Author: Renu Roy
Medication Safety Pharmacist
The Hospital for Sick Children
Returning from a Saturday morning outing to her favorite bakery with my husband, my daughter said, "Mom, I think there's nuts in this." She placed a square on the counter (with one small bite out of it) and as if on cue, a walnut came tumbling out of the bar. My daughter is anaphylactic to walnuts.
I remained "calm" and gave her a Benadryl®. I'm thinking, well, maybe her reactions are not so bad anymore. This can't be happening, not to my child. Also, we have too much to do today. And well, of course, she's going to be JUST FINE. A few minutes later, her sclera began to turn bright red and her stomach started to hurt. She said, "Mom, we need to go." You may be asking now, "What about the EpiPen®?" Well, I asked myself that too. I can't explain why I didn't tell her to use it, or use it myself. My mind was racing a million miles per second, and probably at the forefront of it all was a categorical denial that this terrible thing could possibly be happening to my child. And I'm embarrassed to say that another factor was that well, if she's not THAT allergic anymore, then giving her the EpiPen® means we have to go to the hospital and well, I know what those wait times are like lately . . . .
Certainly if this was someone else relaying this story to me, I'd be thinking, "For the LOVE OF GOD, WHAT WERE YOU THINKING?"
My husband asked me where to go: the local community hospital or the large paediatric academic hospital where I work. My initial reaction was not my workplace because I thought oh God, they're going to judge me. Not waiting for a response, he indeed headed towards the hospital where I work.
Somehow when we arrived, there was no one standing in the triage line. This was a lucky thing because I honestly don't know what I might have done or said if I wasn't next in line. Now, this was mostly because of the intense guilt I was feeling of being an inadequate parent and a useless pharmacist. At triage, the nurse behind the glass began asking the usual questions: name, travel history, health card. At this point I was beside myself, could she not see that my child was dying??!! A nervous wreck, I promptly handed the nurse my own health card. She calmly handed the card back to me, and I heard a robotic voice say, "That. Is. Your. Health. Card." Giggling nervously, I handed her my daughter's health card. Understanding that the nurse was doing her job and that I can't possibly lose my sh*^t in my very own workplace, I held fast to the knowledge that this person was a professional and that she knew what she was doing (but still, didn't she see my child was dying?!). I held my composure because I took note of her eyes darting to observe my daughter (who, did I mention, was dying?!) while she continued to type and ask me questions. While I respected her calm demeanor, I was uneasy about this person behind glass asking me formulaic, monotone questions (and remember, my child is dying!). She finally told us to take a seat outside of room A.
The nurse in room A said to me, "Did you give her the EpiPen®?" When I shook my head "No," she screamed (okay, she didn't scream, but that's what it felt like) "Give it, give it NOW." This was followed by a scolding, "You ALWAYS give the EpiPen®." I yelled (yes, I probably yelled) back, "I KNOW. I'm THE SAFETY PHARMACIST, I KNOW." In my mind, I'm thinking "See? They are judging me." As my husband and I started the blame game, "YOU gave her the nuts." "Well, YOU didn’t give her the EpiPen®." . . . my daughter gave herself the EpiPen® and we were quickly silenced as the nurse counted with her "10, 9, 8, 7 . . . ."
Within minutes, my daughter was feeling better. The nurse explained the appropriate use of the EpiPen® to her and then kindly reinforced to both me and my husband that we should never hesitate to use it. We were placed in observation for 4 hours, under the care of a lovely doc and resident who also went over when, how, and why to administer the EpiPen®.
When an ED physician I know walked by and saw me standing outside our room, he asked "Are you here as a mom or as a pharmacist?" I thought to myself, "Apparently, today I'm no good at either."
We all learned some valuable lessons that day. I realized how true it is that when faced with caring for one's own child, it is terribly difficult to maintain the necessary amount of emotional and clinical objectivity required. I still have difficulty articulating why I did (or didn't do, as the case may be) what I did that day. I have new insight into parents who are dealing with a sick or dying child. We cannot be quick to judge their decisions or their reactions. I do know that going forward, I will ALWAYS administer that EpiPen® (it's really quite magical). And thanks to that nurse in room A, and the doctor and resident, my daughter now has no reservations about using the EpiPen® herself.
I would describe our experience in the ED as excellent. We were met with professional, knowledgeable, and respectful staff. I know my worries about being judged were largely my own and I continue to reflect on why I ever even worried about that. My child was cared for with an expertise and compassion for which I will always be grateful.
PIPSQC Links - Paediatric Patient Safety (by Topic) - "Medication Safety"