Melissa took a sip from the glass of water in front of her before speaking.
“It was supposed to be my night off, but I came in extra at 11 for an eight hour shift. There was a sick call, and when they got a third admission that night, the charge nurse asked me to come in. I took report on the new admit from the charge nurse, who’d settled him into his room with his parents, but nothing else, because she was busy helping another nurse with a transfusion.”
“Did you have other patients assigned to you that shift?” Grant interrupted.
“Yes, I had three other patients, besides, you know. One’s IV was out, and I needed to restart it. I did vital signs on the new admit, and hung his antibiotic first, though.”
“So, you assessed Bobby and started his antibiotic within an hour of his arrival on the pediatric unit?”
“And then you went to another patient’s room to start an IV?”
“When did you return to Bobby’s room?”
“I went in when the pump alarmed that the antibiotic infusion was finished. That’s when the parents pointed out Bobby’s rash.”
“Were you concerned by the rash?”
“Yes. I took another set of vital signs, which were unchanged. Then I called Dr. Straid at home.”
“To report the rash?”
“Yes. I was worried that it was serious. It was all over his body, even his cheeks. He seemed more lethargic than when I’d seen him earlier.”
“What time was this?”
“It was after midnight. Dr. Straid told me that Bobby’s lethargy was due to his needing sleep, and that I should stop over-nursing him.”
“But Dr. Straid was concerned about the rash, and ordered treatment for Bobby, didn’t he?”
“Yes, he ordered IV diphenhydramine and an IV steroid to cover the rash. The next dose of antibiotic wasn’t due until morning, and Dr. Straid said to hold the dose until he came in to assess the patient.”
“Did this sound like a reasonable plan to you?”
“No. Bobby seemed more sick than tired to me. His parent’s said he wasn’t acting like himself. I asked Dr. Straid to come in and see him then.”
“Because the boy had a rash, and was sleepy?”
“Lethargic, I used the word lethargic.”
“Were you aware of the severe neutropenia?”
Melissa looked at the hospital lawyer, then her hands folded in her lap before looking at Grant and answering softly, “No.”
“So Dr. Straid was unaware of the lab results. You asked him to come to the hospital in the middle of the night without looking at or reporting the lab results. Do you think that if Dr. Straid had been aware of the severe neutropenia he would have come to the hospital to see Bobby immediately?”
“Maybe. I don’t know.” Fierceness flashed in Melissa’s eyes at this inquiry.
“What do you mean, you don’t know?”
“I mean Dr. Straid has a reputation for not coming in to see his patient’s when asked by a nurse. I mean that most of the nursing staff is afraid of calling Dr. Straid in the middle of the night because he usually bites their heads off.”
“There’s no notation in this patient’s chart that Dr. Straid refused to come in, or that he was rude to you on the phone.”
“I’ve stopped writing about Dr. Straid’s behavior a long time ago. Writing him up doesn’t do any good. Nothing happens.”
“So you assumed Dr. Straid wouldn’t come in to see this patient because he is sometimes rude to nurses? You knew that reporting the lab results was useless?”
Melissa sat in awkward silence.
“Did Dr. Straid refuse to come in to see the patient after you told him the lab results?”
“Objection!” The hospital lawyer said quietly.
“Melissa, did you report the lab results to Dr. Straid?”
“No. I did not report the lab results.”
“Because I hadn’t seen them.”
I sat in conflicted silence. She should have looked at the lab results before getting on the phone with Straid. She should have trusted her nursing instincts that the boy was gravely ill. Anxiety over calling Dr. Straid in the middle of the night, combined with a busy shift, and inadequate staffing got the best of her, an all too familiar story in nursing. The result was catastrophic.