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    Sunday, January 28, 2007

    Listen to Your Mother: I spent most of yesterday in th emergency room and the rest of it cleaning up blood and nursing my son who maimed himself with a combination of dry ice, water and a soda bottle. I told him not to do it. I told him he would put his eye out. But kids never believe mothers when they say that, do they? He was trying to launch the cap off the bottle. He did it outside, with the cap away from himself and everyone else, but the cap was too tight and the bottle exploded at the bottom sending plastic shrapnel into his face. He was a bloody mess, but most worrisome, when I looked into his eye, I saw blood in the anterior chamber. I wanted to yell at him and hug and hold him all at the same time.

    I must say, the emergency room at the Children's Hospital is a very family friendly place. My husband wasn't home, so I had to take the three other kids with me. They were allowed to come into the room with us, until they couldn't stand the blood any longer, but there was a special waiting area with toys and a television in the treatment area where they could be nearby. I didn't have to worry about them being alone in the main emergency room lobby. But, I was a little surprised at how much of an advocate I had to be for my son the patient.

    I told the triage nurse that he was bleeding in his eye, so she took him back right away. But maybe there isn't a drop-down menu choice on their EMR for "bleeding in eye" as a chief complaint, just "eye injury." The first exam was a quick one. Check to see if he needed sutures, try to check for obvious damage to his eye. But, by then his eye was very swollen and difficult to open so it was impossible to get a good look at his anterior chamber. If you didn't know his eyes were blue instead of brown, the blood was easy to overlook. So, we were told that "Ice would be his friend", and that he would get a patch and antibiotics for his corneal abrasion. "But, I saw blood in his anterior chamber."

    That got me a quizzical (or maybe annoyed) look from the resident, but later the supervising attending came in to examine him. Same thing, "Ice will be your friend," and see an ophthalmologist first thing Monday morning. "But, I saw blood in his anterior chamber.
    That's why I brought him in right away." I helped her pry open his eye and she agreed, so the ophthalmologist came to see him yesterday rather than two days later. Thankfully, he didn't rupture his eye., and there wasn't any plastic shrapnel in it. He was sent home to bed rest, several eye drops, and frequent outpatient follow-up with the ophthalmologist over the next week.

    As a physician/mother, I could be an effective advocate, but if I weren't a doctor, I suspect the hyphema would have been missed. If I weren't a physician, I wouldn't have looked for it when he walked into the kitchen bleeding all over the place. I would have been distracted by the blood and mangled face, and I probably wouldn't have thought to look into his eyes. And if I did, I wouldn't know what to do about it. And without that observation, his treatment would have gone down the wrong path.

    But, there's a drawback to being a physician/patient, too. Other doctors assume you know everything they do, so they don't always provide detailed explanations. It wasn't until we got home and I had a chance to read up on hyphema that I realized he wasn't out of the woods yet as far as preserving his vision goes, though I should have deduced that from the instructions for close follow-up.

    It's always an eye-opener when you get the chance to experience medicine from the other side.
     

    posted by Sydney on 1/28/2007 10:54:00 AM 3 comments

    3 Comments:

    I hope your son is doing well. Fortunately, he's in good hands!

    Being a parent or patient and a doctor is indeed an interesting situation. In my (unfortunately extensive) experience, there are one of two reactions I get from the treating physicians- either extreme caution & over-treatment, or a feeling that we (my spouse is a doctor as well) don't need information, which isn't true. My daughter has twice avoided hospitalization because of our background, though. So it's not all bad.

    When my last child was born it was quite the event. I experienced the most odd behavior on the part of the physicians that I can only attribute to my being a doctor (OB/GYN, no less). It went all the way from the anesthesiologist saying "You know all about this, so could you just sign here," to an exhaustive description of every bad thing that could befall a 31 weeker, as if his birth were somehow elective. He stayed much longer in the ICU than he should have, to the point where friends thought he was seriously handicapped, though he wasn't. But, all told, I'm sure the doctors were as glad to see us go as we were to get out of there ;-) It's just strange for everyone involved.

    By Anonymous danie, at 6:03 PM  

    I hope a full recovery for mother and son follows. :)

    I'm also very happy to see you blogging again. I know you stopped a while back, and started again- but I'm not sure when. In any case, thank you.

    By Blogger Jill, at 12:35 PM  

    I am a GP/ER/OB rural type doc and my wife is a lawyer - the fear at her Csection was palpable!

    By Anonymous Anonymous, at 1:24 AM  

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