At 6:45 am, just when things should be tied together for the end of my shift, medics brought in a ten-year-old girl having a seizure. Her mother and the paramedics had both given her emergency medication but she was still seizing, though not violently.
Before I could even evaluate the patient, the mother approached me to say her daughter had a long history of seizures. She said she had with her a letter from their pediatric neurologist saying the patient should be given 20 milligrams per kilogram of phenobarbital in situations like this. Information from family is always helpful. It helps guide, but never overrides, my best judgment on how to care for patients. In this case, I reassured mom we would give her daughter that medication as soon as we had an IV line in place. Mom told me she was going up to the inpatient pediatric unit to “get help.” “Oh well,” I thought as she disappeared.
Our excellent nurses quickly placed two IV lines so, without delay, we were able to give the child 2 milligrams of lorazepam intravenously. This fast-acting medication stopped the seizure. Once that was controlled, we discovered the child also had a high fever, so I ordered all the tests we normally do on someone with uncontrolled seizures as well as those to find out why she had a fever.
By this time, the mother returned, apparently frustrated in her efforts to rally help from the people on the pediatric unit. She immediately tried to take control of the situation in the emergency department. She refused to let us put in a urinary catheter so we could collect and check her daughter’s urine for a urinary track infection. She demanded that one of the two IVs be removed. She refused to let one specific nurse provide care, etc. Her understandable concern for her daughter was disrupting the care her daughter needed.
I took mom aside and made her look directly at me. Then, in a calm voice, I pointed out her daughter stopped seizing after the medicine we gave her and I explained what else we were doing to take care of her. Mom argued that the lorazepam would not last for long. In reply, I pointed out the nurse who, at that very moment, was giving the longer-lasting phenobarbital she had told me the patient needed. With that, Mom seemed to relax somewhat.
I updated the day shift doctor on the case and went to finish up my charting. From the nurses’ station, I heard the mother get so out of hand my partner threatened to remove her from the emergency department if she didn’t calm down. In response, mom called the police on him.
Records showed that this mother had done similar things during previous hospital stays including calling the police to report nurses and doctors. People had spent time helping her see the effect her behavior might have on care providers. It obviously didn’t work because the mother resorted to the same behavior the morning I was in charge of her daughter’s care.
It is hard to imagine how difficult it is for parents to deal with stressful, long-term situations like this. You learn by experience what works for your child. And because you would do anything necessary, you can’t stand someone doing things different than what you would do. Your love and frustration drive you to take control of situations even when that causes problems for those caring for your loved one. You just want your child to be safe and normal, and you would do anything to make that happen. (In this situation, we later found out the child had been taken to China for experimental stem cell injections in an effort to cure her seizures.)
As I walked through the emergency department on my way out, the mother approached me in the hall and took time to thank me. She told me I was the first doctor to ever listen to her. I found that amusing and it made me feel good though I doubted it was true.
Trackback from your site.