Saturday, January 15, 2011

The problem is "they" don't know what they know and what they don't know...

***Before I start this post, I MUST clarify. THIS is MY opinion only and is not based on anything other than MY experiences through raising a chronically ill child and our emergency room/hospital vists. This is not a testament to ALL doctors, just the ones I have personally had experience with and have "generalized" here. If you don't agree with me or don't like what I am posting, please don't make rude comments. Feel free to share your opinion in a respectful and tactful way. Comments are approved by the author of the post.***

Ok, on with the post...and I am sorry it is a little longer than I had anticipated, but I wanted to include all the details...

As you all know, The Superhero had to go to the ER 2x last weekend. Both times were diabetes related. Vomiting. Ketones. High/low blood sugar. Dehydration. Each experience in the ER was completely different.

Saturday when we went, we were taken back immediately.

IV was started fairly quickly, especially after he puked all over the place. Zofran was given to clear up the nausea and vomiting.

They called HIS endo (even though she is not associated with the hospital anymore).

They let ME manage his diabetes.

Things were GREAT.

I mean, as great as they could be when in the ER with a puking diabetic.

When his BG started to come down more than I liked, I asked for a glucose drip, they got it approved and started NO PROBLEM. BG came up, insulin was given via pump, and ketones went DOWN.

All was good.

He started eating and we all felt comfortable with him coming home (including the staff there).

Then on Sunday when he started throwing up AGAIN, this time with lower blood sugar readings, we took him back in. NOTHING seemed to be absorbing in his tummy and we could NOT keep his BG up enough to get rid of the ketones.

So, back to the ER we went, knowing we would be admitted this time around.

We were taken back right away, even with a waiting room full of sick kids. I am still always amazed how quickly a vomiting, ketone filled, Diabetic gets whisked back to the ER rooms. They definitely know to take THAT seriously.

They came in and got the IV started fairly quickly again. The Superhero's BG was starting to trend downward. I asked the nurse if we could get a glucose/dextrose drip going to get his BG up, since he was not tolerating nor absorbing anything through his stomach. (BG now below 100)

The resident came in and introduced herself to me. She explained that they would call his doctor once the blood work came back and would not start a glucose IV until then. I mentioned to her that his BG was dropping and that I needed them to start the glucose ASAP. She explained that it was not "protocol" to do that. I asked her what her plan was then to keep his BG up, or what they were going to do if he passed out or had a seizure. (yes, I actually asked this) She said they wouldn't let that happen. I told her that if she wasn't going to call HIS endo immediately, I would call her myself and have her call them. I knew she would want to know we were back in the ER and his BG was dropping. She then reluctantly took the phone number from me and went out to call.

I hated the vibe from this resident. She seemed very defensive when I was explaining what I thought needed to be done. And I really hated hearing how "protocol" was something different than what I KNEW needed to be done.I was as respectful as I could be, but my child's life was WAY more important than THIS resident's feelings.

After she left the room, her supervising physician came in. He was SO nice and I definitely got a different vibe from him.He said the resident was on the phone with our endo and would be back in after that conversation. He then listened to my concerns and I explained that The Superhero's BG was dropping even more and was now in the upper 80's.

A few minutes later my cell phone started to ring, it was not a number I recognized, but it was local so I figured it must be someone I knew. I answered. It was OUR awesome Endo. I just love her so much. She was calling to tell me about HER conversation with the resident.

Apparently the resident called the endo and without telling the endo what I had asked for, Dr. D told the resident the EXACT same thing I had. He needed glucose, ASAP. We needed to get his BG up so we could bolus insulin so we could get ketones down. Dr. D told me that the resident was VERY defensive and did NOT want to do that. Dr. D had to say something like "I am the endo, and this is my patient, THIS is what he needs, now..."

As I was talking with Dr. D on my cell phone, the nurse walked in with the back of glucose/saline and the resident came in behind her to explain. She saw I was on the phone and came back after I got off the phone. Dr. D explained that they would keep The Superhero for at least 24 hours. I told her I expected that, and we  were ok with it. We needed to make sure he could hold food/liquid down again before going home.

Then the resident came back in. She told me she had spoken to Dr. D and that they would wait to start the glucose until the bolus of regular saline bolus was completed.

Uh, NO.

I told her that wasn't happening.

His BG was now in the 80's and he NEEDED it started NOW. She did not seem thrilled, but said "ok". And the nurses hooked up the glucose. BG came up slowly (after dropping into the 70's) and leveled out in a much safer range.

That was the last we saw of the resident, this round anyway.


And now for MY theory.

The longer you are a doctor, the more humble and knowledgeable you become.

Now, the knowledgeable part should be a no brainer, it is the actual knowledge that is gained that is what is part of my theory.

The longer someone practices medicine, the more they realize what they know and what they don't know.

And those who are NEW to practicing medicine (ie: RESIDENTS), don't know what they don't know until they are HUMBLED by a doctor/patient who knows more.

Those who have been practicing longer SHOULD realize that SOMETIMES the PATIENT might actually know what they are talking about.

Especially when they are talking about a disease they LIVE 24/7/365. Especially when it has been 2 1/2 years since they were dx with the disease. Now, not everyone who has a chronic illness and lives it 24/7/365 is as knowledgeable as others.

BUT, I think the doctors can "read" a patient to judge how much they might actually know.

If someone walks in saying they have no idea what their kid needs, he is vomiting and has ketones, but that is all they tell you, I would expect the doctors to know more.

If a patient comes in telling you they need IV fluids with glucose to get the blood sugar up, so insulin can be given, so we can get rid of the ketones, I would bet THAT person knows a little more about Diabetes.

Just sayin...

And here is a link to an article that seems to agree with this theory. (Med School Grads May Not Be Ready for Primary Care; Diabetes is mentioned)

*Disclaimer: I am a mom of a T1 Diabetic child. I am NOT a doctor. I just play one in real life. Please do not take anything in this post or any other post on this blog as medical advice. If you have questions or concerns of your own, please seek advice from your doctor.*


Lora said...

I am glad she finally listened. I can't belive she wanted to wait even after talking to the endo. WTH?

Alexis of Justices Misbehaving Pancreas said...

I totally agree! We only had one ER experience --knock on wood- since dx. J was low not coming up and dry heaving. We get to er and hes 240 ofcourse. Anyhoo resident and triage looked at me like i was nuts but attending called our endo did as HE said.

Point is ...sometimes they need to stfu and listen! You did great and he is one lucky boy to have such an awesome pancreas!

Shannon@ The New Normal Life said...

this was a great post!! Im sorry you had to go through it but glad you stuck to your guns!! You are an awesome advocate for your child and I am so proud of you!

Amy said...

Tracy, this is one of the EXACT reasons I didn't wrap my daughter up at 4am to head to the ER! I have heard many a story of D-rents having to insist on a certain level of care and having to butt heads with egocentric interns and Dr.s. Now, don't get me wrong . . . our situation was maneagable at that time, but I would't have hesitated to go if another 'thing' fell out of balance.

Thank you for sharing the experience so others know what they may be in for and be able to be prepared for it.

Why ANYONE wouldn't listen to the parent of a CWD is beyond me. We do it 24/7 and they think they know better????? We just come to them (the ER) for things we cannot access elsewhere (glucose drip, IV fluids, crash cart, etc). If we had that kind of equipment at home we wouldn't need anyone but our Endo's ;)

((hugs)) and GET WELL WISHES!!!!!

Anonymous said...

Thanks for sharing!I know we all have these experience when the medical people don't like to listen to us. We live this life every day- We know our kids and what they need!

Lorraine of "This is Caleb..." said...

Good for you! We should hand out cards: "We are D-Parents and not to be messed with. Proceed at your own risk." :)

Shannon said...

After our last stay, I thought to myself...."Wow, this disease could make a woman a bit of a tyrant." I mean, I am a more passive personality, and I felt the need to be a little pushy. After all, we are their advocates. son is learning to advocate for himself. When I arrived at the hospital the next morning, my son was very angry because he had keytones the night before and they would not let him drink any soda... He wanted to take some insulin to bring down the large keytones that popped up. I am happy he is learning to advocate for himself.

Reyna said...

Oh Tracy...I am so sorry that this resident was not pleasant to deal with. You are right...a little plate of "humble-pie" was much needed and a good swift kick in the ass to hang up some ef-fing dextrose woulda been nice!!! UGH.

I am so glad you were able to advocate so effectively for The Prince.

Love to you...NOW...STAY HEALTHY!!!!! :)

Reyna said...

OOPS...I meant "The Superhero" - DUH...Not "The Prince". Sorry, my brain is mush after pancreating for my little hockey star all w/e - LOL.

Meri said...

Very true Tracy! We have to FIGHT for what we need in the emergency rooms, and it just isn't right. These residents need to check their ego at the door. Period.

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