A note from Stephanie B. McNerney, CPNP, Pediatric Nurse Practitioner, University of Virginia Children’s Hospital Division of Neurodevelopmental and Behavioral Pediatrics:
I am writing to share about an example of excellent, trauma informed, compassionate care in Peds. *Patient name has been changed to protect identity.
I was the foster parent of an adolescent girl that received the majority of her pediatric care in Birdsong clinic from early school age to present. When *XXXX came to live with us, she was 16 years old. She is now 20 years old and with complex medical and mental health comorbidities. We have remained parental figures for her and continue to help her access medical care at UVA.
I want to write about a single episode of care that stands out as excellent (yet should be the norm!) XXXX has pre-existing conditions of asthma, obesity, mood disorder, ADHD and PTSD. She has experienced homelessness, food insecurity, and mental health disability for years. She also had her own child 10 months ago. We are now the foster parents to her child.
XXXX developed a respiratory illness that resembled COVID a few weeks ago. She was taken by ambulance for respiratory distress and triaged in the ER, an admission was recommended by the general medicine service. Unfortunately, she left AMA related to a misunderstanding with the floor staff. One day later, she continued to have low saturations and distress at home. She was then taken to the ED by a family friend in the middle of the night. Despite the same clinical status her admission was not recommended, yet her diagnosis, plan, and follow up had not been communicated. It was confusing even for me, as someone with access and health literacy.
At this time, I paged Dr. Holland who was the attending on call for Peds. Dr. Holland listened to my concerns and agreed to come assess the patient to make recommendations. Of course, Dr. Holland was busy, but she listened to me, and I think gave up her lunch time to come assess this patient.
She was there within 20 minutes. She listened to XXXX, asking pertinent questions about medical compliance and HPI that I am not sure had really been asked of her. She immediately assessed that her asthma was poorly controlled and that there were clear changes and actions that would greatly improve her symptoms. She was compassionate, non-judgmental, and kind.
My VERY skeptical and guarded foster daughter immediately felt at ease with Dr. Holland. She felt validated and not judged. She listened to asthma education with new ears (I now realize that no one had ever taken the time to walk through proper administration and implications of her medication). Dr. Holland weight adjusted her steroids and made recs to the ER team that I think completely changed the course.
I know without Dr. Holland’s compassionate and expert ear, she would have been in the ED the next night in the same situation, only to be met with more frustration from the ED staff. Dr. Holland could have easily said, “This is not my case, not my formal consult, not my problem,” but she responded to the vulnerable need and her expert advice changed the course for this patient. I am so grateful for her, both for her clinical expertise and for her compassionate and non-judgmental approach.
From Dr. Eliza Holland, Pediatric Hospitalist
To be honest, I was a little confused and not quite sure how I could help when Stephanie called me from the Emergency Department. It was very clear that Stephanie was worried about her foster daughter and was advocating for her. Once I met this young woman in the ED and heard her story, things became much more clear and I realized there were a few things I could do. Maximizing her asthma medications, reviewing how to properly use each medication, and getting her a spacer for her inhaler were easy fixes.
I had the luxury of being able to spend as much time at the bedside as XXXX needed to feel comfortable with her care at home. That is one of the aspects of pediatric hospital medicine that I love; after rounds, I am not constrained by the number of people in the waiting room. I was pleasantly surprised and honored when Stephanie wrote the letter on my behalf because I have rarely been recognized by a family member in this way. I did not think that my time with XXXX was noteworthy; I am confident that my partners would have provided the same level of care. As pediatricians, we all strive to do the right thing for the patient. And we know to listen to the parents because they are the child’s best advocate.
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