Overall I’ve been very happy with the services provided by our hospital during my kids’ numerous surgeries. I love our surgeon and physician’s assistant, and the rest of the staff has been great. But we had a pretty frustrating experience after Sheehan’s surgery last week. Namely, an inexperienced nurse.
Last Tuesday, when Sheehan came out of surgery I was led to the recovery ICU where there was a very pleasant and kind nurse attending to him. That’s kind of where her good points end, unfortunately.
One of the jobs of the nurse is to make the patient as comfortable as possible. I felt like this nurse did the opposite.
First, as I walked back toward Sheehan’s bed in the ICU she informed me that he had just thrown up. Not uncommon, he often gets nauseous after anesthesia. When I came around the curtain to see how he was doing, he was kicking and crying – which is not common for him after surgery. I noted that the head of his bed was at a 90-degree angle to the rest of it, which looked particularly uncomfortable. As Sheehan kicked, I asked him what was wrong as I was alarmed by his unusual reaction. He said, “It hurts!” I wasn’t sure exactly what hurt, I assumed the inside of his mouth where he had surgery. Why didn’t he hurt like this after past surgeries?
The nurse told me that she hadn’t given him all of his pain medicine because she needed to balance it out with giving him his nausea medicine. Okay, I understand that. We’ve never had this issue before, but it made sense – at least from what little I know about medicine. She slowly added the medicine to his IV, but his pain didn’t subside. He continued to kick and cry. I assured him the medicine was slowly going in and explained the situation to him. That didn’t help. He continued to kick and cry, me asking him what was wrong, until he was finally able to spit out, while pointing, “The bed!”
Because the bed was at a 90-degree angle, so was his neck. He had just had cranio-facial surgery, so I can only imagine what kind of pain this added to what he was already feeling. I translated to the nurse that the head of the bed was too high and she needed to lower it a little. She became defensive and said that the bed had to be up because if he threw up again, we couldn’t risk him choking. Okay, I get that, “but can we at least not put it at a 90-degree angle?” Who sits like that? Especially right after surgery. Plus, I’d never seen any of the other nurses put it at a 90-degree angle after he’d thrown up. She reluctantly put it down, but put it flat. What the? I didn’t say flat. I just wanted it not at 90 degrees. Eventually, she had another nurse come over and they pulled him up in the bed and put the the bed back at a reasonable incline.
That was great until he mentioned about 30 minutes later that he was feeling nauseous again. The nurse immediately jacked up the incline to 90 degrees. He began kicking and crying again. She asked him what was wrong. I translated to her that he was complaining about the head of the bed being so upright. She got defensive again and told me that she couldn’t let him choke. I said, “I understand that, I’m just translating.”
Eventually, the pain medicine kicked in and he also wasn’t feeling so nauseous. She lowered the bed to a reasonable angle. He then told me that his nose was hurting. That puzzled me. I recalled the anesthesiologist mentioning that they were going to insert a nose tube during the surgery. I suggested this to the nurse and she said, “No, they used a mouth tube.”
Okay, maybe they changed their minds. Or maybe I heard wrong. I then recalled our surgeon saying that he noticed the beginning of a sinus infection in Sheehan’s sinuses during the operation. I suggested maybe this was what was causing the nose pain and the nurse agreed that maybe it was.
Eventually Sheehan began to get drowsy. So he began to nod off. As he nodded off, his oxygen levels, as measured by the oximeter on his finger, began to drop. He was having sleep apnea. Every time he fell asleep, he’d stop breathing. The nurse called out, “TAKE A DEEP BREATH! DEEP BREATH!” She attached a tube to an oxygen tank-thingie on the wall and blew the oxygen directly into his face.
Sheehan balked immediately and began crying and kicking.
“What’s wrong?” I asked.
“It hurts my nose. It’s cold. The air hurts my nose. Get it off my nose!” He pushed it away. The nurse put it back.
Sheehan has never really been able to breath through his nose much anyway, so I suggested to the nurse that we angle the tube at his mouth since the oxygen probably isn’t getting in through his nose anyway.
She said, “Oh no, it’s oxygen, it doesn’t matter, it’s getting in both ways.”
Okay, what do I know? I’m just the mom. It doesn’t make any sense to me, but I’ll let it go – when you’re watching, Nurse. When you’re not, I’ll point it at his mouth – the hole he can breath through!
Later the anesthesiologist came over and said maybe his nose was hurting because of the nose tube he had put in.
Hmm. So I guess he did have the nose tube after all. She didn’t even know he had a nose tube in. Isn’t this information recorded in one of those books?
Sheehan fells asleep again and stopped breathing, abruptly awakened by the sound of, “DEEP BREATH! DEEP BREATH!”
As Sheehan took his fifth deep breath…”DEEP BREATH! DEEP BREATH!”
“I AM TAKING DEEP BREATHS!” He yelled.
When she walked away to get something and I noticed his oxygen dropping as he fell asleep, I gently squeezed his shoulder to wake him up and told him to take some deep breaths. He complied and his levels went back up. I did this a few times and he was okay with it. On the third time, the nurse walked around the curtain as Sheehan was on his third breath, “DEEP BREATH! DEEP BREATH, SHEEHAN! DEEP BREATH!” through his total six breaths when the oxygen levels finally went up.
This conversation continued multiple times.
He’d fall asleep.
His oxygen levels would drop.
The nurse would yell,”DEEP BREATH! DEEP BREATH!”
Sheehan would do multiple deep breaths.
As he was deep breathing, “DEEP BREATH! DEEP BREATH!”
Sheehan would respond. “I AM!”
After the fourth time she yelled, I said, I’ve been encouraging him to take breaths when he falls asleep and after about three to five breaths, his levels seem to rise. I was trying to let her know that she didn’t need to scream “DEEP BREATH” over and over while he was in the process of taking multiple deep breaths. I then suggested that maybe it takes time from when he breaths in the oxygen through his lungs to travel through his blood system to his finger where the oximeter is located, and maybe we just need to be patient. She said, “No, it wouldn’t.”
I thought, Okay, whatever. I’m not going to get through to this chick.
During her screaming of “DEEP BREATH!” she was searching for a solution to Sheehan’s oxygen issue since the oxygen-blowing tube didn’t seem to work. She wanted to put an oxygen mask on him to see if that would help.
She unwrapped a child-size mask and put it up to his face. I wasn’t sure about this, as the surgeon said he noticed that Sheehan had the beginning of a sinus infection and that his nose was hurting anyway. She put the mask on his face and pulled the strap around his head. I wasn’t comfortable with this. I knew it had to be painful. Then to make the mask more air tight, she squeezed the metal bar over his nose, pressing it down on his nose. My whole body cringed and I sucked in air through my teeth, sure this had caused him pain. He cried and ripped the mask off his face.
Then she got an adult-size mask. Sheehan didn’t like that mask either. I recalled that Sheehan had a different mask the last time he had surgery. I tried describing it to her – it was bigger and softer, but she didn’t know what I meant. Finally, another nurse came over and said, “You can’t put that on his face! He just had face surgery! You need an oxygen tent.”
An oxygen tent! That’s it! Thank God.
Finally she hooked up an oxygen tent to the oxygen tube. It was very large and flexible. It covered his face from the top of his nose to his neck. This didn’t cause him any pain and it seemed to work. He was able to fall sleep without his oxygen levels dropping.
Throughout the three hours that we were in the ICU, the nurse had determined that because of Sheehan’s oxygen levels dropping he would need to spend the night in the pediatric ICU. I understood this and agreed, even though we were scheduled to stay over in a less expensive regular hospital room. We both agreed that he needed the additional nurse care throughout the night. So she called the anesthesiologist to confirm where we would stay. He agreed and she called upstairs to get us a room.
Then the same seasoned nurse from before came over and asked where we would be heading. Our nurse said pediatric ICU. The seasoned nurse said, “Did you confirm these plans with his surgeon? You can’t send them up there without getting their surgeon to okay this.” Our nurse had not confirmed this with our surgeon. So she had called to get our surgeon to okay it.
This made me wonder if this nurse just started last week. How could she not know this stuff?
As they were wheeling Sheehan’s bed from Recovery ICU to Pediatric ICU the person pushing his bed asked about this oxygen tent because she hadn’t seen it before. Sheehan’s nurse explained to the woman everything about the oxygen tent as if she’d known for years what an oxygen tent was and why it needed to be used on a cranio-facial patient.
I just shook my head. At least she was kind.
I get surveys after each of our visits to the hospital. I usually toss them in the trash, but this time I’ll be filling it out and mailing it in.
What do you think of this situation?