The dispatch information said the kid weighed about 3kg. I see a teensy little one under a french-fry lamp, extremely jaundiced, see-saw respirations, weak cry. The kid weighed 2lbs at birth, along with her twin. Being premature by 9 weeks didn’t help. I noticed scars across the abdomen and sternum from two separate operations conducted just after birth.
Mom says the sleep apnea monitor kept going off at home – eg., the tyke’s breathing kept stopping. “This is just what happened to her sister last week; she had to be intubated and flown. And (the sister) has RSV”.
The RN pops in. “She’s really very stable. You can go ahead and take her.”
Something about this isn’t filling me with confidence. Just the other week an entire Pediatric ICU team was needed for a 2-year old with respiratory distress. We played Glove Balloon Volleyball with him all the way to the ICU. This kid looks nowhere near as good. I’m thinking more hands in the back would be nice if the kid crumps and I have to intubate, pump and blow, that sort of thing.
“You know,” says DTs, “Just to err on the side of caution, she looks like a really good candidate for a PICU team transport. Let me contact those guys and get an ETA for you.”
“Why?” asks the nurse. “She’s really stable.”
“Yeah, well, call me careful…”
The doc walks in. “Good news! The chest x-ray confirms the pneumonia is mostly cleared up.”
“She has pneumonia?” asks mom.
“Well, not a lot, it’s mostly cleared up.”
“But she was just in the NICU two days ago and they didn’t say anything about that.”
Say WHAT? thinks DTs. This is just getting better and better.
The doc turns to me. “So, ready to go?”
“I’m thinking PICU team here, or at the very least getting another unit of ours for extra hands in the back.”
“Why?” asks the doc. “She’s really very stable. You should just go.”
And this, Gentle Reader, is where I have noticed that a little more communication might help.
We have here a doc – many, many years of school; more years in the trenches. Highly educated.
Doc is talking to “the ambulance driver” – who probably had a couple of weekend classes and watches House, ER, and Scrubs to supplement his training.
In doc’s mind: “I am a doc, and I tell you three times the patient is cool. When you don’t believe me, Ambulance Driver Guy with a little bit of knowledge, I get exasperated.” And that’s completely understandable. If you think that way.
But some docs use the same reasoning for Good. I don’t mean that they’re condescending, although those guys exist. I mean the docs who take the time to address any concerns we have. The kind who understand that yeah, if the shitstorm arrives, it will be ME, thank you, in the back of the unit, with far less help on call, far fewer resources, and yes, I admit it, far less training – although what I do have is the same as you where it counts. These are the docs who are willing to address your concerns.
And they’re certainly not the docs who say, “Yes, well, very good, all is well, off you go, no problems here, don’t worry about a thing, see you, bye-bye, hit the road-”
That just sends the wrong message.
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