Close Encounter of the Nurse Kind

Who better than a nurse, especially a nursing instructor, to judge the compassion and skill a hospital brings to patient care? And if the nurse is the mother of a teenage girl brought to the ER in agonizing pain, what she has to say is definitely worth reading.

As "Sister Nurse," Karen Madsen writes a monthly column for Stressed Out Nurses, an arm of hospital consultant HCPro. She is an assistant professor at Cox College of Nursing and Health Sciences in Springfield, Mo., and she is the mother of 15-year-old Grace. I was informed and moved by Madsen's account and offer it to you (edited slightly to be shorter than her two-part opus) as something more than just another cautionary tale:

I don't like this side of the bed. No, I take that back. I loathe this side of the bed. It scares me, it makes me angry, it makes me cry. I have no control over this side of the bed, I have little identity, I don't have much of a voice. All this and more ran through my mind as I sat at the bedside of my 15-year-old daughter recently. It had been a long time since I had been part of the patient equation of the hospital rather than the nurse. It was just as much fun as I remembered....

A few weekends ago, our daughter, Grace, came home from a school-sponsored trip pale and pouty. She can be dramatic, but is rarely pouty. I should have known then something was up or something was wrong. I checked her forehead with the inside of my right wrist, my trusty mother thermometer. No fever. So I basically told her to suck it up and quit whining. Later that night, she had several episodes of vomiting and I began to think food poisoning. Still, she had no fever, no localized pain, certainly no pain on either side of her abdomen. "Relax, "I thought. "There are a million viruses out there right now. She'll be better in the morning." And she was. Or at least I believed she was. She woke up, ate a bite or two of breakfast, and had another nap....

It was another story when she woke about 5 p.m., moaning and retching. She drew her knees up in fetal position and nothing her dad or I could do would convince her to put her legs down. Now she had a fever, now she had localized pain in her abdomen, now she was crying with pain. She was tachycardic and diaphoretic and clammy. Grabbing my insurance card, we made a quick trip to the hospital ER. After we checked in, we waited. And we waited. And we waited. And we waited. Waiting in the ER with a child who is crying in pain is a nightmare. Waiting in the ER with a child who is crying in pain is a NIGHTMARE!

That never-ending night in the ER, I saw the very best of nurses and nursing—and I saw the worst. The worst wasn't that the nurses in triage were mean or unskilled; the worst was they didn't care about my daughter. They didn't care about the young woman across the room, also crying in pain, also waiting for hours. They didn't care about the young man who came in bleeding profusely. The initial nursing triage staff did the bare minimum required of them; they did it without a smile or a touch of concern. They did it quickly and efficiently and soullessly. They sat at their desk and ordered food and talked on their cells and told jokes within feet of my daughter who was in agony. How could anyone, let alone a health professional, be so insensitive? As a healthcare consumer, I was bewildered and angry. As a nursing instructor, I was horrified. And as a member of the nursing profession, I was embarrassed and ashamed. These were my colleagues. This was America in 2008. No one should be treated like we were that night, no one.

Four hours after our initial check-in, we were admitted to the main emergency room and eventually, things got much better. We had a stellar nurse named Kristi, who came to our room with morphine in her hand for our girl. Kristi was kind, she was efficient, and she was incredibly skilled and competent. The doctor on call was concerned and also very kind. After a CT scan and a call to the surgeon, Grace was on the way to surgery. There was a lovely OR nurse named Bill who took Grace's clammy hand out of my desperate grasp and held her hand all the way down the hall as she rolled off to surgery. That moment rates right up there as one of the five worst of my life. My daughter, my baby, was now in the hands of people I didn't know and had never met. I had zero control. I was helpless to fix this.

Fifty-eight minutes and 45 seconds later, her surgeon met us in the waiting room. Grace had a perforated appendix and I had missed it. All those signs and symptoms and I had missed it. Her belly was full of pus, she was septic, and I had missed it. Some mother, some nursing professor, and some advanced practice nurse I was! Her dad tried to make me feel better, the staff on the floor tried to make me feel better. Finally, her surgeon told me "to just stop it. You're not helping anyone." I joked that "I run for mother of the year all the time." But I was appalled: How could I have passed off appendicitis for the flu? How could I have discounted her pain as just being dramatic?

But pretty quickly, I was too busy for self-recrimination. She wanted us in the recovery room, she wanted us in her room, and she wanted one of us with her 24/7. So I was. I helped her push her PCA button; I helped turn her and got her to cough. I rubbed her feet and got her new socks and tried to untangle her hair. I was fully her mom but I was also fully her nurse (not my role, in case you missed it.) I made her blow in her spirometer (and she cried). I made her sit up on the bedside (and she cried). I made her walk and walk and walk (and she cried and she cried and she cried). I began to try and control what I could. I made my own MAR (medication administration record), I kept my own I's & O's. I wrote down her caregivers, I wrote down questions for her surgeon. I knew some nurses on the floor she was on because of school clinicals that I had taught. I knew who I wanted for her nurse and who I didn't; I wasn't shy about asking for the right ones and refusing the wrong ones.

So, yes, I was one of "those" mothers. I tried hard not to be but about 24 hours into our stay, I gave up. While I tried to be nice about some things, I wanted what I wanted and I wanted it right now. Bless their hearts, her nurses never yelled at me. If they talked about me behind my back, they were very discreet. And if they were frustrated with me, they never took it out on my child. If anything, these nurses were overly understanding of my feelings and took time to check on me and talk to me about orders and meds and "How are you doing tonight, Professor Madsen?" They were wonderful. They were brilliant....

Grace is home and continues to recover. I still hate that patient side of the bed, but it's not a bad thing for either my ego or my teaching to be there once in a while. I have a new passion for making sure none of "my" nurses ever act like the ones I observed in the ER. I have a new passion for teaching effective communication. And I have a new depth of love for my daughter and my family.