondered if this mother actually thought he daughter weighed 95 pounds. She was obviously obese... like her mother.



"I think it is the headaches and the stress." She defended.



"I think it is her weight." I could only be honest. I can not be politically correct when a 12 year old girl is standing in front of me weighing in at 209 pounds, and everyone is denying it. "I do need to get some blood work." I continued.



"She has very small veins..." Mom said. I took a look. She did not have small veins. She had great veins. They were buried in fat.



Here is a little hint.... never tell a pediatric emergency dept nurse that you have veins that are too small to puncture. It is my job to be able to puncture the smallest, most dehydrated spider like veins. I sometimes put IV's in baby's scalps.



And so goes another shift in the Pediatric Emergency Dept. If the patient population was actual emergencies, we'd only need half the staff that we have. The problem is.... the patient volume and the reason that they come to see us.



This morning it was a mom and her 2 daughters that missed their 10am appointment. They came to us at 11 instead of rescheduling. Mom wanted to know how long the wait would be. After all her daughter has had a sore throat for TWO days!



Last night a young boy came in with a burn. I love pediatric burns ... not because a child was burned... but because there is so much you can do to help them and their family. So picture this, burn boy comes in via ambulance (EMS we call it). I check them in, medicate him, apply dressings to his burns, tell the family we will need to begin IV fluids. I finish checking them in so I ask the EMS crew to meet me in room 37 Left, and I will be right there. As he wheels away an 18 year old boy comes in on a stretcher. His mother is next to him. realizing the other nurses were also swamped I begin to triage, assess and check him in..... while my mind is on burn boy.



"He's been sleeping longer than normal" Mom said to me. 'And his left elbow hurts." I looked past her as the 18 year old wide awake boy. On a stretcher. Form an ambulance.



"How are you feeling buddy?" I call to him.



"Fine." He says. After I took his history and vital signs I shake my head at the fact that 911 was called for this.



"I have to tell you..." Mom said in a quiet voice. "He is very irritable and sleeping 13 hours a night." Then she looks right and then left "And the last time I was not impressed with the doctors here."



Okay red flag..... big mistake Mom. Don't come to my hospital and tell me you don't trust the doctors here. Just because you have watched ER, Grey's Anatomy and Scrubbs .... you are not a medical expert. Coming to my hospital and stating to me that you don't trust my colleagues, you just got a red flag. Especially for calling 911 because your teenage boy is cranky and sleeping 13 hours a night.



My charge nurse directs me to place Sleepy boy and Mom into the waiting room. Now vitals were perfect and he said he bumped his elbow. I have a kid with a pretty big 2nd degree burn waiting for me and 6 other patients who are much sicker on my assignment. And a whole waiting room of stuffy noses waiting to be seen.



"Oh no!" Sleepy boy's Mom cries..." He needs to be seen NOW" She is getting loud, and I am sorry, I just don't' deal well with that.



"Ma'am." I say quietly. "We are full, we have a waiting room full of children, we have several children who are sicker than you son is right now, I appreciate your patience we will get to him as soon as we can."



"I AM NOT WAITING!" She screams. "SOMEONE NEEDS TO SEE HIM NOW!!!!" By this time I have created a comfortable place in a wheelchair (as comfortable as they can get) in which sleepy boy could rest and wait.



"Ma'm." I tell her sternly. "You have the right to leave and be seen at another hospital. Right now I have a badly burned child to attend to. Here is where you son can rest and wait." I turned to Sleepy boy, "Are you okay with that?" He nodded looking annoyed with his Mom. "So while you make this decision I need to go and take care of a burn."



And so it continues int he life of the Peds Ed. Where your child, your problems, your situation is always the worst. Where we are always wrong, where the hospital never knows what it is doing.



Let me remind you.... you cam to us, we didn't go out and invite you in.



Better yet, let me explain how things work.



We have X number of rooms. We have 3 times that many patients. The sickest kids come back first. The nurse and resident will see you. The attending will see you. Maybe in that order, and maybe not. If you need X rays you will get X rays. If you need a CT you will get one. It might be in 5 minutes and it might be in 5 hours. There might be a level II trauma that comes in and bumps you back.



We may need to get blood work. Your pediatric nurses are your best bet for hitting a vein. It's pretty much all we do. We poke babies, children and young adults. Your child is a wrestler? We handle it. Your child will cry? We know that, we help them through it. Having your coping skills encompass doubt towards our abilities will not help. Comfort your child and we will get the vein. They won't pull it out because we know how to prevent that.



It is supposed to take 30 minutes before the blood work is back. It may take longer.



Your X Ray results are not final until read by the radiology attending. I can't do anything, even if I can assess the X Ray myself... until the attending gives their read.



If you ask me how long anything will take I will never know. I don't even know the guesstimate. If I tell you an hour and a pediatric trauma rolled through the door, it just because 3 hours.



We are not here to torture your child or to screw you over. Believe it or not we are here to help. But before you berate me for the length of your stay please remember one thing....



Before I walked into your room I just might have been holding the hand of a child who died.



:-) mary