Sunday, September 7, 2008

The Burned Girl - continued

Several weeks ago, I provided anesthesia for the daily dressing change of a child who was severely burned. In the weeks that have passed, her condition has improved, the skin grafts are looking fine. I was sent again to anesthetize her. But the plastic surgeon said that at this point in her recovery there is no need for anesthesia. She had already begun walking with the aid of a walker. However, she continues to scream and cry anytime the nurses touch her, or even approach her with scissors. Since pain is a subjective experience, it is difficult, especially in children, to determine if the behavior is because of pain, anxiety or both.
As the nurses began to remove her bandages, I observed her behavior. My gut feeling was that her screams were more from stress and anxiety than from pain. Surely she had good reason to be anxious. This little girl has experienced more than her share of suffering. I tried to engage her in conversation to try to divert her attention from what the nurses were doing. I had little success, the nurses were concentrated on what they were doing and didn't realize what I was doing and so there was no cooperation on their part. The girl had fasted in anticipation of the anesthesia which probably added to the stress. I made my mind up, I won't anesthetize her. I gave her a cup of water. While she was drinking, she didn't notice what the nurses were doing, which confirmed my instincts. A therapist also joined in the proceedings. She took measurements for a pressure suit that the girl will have to wear to improve the healing of the skin. Even the measuring tape frightened her.
At this point it was futile to try to calm her. So many people were talking at the same time to try to sooth her and it was having the opposite effect.
Truth be told, I was becoming irritated at the staff who prevented me from doing what I do best, induce relaxation. I don't necessarily need drugs for that, just the right attitude. I refrained from reprimanding the staff in front of the girl and her father. I didn't want to embarass them or add to the level of stress in the room.
After the bandages had been changed, the nurses were about to put a fresh diaper on the girl. I said, "No diaper!" Amazing, they listened, and dressed her in hospital pajamas. I took the father aside and told him that this is an important step in her rehabilitation. For three months she has been serviced by the staff and her family, justifiably, but now is the time for her to become an active participant in her recovery. So let's start with this. She is old enough to tell you if she needs to use the toilet. If so, then she can use the walker, a wheel chair or even be carried there. This is the beginning to restoring her autonomy.


rutimizrachi said...

Kol hakavod. I hope we never need you; but if we ever need an anesthesiologist, I hope we find one as sensitive to the whole person, and her recovery, as you were in this case.

May you continue to be blessed with this kind of clarity in everything you do.

Baila said...

After being placed in an induced coma for approximately two weeks, my daughter was awakened in a total state of bewilderness at her complete loss of independance. Everything needed to be done for her. Taking the few steps to be able to use the bathroom independantly was a huge milestone in her recovery. The nurses did recognize this an encouraged this almost from the start. (Thank G-d she is doing well today).

I'm sure the girl and her family were very grateful to you. I just wish the nurses would have been sensitive to this.

Shirah said...

I know this is entirely off topic, but you're the only Israeli doctor I am in any way familiar with. I'm looking to volunteer in a hospital setting while I'm waiting to apply to medical school. Are there any programs that you can recommend in Tel Aviv? Or would MDA be the best way to go?


QuietusLeo said...

Shirah - Both options are possible. It depends in what you are interested. MDA obviously is "in the field" whereas the hospital can offer a much more diverse experience.

Shirah said...

I guess what I am most concerned with is getting hands-on experience. To be some sort of saya'at, or something of that caliber. Do they train for those types of things for hospital volunteers?

Jameel @ The Muqata said...

QuietusLeo: I don't have anything brilliant to add to this post or the comment thread - just wanted to write that it's a pleasure reading your blog.

(And from a medical perspective, I find it fascinating)

QuietusLeo said...

Shira - sorry not answering your query in a timely fashion, lot's of calls lately. More than what I mentioned before I can't really help. I suggest that you go to the personel office of the hospital you are interested in, and ask them about volunteering.
Jameel - Your thumbs up is greatly appreciated. Right back atcha fella!

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