Saturday, April 9, 2011

Worst ER Experience...Ever

I think I'm experiencing deja vu.  I last updated on 3/20/11 after a trip to the ER on 3/19 where we had a horrible nurse who was all kinds of stupid wrapped into one package....

So, yesterday, 4/08/11, I had to take Peyton to the ER.  The nurse who took care of her was a horrible nurse who was all kinds of stupid wrapped into one package....

I'm really not trying to sound mean.  This is as complimentary as it gets.  Trust me, I AM being nice.

On Thursday night, before Peyton's nurse left, she mentioned that the 'g' portion of Peyton's g-j tube was running slowly.  It is the g portion where all of Peyton's meds go, so it's accessed only when she needs meds and if we decide to do a small water flush of the g-tube throughout the day.  Otherwise, everything else - pediasure and waterr - goes through the 'j' portion of the tube.  She mentioned this so I could watch out in the morning as there could be the potential for it to wind up being clogged.  There's one particular antibiotic which she has claimed a few times to be problematic in the tube.  I, personally, have not had these problems.  Anyway, it was slow, so I was to watch it.

Friday morning, another of Peyton's nurses arrived at 7:30am for her shift.  First thing she does is to administer the first round of meds.  The g-tube was completely clogged.  There was no budging - you couldn't draw fluid out or push any in with a syringe.  While a common practice is to try to get some cola in the tube to help break down the clog, that becomes impossible when you can't even move anything in the tube.  I wound up calling the Physician's Assistant (PA) in the surgery clinic.  They are the ones we deal with when we have issues with the tube.  I wasn't sure if we could come into the clinic or if we just needed to go to the ER.  They don't have clinic every day, so I felt like we'd probably wind up going to the ER, which is what the PA did suggest.  She told me to let them know that I'd already spoken with her and they could contact her.

So, we loaded up Peyton and her gear and headed to the Children's ER at MUSC.  Not at all what I'd planned for my dad, as I was really feeling quite strongly about catching up on some sleep that day.  That didn't happen.  I knew from past experience that all they needed to do was to verify that the line wouldn't flush or draw back and that they would get that "clog zapper" stuff and go about releasing the clog using that, and an hour or so later we'd be on our way (after whatever wait time we'd have on the front end of the visit). 

The ER was not busy at all on Friday.  There were two nurses at the front desk.  One recognized me from prior visits.  I gave the current issue and history to the other.  They called the back and within a short amount of time, a nurse appeared in the waiting room to take us back.  As soon as I saw her, I shuddered.  It was the same nurse we'd had such a horrible experience with last time.  UGH!!!  So she already knows who is coming back to the ER with her and what the issue is, but she sees us and starts going on about that last visit in the waiting room to the two nurses at the desk!  She starts going on and on about how long we had to wait last time just to get some coke to put in her tube to unclog it.  She's really being dramatic about this and I'm thinking, what are you talking about lady???  The last time we were here, she pulled her tube OUT!!  Then I'm thinking, I sure am glad there's no one else in this waiting room as you're probably breaking every privacy regulation known to the medical profession right about now!  I didn't appreciate her rant, even if it was to other medical professionals.

We followed her back to where the ER rooms are.  The triage and waiting area is separate from the area where the rooms are.  You actually have to leave the waiting area and take a few common area corridors to get to the door that leads to the rooms.  The ENTIRE time we're walking, she's discussing Peyton's last visit and why we're here now...all while we're passing random strangers in the hall!!  Again, HIPAA anyone???  Surely this is an absolute violation of our privacy.  Forget the fact that she didn't even have her facts straight - she's just violating our privacy!

One of this nurse's biggest issues is that she speaks over you constantly and doesn't even LISTEN to you.  I explained the past history using the clog zapper and that I'd spoken with the PA in surgery and she knew we were coming to the ER to have the clog resolved.  She kept referring to the PA as "Judy" instead of "Julie" no matter how many times I corrected her.  She asked if we'd like a dvd or anything for Peyton.  I said no thank you, that wasn't necessary.  She left the room presumably to begin the process of getting Peyton taken care of.  Instead, she returns with a couple dvds a short time later and begins trying to figure out how to work the dvd player in the room.  Huh????  I just said I didn't want anything!  I want Peyton taken care of, and now you've just wasted 10 or 15 minutes of time that could have been spent working on her.  That puts us 10-15 minutes even later on the ability to give Peyton her meds once the issue is resolved.

At some point she said she'd go get a syringe so she could "go through the motions" (her words, not mine) of trying to flush the line before trying this clog zapper stuff.  She got a syringe, filled with some water, and began to try to flush the tube.  As expected, it didn't budge - couldn't flush and couldn't draw back.  Now, I fully expected this would be part of the process and don't have a problem with her having gone this far.  However, it was at this point that she started to try to continuously push in and pull out the plunger on the syringe in an effort to push out the clog.  This was requiring some effort on her part because it was 100% completely clogged.  This is where I started to get anxious.  This is NOT how this issue should be resolved.

A resident came in and he began speaking to me about Peyton's history and current situation.  At the same time, the nurse is STILL working with the syringe trying to force the clog out.  The clog was way down the tube right at the point where the tube enters the skin (there's about 6" of tubing hanging out of her).  Anyway, I'm agitated because I can't concentrate on the resident when the nurse is doing something she shouldn't have been doing, but I'm also too dumbfounded to speak up.

The resident wound up taking a seat across from the stretcher.  The nurse and I were on the opposite side of the stretcher facing him.  She keeps on keeping on, and I'm talking to him when all of a sudden, he gets thoroughly doused with water.  You see, when there's pressure build up, the syringe, which is inserted into the port, will actually be forced out and if you're pushing in on the plunger, you're actually just going to squirt the contents of the syringe straight out with the brute strength force you've been using to try to free the clog.  This has happened to me personally, although not with a clog.  It can just happen.  Anyway, the resident wasn't impressed, nor was I.  You'd think this is where the nurse would give up, right??


It's at this point she decided that the clog was moving and that she could actually fix it.  Did I mention that prior to the above incident, as I was watching her work on Peyton's tube, I could actually see a pretty good sized air bubble forming on the tube??  That means that this normally tube shaped line had a round bubble forming at one end of it caused by the enormous pressure build up from what she was doing.

Ok, so you may have been wondering why it is that this is not the method one should use to free a clog?  You might be thinking, well, if that's all it took, why didn't I just do this at home?  What's the big deal with what she was doing - she is just trying to help, right??


What she was doing was wrong on so many levels.  What she was doing could actually cause the tube itself to rupture.  Peyton has a g-j tube, which means that a portion of the tube empties into her stomach, while a longer portion continues on past the stomach into the upper intestines.  The process of inserting the tube is done in radiology as it has to be guided by x-ray by an actual doctor.  If this has to be done, they have to get surgery involved as they're the ones who have to assess the situation and make the call as to whether or not a new tube is needed or to at least get radiology to see if one is needed or not.  It becomes a more time-consuming and costly incident.  It's not like her old g-tube, where if she pulled it out I could just replace it at home myself without even having to call the doctor. 

So, yes, the nurse did wind up freeing the clog.  Peyton's home nurse and I were dumbfounded and shocked.  Obviously there was little else to be done, so the resident pretty much wrapped it up.  The nurse left the room at one point and I briefly attempted to convey my anxiety about what occurred, but I just couldn't.  It didn't seem to bother him at all, but I wouldn't expect him to understand what my problem was, being a resident.  No offense to residents.  It is true that a lot of residents in the ER setting have no clue about tubes in general, much less the process by which a clog needs to be resolved.  The attending came in before we left, pretty much just to say hi since the situation was resolved.  Again, I was too shocked to speak up and we signed the discharge forms and were on our way.

So we left the hospital in shock.  The nurse and I were both completely unimpressed with everything that had just happened.  Yes, the clog was resolved, but at what expense??  It caused me great anxiety, and I went home very anxious because I CAN'T SEE INSIDE PEYTON!!  How was I to know she hadn't damaged the tube in the process.  So here I sit on late Saturday night, a day and a half later STILL anxious.  All I knew at the time we left was that when I got the follow up call from the ER the next day, I was going to rat out this nurse (the hospital always makes follow up calls within a day of discharge to see how the patient is).  Wouldn't you know, I still haven't gotten a call??

I waited out Friday just in case the hospital happened to call late the same day rather than the following day.  After some time had passed, I knew what I needed to do was not to just voice my concerns to whoever called to follow up, but to actually file an official complaint with the hospital.  I got the number from a friend of mine who works at the hospital, and I was going to use it...but I wanted to wait a little on Friday to see if maybe I'd get that follow up call.  I didn't.  Life happened that day as well, so I didn't get to making my call.  So, last evening I got on MUSC's website and found that they actually had an online form for filing a complaint.  Goody!!!

I know you may find this hard to believe, but I wrote a rather lengthy complaint, listing the actual name of the nurse involved.  I explained that we're no stranger to MUSC, hospitalizations, tube problems, etc.  I explained that I respect protocol and she had to at least try to flush - but that when it didn't right away, that she should have moved on to the next step - get the clog zapper.  I explained how dangerous what she did was.  I complained about the HIPAA violations from her initial appearance in the waiting room.  I also complained about the fact that I'd contacted Peds Surgery before coming to the ER and that the nurse claimed she would call them while we were there, but that I highly suspected she did not.

I then followed up with an email to the PA in Peds Surgery to let her know (briefly this time!) what had happened and that I had actually filed a complaint against the nurse.  I wanted the PA to know exactly how Peyton was treated and that I had some concerns. The tube actually wasn't sounding or feeling right last night, so I'm still a little leery about it.  For the most part, it's been ok, but after our experience, I'm not 100% comfortable just yet.  I emailed the PA because I wanted her to know how tube patients are being treated by this particular nurse in the ER.  I told her my suspicion that the nurse hadn't contacted the PA.  I also wanted her to know I filed a complaint in the event that the hospital's follow up to my complaint somehow wound up involving Peds Surgery (I'm thinking it's possible since they might actually want to verify that what I was saying about how it SHOULD have been done was the truth).  I actually just heard back from the PA this evening (yay for having someone who was concerned enough to respond on a Saturday night!!).  She said no one from the ER contacted her.  Nice.  She had a few things to say and then said she'd be in touch with me Monday to see how things went over the rest of the weekend.

I've had a very frustrating week and this ER visit was just the icing on the cake.  I am trying my best to remain positive and to not lose sight of God in everything.  I am trying to see the good in things.  I am trying, but this week, I am failing miserably.  It's just been "one of those weeks" and I'm spent.  Hoping for an awesome church message in the morning.  I need it.

For now, Peyton is ok.  Her tube is ok...I think.  We'll see what next week brings.  Please say some prayers about this complaint process.  I just want to ensure the same thing doesn't happen to someone else.  I also want to ensure that it is within my rights as a patient's representative to request that that nurse never lays her hands on my child again.  I'll let you know what happens!!

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