A Tale of Two Residents

So yesterday, we returned to the hospital for our other child's tonsillectomy and adenoidectomy procedure. We were more worried about this one because he is younger. To read about the positive and negative aspects of our first experiences, please read the Tonsillectomy tales 4-part series. Everything pretty much went well except for a ridiculous situation that occurred shortly after the surgery. My son (who is only two and a half) did not wake up from the anesthesia in a pleasant state. He was crying, screaming, arching his back, and squirming. Of course, the nurse on the floor didn't have the orders for pain meds from the nurse who was with him in the recovery room. This is one of the most annoying and common things that happens upon a transfer to a new floor and can so easily be corrected by implementing an efficient system. How about this idea? Don't transfer a patient to a new floor UNTIL the floor has all the orders for the medications. Sheesh.

Anyway, in the midst of this chaos, a meek lady with a white lab coat walks in and just starts asking medical questions. If anyone has read this blog before, you know that I cannot stand this. Medical professionals need to introduce themselves when they walk in a room. So my answer to her first question was "Who are you?" She apologized and said she was the pediatrics resident and asked a bunch of questions that didn't seem to us to have much bearing on the situation at hand. We asked about why my son was making unusual gasping breaths ever since he woke up and she said it was because he was crying. We said that he was making these breaths before he started crying. She then said it was probably hiccups. My wife, who is a registered nurse, said there was no way it was hiccups because she felt him pressed against her body and could tell. The resident then said that it was probably due to the anethesia. I could tell she was just giving that answer to say something but really had no clue what was going on. So I challenged her on it and said "Have you ever seen this after aneshesia before?" She paused and said, "Maybe once." That's nice. Then how can that be thrown out so cavalierly as the explanation?! If you don' know, say you don't know, and get someone who may know such as a senior resident or attending physician.

After 15-minutes of needless screaming, the nurse finally comes in with two syringes. One had Tylenol. Another had codeine. Within 5 minutes, my son's face started to swell and get red, as did both of his arms. We told the pediatrics resident about this and she said that it was probably because he was crying. Oh no, I thought, here we go again. So I had to point out that these were new findings since the codeine and that it may be an allergic reaction. She said it may be from the anesthesia. Sighhhh. I again explained that the symptoms just started as soon as he took codeine and that he never took codeine before. I then suggested the possibility of an anti-allergy medication and she said she agreed and would order Benadryl. I sat there amazed that here I am as a non-MD having to lead an MD to figure out what is happening here. So then the nurse walks in and I asked if she had the Benadryl. She said she saw the resident in the hall who just said they are not going to use Benadryl. Ummmmm. Do you think the resident ever informed me of this? Nope. I was of course aggravated at this but then the ENT resident walked in.

What a difference. His first comment to my wife and I was "You two know your child better than anyone and you are the first line of defense." OK, so instantly he is acknowledging we have some insights that need to be listened to since after all, we are his parents. Good. Then he demonstrated he was taking our complaints seriously, examined my son, acknowledged this could be an allergy to codeine, explained the pros and cons of Benadryl at that stage, and assured us this would be appropriately and closely monitored. He also said that he was in charge here and not the pediatrics resident since this was an ENT patient. He also said he would have his senior resident come down to take a look just to be sure. Two different residents, the same exact situation, and both handled in polar opposite ways. What a relief it was to have the ENT resident and I felt very comfortable at that point. We decided not to use the Benadryl in favor of observation. In reality, this story has nothing to do with Benadryl, but has everything to do with communication and coming across professionally. Eventually, the symptoms went away and the breathing problems stopped. Today, my little buddy was having fun scooting around the house on his fire truck. :)