An Awkward Silence (the trouble with bullies)

Chapter 42

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?”

“Yes.”

“And then you went to another patient’s room to start an IV?”

“Yes.”

“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.”

“Why not?”

“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.

 

 

Seeking Justice (Niki reviews a nurse’s notes)

Chapter 37

In the conference room, Grant gives a brief explanation of the case I’m to review:

“According to the ER record, the parents reported their three-year old wasn’t interested in eating for a couple of days and when he stopped drinking fluids too they became concerned, bringing him to the hospital’s ER. A temperature of 102.5 was recorded, but otherwise his vital signs were normal, with a slightly elevated pulse. Concern for dehydration led the ER staff to draw blood tests, and start an IV. They decided to admit the boy to the pediatric unit for IV fluids, antibiotics, and observation overnight.

He arrived on the pediatric unit at 10:30 pm. According to the nurse’s admission note, he was lethargic. He received a dose of IV antibiotic within an hour of his arrival. After that, the order of events is vague. His mother noticed a rash on the boy’s chest and arms during the antibiotic infusion. The nurse called the attending pediatrician, who was at home, and reported the rash. The boy received a dose of IV diphenhydramine, and steroid to treat the rash assumed to be an allergic reaction to the antibiotic. The boy fell asleep.

The next entry in the nurse’s note records that an hour later she was called to the room by the boy’s parents. The rash had spread over his entire body. They were unable to rouse him.

The nurse documented a blood pressure of 67/45, a pulse of 50, and respirations of 10. She called a code, and the boy was intubated in the room. Resuscitation attempts followed. The attending pediatrician was summoned from home. He arrived half an hour later. Unfortunately, the resuscitation attempts were unsuccessful, and the child died.

Later, the results of the blood tests drawn in the ER revealed a severe bacterial infection, which was the cause of the rash, not an allergy to the antibiotic. The parents are suing the hospital and the attending pediatrician for wrongful death. Our client, the attending pediatrician, maintains that he is not at fault because the nurse failed to report the results of the blood tests, and how sick the child actually was. Therefore, the responsibility for the boy’s death rests on the nurse, and as her employer, the hospital.

What I need you to do, Niki, is review the chart, and find indications that the pediatric nurse neglected or did not follow standard practice in her care of this child; anything pointing to our client’s innocence.”

“Wow. Okay Grant. I’ll read through the record, and see what I can find.”

“Thanks Niki. If you need anything, let Claudine know. I’ll see in you in a couple hours. Raquel and I are looking forward to having you stay with us the next couple of days.”

“Me too. Thanks for inviting me, Grant.”

After Grant leaves the room, I settle into the leather chair at the large, polished table of the conference room, a hard copy of the medical record lying on it. Leafing through its pages, I feel queasy at the realization that whatever I find wrong will be used to blame another nurse. I dismiss the thought, however.

“I am a patient advocate,” I remind myself. “By reviewing the medical record, I’m helping a family receive justice.”