As medical professionals, we are used to everyone having all eyes on us during a crisis.  We get paid to make decisions, right or wrong.  We’re expected to be the adults in the room who know what to do.  It’s part of the job description.  As parents, our number one job is protecting our kids from both physical and emotional harm.  As medical professionals who are parents, the lines quickly blur.

Those of us who work in the acute care setting must find a way to separate our emotions from our job.  When dealing with a sick or injured child, we can’t be distracted by our feelings.  It isn’t that we don’t have emotions; we just keep them bottled up and then celebrate or grieve after the work is done.  There is a good reason the AMA code of ethics says physicians should only treat their family if it is imminently necessary.  It’s too hard to ignore your emotions when it’s that personal.  Here’s my story of my two-year-old son aspirating popcorn and the series of hospital visits and provider encounters that transpired.

 

The Event

 

1 pm: My two-year-old son snuck a few bites of popcorn from the bowl my husband and I were eating.  He had tasted it a few times before with no issues, so I ignored my spidey sense to take it away.  Mistake number one.  After a few bites, we were done with snack time and needed to take the bowl away.  He immediately took a deep breath in to cry, coughed, threw up, and started to cry.

I was immediately nervous that he had aspirated the popcorn, so I listened to his lungs and watched his breathing.  Everything seemed normal, so I let him sleep on my chest for his nap so I could watch him closely.  When he woke up 2 hours later, he acted his usual self, so we had a snack and went to my sister’s house for a planned family dinner.  He ran around with his cousins and behaved normally, and my concerns started to ease.  We dodged a bullet, I thought.

popcorn

8 pm: Before bedtime, my husband asked if I would listen to his lungs again before he went to sleep for the night.  There was noticeable wheezing, and I knew those little kernels made their way into his lungs.  I just said, “F***”.  My husband, not being medical, started to panic.  Immediately deferring to me, “What do we do?  Do I need to call 911?  Do we go to the ER?”.  

 

 

First ER Visit

 

Knowing the ultimate treatment would be bronchoscopy,  I knew that of the three local ERs that we have in our town, none of them have surgeons that would operate on a two-year-old.  I called the physician working overnight at my ER.  He was unimpressed.  Since nothing could be done locally, he advised me to watch him or take him to the pediatric hospital, which is two hours away.  I decided to take him to the Free-Standing ER (FSER) that was closest to my house and try to figure out where to take him next—mistake number two.

popcorn

Everything was downplayed when we checked in until the physician saw him an hour later.  When the doctor put his stethoscope on his chest, he immediately took it off, looked at me, and said, “It’s in his bronchus; he’s going to need surgery.” We agreed on that.  I asked if he could give him a breathing treatment to help the wheezing (which was becoming more audible), so he did, as well as a dose of steroids.  We wasted the next three hours waiting for the hospital two hours away to see if they had a pediatric surgeon on call for a bronchoscopy.  Around midnight, I decided to drive him 4 hours to the larger children’s hospital that I knew would be able to care for him, so we got our discharge paperwork and left the FSER.

 

 

2nd ER Visit

 

My mom came to watch our other child while she slept.  We loaded up on coffee, and just after midnight, we were on our way to Dallas.  We pulled into the parking garage just after 4 am, woke the little man up and checked in.  The nurse checked his vitals, listened to his lungs, and said, “He sounds clear, no wheezing.  I bet you guys will be out of here in no time; I don’t think anything is in his lungs.” Rolling my eyes but trying not to be “that patient,” I didn’t respond. 

The physician evaluates him and says similar findings- his lungs sound clear, he is in no distress, and his vitals are normal.  I think we should watch and wait to see if anything changes.  Despite trying to hold it back, Mama Bear came out.  I said, “I know he isn’t wheezing, but I am not an idiot; I know he has kernels in his lungs; I heard the wheezing.  He got a breathing treatment and steroids, which have opened him up enough to stop wheezing, but it is still in there.  Can you do a scan to make sure before we are discharged home?” She complied, ordered a CT of his chest, and we took a two-hour nap waiting for the scan results.

medical professional parents

Our nap was interrupted by comments from the physician, “Good catch, Mom, he has kernels in both of his bronchus and needs surgery; some kids die from this, so thanks for pushing us to get the CT.” Within three hours, he was prepped for surgery, taken to surgery, back in recovery with us, and discharged home.  We were headed home by early afternoon with clear lungs and popsicles on the weekend menu. 

 

 

Lesson number 1: No popcorn until the age of 10

 

Our surgeon recommended no nuts or kernels of any kind until age 10.  We have all heard the stories and always thought it wouldn’t happen to us, but it did, and it is not worth it.  My son now knows he can’t have popcorn, and if it is ever offered to him, he says, “I can’t eat popcorn until I am 10 because one time it went into my lungs, and I had to have surgery to get it out.”

medical professional parents

Lesson number 2: Be the advocate, not the physician

 

My biggest takeaway from this experience is that it is okay to advocate for your child, especially if you have medical knowledge and know what is happening.  If you are in medicine, it is usually apparent to the provider taking care of you that you are medical and know what you are talking about.  You don’t need to flex your credentials to get your desired result.  By staying factual and knowledgeable, you can get the same result.  

Having medical knowledge doesn’t necessarily make it easier to make decisions, especially for your children.  As a mom, we jump to worst-case scenarios, and I have to talk myself off the ledge.  Advocating for their care while staying objective and not letting things cloud your judgment is a medical professional parent’s primary goal and role. 

 

 

Lesson number 3: Treat your family like your patients and your patients like your family

 

Most of us have been advised to treat our patients as we would want our mom or close family member to be treated.  I think I do this well.  I am kind and empathetic, and I genuinely care.   And I try to make their experience a positive one.  These are the characteristics I would want in a physician treating my family members.

The flip side is treating your family like they are your patients.  My general rule is that I only treat my family outside the clinic setting if it is very simple, mainly because maintaining objectivity is difficult.  I am on both ends of the spectrum.  With my children, I always consider the worst possible outcomes.  Still, with other members of my family (my husband, namely), I will downplay his injuries/illnesses, assuming he is being dramatic.  In both cases, treating my family like my patients, I would be attentive, objective, and empathetic. 

Reflecting on my experiences here and other hospital visits (I have two toddlers, it happens), I see how hard it is to remain objective during their care.  I have learned to back off and not get in the way, especially when I trust the physician.  I use this in my daily practice, which helps me stay centered and provide the best care. 

 

 

Lesson 4: Don’t underestimate parental intuition

 

In my training, multiple physicians told me to always listen to the mom.  Although sometimes moms panic, if you have a reasonable parent, they have intuition about their child, and you need to listen and consider the concerns valid.  I was initially blown off in Dallas, but I am thankful they ultimately listened to my concerns and took the appropriate steps.  Don’t dismiss a parent’s concerns.  Validate their concerns and always do what is right for the patient. 

parents

Lesson 5: Trust your gut

 

I don’t like to play the “what if” game (no, seriously, I hate it; ask my husband) because I am much more matter of fact than that game allows.  But for some perspective, my son had popcorn kernels in both of his bronchi.  What if I hadn’t listened to his lungs before bed or had decided to watch and wait like the physician in the ER recommended?  What if I hadn’t pushed for a CT and went home with him? Or what if the kernels moved and obstructed his airway en route to the ER by private vehicle?

I am thankful for our outcome.  I could learn from it as a provider, and nothing major happened.  My little man was safe from any significant infections or complications, so I am thankful that I trusted my gut.  You have to trust your gut.  Always.

 

 

Conclusion

 

I am grateful to be on this side of the stethoscope, even if it means it comes home with me.  I would rather have medical knowledge and prepare myself to act objectively and quickly in times of need than have no medical knowledge and entirely depend on someone else’s expertise.  We have a leg up in crisis and illness, so use it. 

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