Tuesday, January 21, 2014

Safe Surgeries Not Without Risk

Not only am I a pediatric nurse, but I'm a mother of two girls age 9 and 11. I tend to worry. Not about the little every day illness and injuries-- like say my daughter's broken arm that I didn't have evaluated for 24 hours. Hey, it wasn't deformed and she had good blood flow. Perfectly okay to see if rest and Ibuprofen made a difference.

What I do worry about is those zebras in the forest. This phrase is typically used for those diagnoses that happen but are a rare occurrence. Like your child with a nose bleed probably (99.5% of the time) doesn't have cancer.

But-- this is what I worry about out. Every headache is a brain tumor. I probably palpate lymph nodes more than I should which got me into an anxious worry cycle when my youngest was around three-years-old.

I looked at her one day and she has a lymph node bulging from her neck. She was otherwise fine-- which was actually more worrisome, because she didn't have a reason for the lymph node to be so prominent. No ear pain, sore throat, fever, scratch . . . etc.

I took her to her pediatrician and he wasn't concerned. They did a CBC-- which is a blood test that looks at red and white blood cells. It can give an indication of cancer but is generally not considered definitive. Even after the CBC came back normal, my mind wasn't completely at ease so I scheduled to take her to the ENT. They, too, were nonplussed but could see how worried I was and so the physician says-- "I don't think it will show anything to biopsy this node but I will take it out if it will make you feel better."

And that's when my nursing brain kicked in and began to override my mommy brain. I was risking surgery to ease my anxiety. I was going to give her a scar so I could sleep at night when this trained and well-respected physician and given me reassurance. I asked him what would be the most conservative bridge between surgery and easing my worrying and he offered to track it by exam every three months for a year.

Done deal.

Not too long after that we cared for a patient that got an infection after this type of surgery. Post-operative infection is a known complication of ANY surgery and doesn't imply that there was negligence.

My concern is this-- many parents are choosing surgery as first line defense when, perhaps, problems could be managed another way. Doctors are deferring to parents, at times, against their medical gut to cover themselves from potential lawsuits-- such as a parent insisting on a CT for head injury. This isn't always in the best interest of anyone. 

Next post I'll be analyzing the case of Jahi McMath-- who is the girl who suffered a surgical complication that led to brain death. Do I think, from what's been written about the case, that the hospital could be responsible for her death?


  1. Jordyn, One of the advantages of being a medical professional is that we can more accurately assess the illnesses of our family. One of the disadvantages is that we generally start with the worst possible diagnosis and work backwards. As my hero, obsessive-compulsive detective Adrian Monk, used to say: "It's a blessing...and a curse."

    1. So true, Richard, so true. My doctor's husband (after I sent him there for an evaluation for frequent headache said)-- "You have to cut her a little slack. That IS how she's trained. To imagine the worst case scenario and rule it out."

      I just hope my nursing brain kicks in before too much gets out of control!

  2. okay, I don't know why I always have to enter my comment twice before it "takes." LOL

    I totally agree with Richard above - and with your post. Just went through this myself but let the pendulum swing the other way because my husband says I always assume the worst case scenario. Had abdominal pain but endured it for 48 hours while I ruled things out, thinking "this seems like my appendix but surely it's not." Finally went in and it was close to rupturing. Can't win for losing. LOL

    1. Oh, I know. I just had a husband boycott his nurse practitioner wife and bring his older child into the ED for one day of fever and he says his wife told him, "They are going to laugh. Fever for one day." Well-- it was a good thing he overruled. The child did need to be there.

  3. First off, I'm over half way into PERIL and loving it!! So much action and adventure! You are such a talented writer.

    Secondly, I couldn't imagine not having any could-be scenarios running through your mind with your intense background. That would be so very hard. Just like you say in your book :-) Glad your daughter is okay. It would be hard not to worry!

    BEAUTIFUL pic of you and your girls! Such pretty girls!

    1. Awww-- thanks, Mart. I'm so glad you're loving Peril!! Looking forward to hearing your final thoughts.