Week Eighty Five - Magical Thinking....

Five days in  a hospital gives you lots of stories.  You meet a lot of people:  Doctors, nurses, housekeeping staff, other parents, chaplains.  You meet people who've been around a long time, and those who've just started. 

Resident physicians ARE doctors.  Their level of experience varies from 4 months to 5 years post medical school graduation.  The Fellows have finished residency and are doing specialty training.  We are always, and will always be, admitted to nephrology.  And we are always placed on the same floor. 

I initially thought that 'our' floor was dedicated to kids with kidney disease.  It turns out that it's dedicated to the adolescents.  The rooms at the end of the hall with the snack bags on the counter?  That's the eating disorders section.  Kids with diabetes are common.  Asthmatics, a dime a dozen.  So we see two teams of doctors each day:  The nephrology team, and the adolescent team.  Each team has Attendings, Fellows, Residents and the occasional student.  Generally speaking I have no objection to being "a good teaching case."  Lord knows I benefited greatly from the patience of all those patients willing to let me learn what I needed to learn, often at their expense, and not always to their benefit. 

But when it comes to procedures I want to know who's going to be poking at my kid.  So I'm STILL miffed that I never met the person who performed Babygirl's spinal tap.  I have no idea if this was a person who graduated med school in June of 2012 or whether there was some experience there.  But on Monday morning I met the neurology resident who innocently let me know that whoever it was who STARTED the tap, she was the one who finished it when that person didn't succeed.

I'd already noticed that there were two puncture marks on Babygirl's back - in fact, I'd taken a picture so Babygirl could see them.  If I had given any thought to it at all, I had mentally dismissed the second puncture as a local anaesthetic injection site.  In retrospect, that was a silly assumption.  Why do a local when the kid is knocked out?

I've done LP's myself.  To the best of my recollection, it's a simple test, and of all the ones I did (and I did dozens)  I can't recall missing even one.  Not even the first one.  But I know it happens.  I also know (because I did it myself) that it's easy to hit a lumbar nerve in the process. 

That's what happened to Babygirl.  The worst of the pain for two days after the puncture was a deep burning discomfort down the side of her thighs.  Her back hurt, and her head hurt, but it was her legs that were the hardest to bear, and hardest to relieve. 

Quite honestly, either person (or both) could have hit those nerves as a normal consequence of the tap.  And I'm guessing the consent I signed on arrival allowed for teaching.  But I want to think things might have gone better if neurology had been on board from the beginning, in charge of supervision instead of the anaesthesiologist.  This thinking is patently illogical.  Anaesthesiologists do hundreds and thousands of epidural injections, and the process is nearly identical (and actually somewhat more technically difficult).  And does meeting the guy who is going to do the procedure actually make him able to do a better job? 

It all comes down to control.  All parents with chronically ill children engage in Magical Thinking.  "If I do ___________ (fill in with any ridiculous idea, like, say, "meet all my kid's doctors") then my kid will ______________ (fill in THIS blank with any impossible thought, like "be magically cured and go back to the way it used to be").    We might as well determine that we need to learn to walk on water and turn that water into wine in order for our kids to thrive.  It's hopelessly hopeless.  We can't control what happens, and we can't go back.

We cannot go back.

DeeDee