Enter Dr. God: Act 1
Posted by realityrounds on April 25, 2009
Act 1: Exam curtain raises. Enter Dr. God.
Dr. God, aka senior pediatric neurosurgery resident, enters room. (all hail). Waltzes over to patient, a full term infant of Hispanic descent, status post myelomeningocele (spina bifida repair), aka Bebe Bonita. Little Bebe Bonita is doing well. She is laying on her tummy under the radiant warmer, sleeping comfortably. She has a large dressing taped to her back. Her back is covered in an abundance of soft, black, downy hair.
Dr. God: “I need to change Bebe Bonita’s dressing now.”
Nurse RR: “OK. Let me dose her with some Fentanyl before you start.”
Dr. God: ” I do not have time to wait. It is only a dressing change, it won’t hurt.”
Nurse RR: Running to medication drawer. “No please just wait. It will only take a second.”
Dr. God: Rips dressing off. All the hair on Bebe Bonita’s back is off. All the monitors are going off. Nurse RR is about to go off.
Bebe Bonita wakes up from her nights sleep by having all the soft downy infant hair on her back ripped off with her dressing. She screams in pain. Then stops. Then stops breathing. Then turns blue. Then becomes bradycardic.
Nurse RR bags and masks Bebe Bonita back to stability. She turns pink and is whimpering.
Nurse RR to Dr. God: “What the hell was that? I asked you to wait for pain medication. How would you like it if someone ripped tape off from your hairy ass?’
Dr. God: “That’s sexual harassment.”
Nurse RR: Pointing to Bebe Bonita’s back: “That’s child abuse.”
Dr. God: Mumbles incoherently. Skulks out of NICU
End of Act 1
Exam curtain closes on an infant who is afraid to go to sleep for fear of waking up in pain, and a nurse who lives with the knowledge that she did not do enough.
RR
Joy said
Your retort, “That is child abuse” was spot on. I would be LIVID. Especially if I was the mother and found out about it. You did what you could by telling him to wait.
realityrounds said
Thanks Joy,
I still feel guilt over this after all these years. It was a truly horrendous thing to witness.
RN-ish said
Dr. God sounds more like Dr. Evil. It is ironic that Nurse RR feels guilty for not doing enough. I wonder if Dr. Evil feels anything at all.
Jill said
Poor bebe. And poor nurse, too. How do you process all of the vicarious trauma from your job?
realityrounds said
We blog.
Edward Gordon, RN said
It’s a paradox, you know? Maybe God does it to keep us healthy: I mean that you did all you can do and yet fear hell for not doing enough. You want to confess something that feels like a sin but might not be a sin at all. Kind of makes you want to slap God in the face for making a doctor and a baby like that and then forcing you to watch the interaction.
Be careful or you’ll burn out. No pun intended.
realityrounds said
I would much rather have slapped Dr. God in the face.
Akiko said
I found it amusing that Mr. Man felt harrassed by you! Hahahaha! Poor little thing! Try not to feel guilty about this. You did your best for her. You cared for her afterwards and helped her to learn that even if she is frightened by pain and has a heart attack a nice person will come to her aid, pet on her and help her get comfy again. However, Dr. Idiot still probably feels like crap about this incident. Maybe he was a bit more careful next time.
realityrounds said
I do not know what happened to that Doctor or baby. I really hope that Doctor found his heart.
Jill said
Hey… random question totally unrelated to this post. Are there male L&D nurses? A hospital can’t discriminate, but…
I’ve encountered a few male RNs but don’t know of any labor nurses. I’m sure that there are a handful of women who would be as comfortable or more comfortable with a male labor nurse based on their history or preference, but that majority? Probably not so much.
realityrounds said
It is funny you should ask that because we were just discussing this at work. Yes there are male L&D nurses but very few. I have worked with a male L&D nurse who is now a great midwife. I have also worked with a male lactation consultant, which honestly, most patients were not comfortable with. We certainly would hire a male nurse, but we have yet to have one apply.
maha said
I cannot believe a pediatric doctor could be so cruel to a little baby! You’d think that with all the education he must have, he would know better than to be so idiotic and thoughtless. You have nothing to regret. If there is such a thing as karma he’ll end up in a crappy nursing home where he too will have dressings ripped of from him. I’m so angry at that doc and feel so bad for that poor sweet baby. If I were the mother and found out that happened, I’d knock his teeth out. End rant.
realityrounds said
In my experience, neurosurgeons are a different breed of human being. Maybe because they have such a high pressure job, they lose some human empathy. I have also worked with adult neurosurgeons, and felt the same thing. Any neuro nurses like to chime in?
SW said
Actually, there is research that shows that doctors (and nurses, or anyone who frequently sees others in pain) do, over time, sometimes lose their ability to empathize. The brain experiences the incidents like the one you described as trauma, so there is a natural protection process that kicks in to cope with the “trauma.” Although the brain is doing us a great favor by helping us cope and handle the excess trauma by putting our minds into a state where we can continue to think well enough to help others medically while not being overwhelmed by the pain we’re watching others go through, this can obviously do a great disservice to “bedside manner.” That being said, Dr. God needed to find a way to cope with his brain’s inability to experience empathy.
RehabRN said
Oh, it’s not just doctors…I work with nurses who think patients don’t need pain medicine because they have x or y thing going on.
I don’t care if I look like a stupid newbie, I ALWAYS ask the patient if they have pain, and if I know someone will do a procedure, I tell them, “You have this pain med ordered. If you want it you can have it, and if you take it now, it may help during the procedure.”
90% of them will take it when offered this way. I just hate the thought of people getting certain procedures with absolutely nothing on board ahead of time.
realityrounds said
Rehab RN,
Your right. I see plenty of nurses who don’t believe in pain. It’s ridiculous. I would take a “stupid newbie” over an experienced hard ass as my nurse any day.
v said
To be fair to Dr God, I was a surgical resident for a while and you do lose human empathy to a shocking extent along with getting a strange idea of what is and is not a major procedure. The way you think about it is “I just cut into this person’s flesh, altered them irrevocably, and put them back together again and here they are alive again.” To me, a dressing change in comparison was a minor thing as it was no doubt for him.
Of course to a baby or any patient for that matter, the painful dressing change is a much much bigger deal than the fact that Dr. God cut into their spine and reassembled their neural tracts without paralyzing them. Similarly I have seen a patient who we cut her chest open for a thymectomy focus on the fact that one of her staples was misaligned and itched postoperatively. It seemed no doubt genuinely to be a bigger deal to her than the surgery which shocked our attending. I would criticize but then as the patient I would probably be the exact same way…
realityrounds said
Well said.
I can understand the blocking out emotions to get the job done, part. Half of what I do would be considered child abuse if it was not medically necessary. As a mom, I of course would be very grateful to the surgeon who saved my child’s life, but as a mom, I would be all grisly bear on that doctor if he “deliberately” caused pain to my baby by refusing a pain medication. So I guess, both surgeons and mom’s can have a certain amount of irrationality to their thinking.
Thanks for the comment.
MomTFH said
Wow. Yeesh. Hair is common in spina bifida. You would think a senior pediatric neurosurgery resident had come across hair around a bandage on a spina bifida patient…ahh, who am I kidding. Most subsubspecialists are more concerned about themselves (note the sexual harassment accusation) than their patients.
realityrounds said
I can certainly understand our brains becoming “numb” to the pain we see everyday. It is why I can start an IV on a two-year old who keeps telling me “bye-bye” to try and get me out of her room. But, causing unnecessary pain when there is an alternative, like waiting half a second to give a pain med, is more than just not being empathetic. To me, it was child abuse.