My room is comfortably small with rubber lining the walls

and there's someone always calling my name

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A very large part of my job involves teaching. Sometimes I teach basic parenting skills, such as how to properly apply a disposable diaper, how to burp an infant, how to clean the smegma out of the foreskin (eew), that babies need to eat at least every couple of hours and not three times a day, etc. I teach parents how to administer medications to their children, including appropriate doses and the best way to force it down their throats. I teach parents and patients how to care for their wounds, and what an infection looks like. You get the idea.

On Friday night, I took care of an 8 year old patient who broke his tibia and fibula and bought himself a cast that extended from his toes to his hip. I spent well over an hour teaching the patient and both parents about pain control, signs and symptoms of compartment syndrome, care of the cast, tips on getting around and activities of daily living (like how to use the toilet and shower), how to use crutches, who to call if they decide they want to rent a wheelchair, and who to call if they have any other questions or concerns about anything related to the injury or the cast or any follow-up care. I gave them several handouts so they had all of this information in writing so that they could have something to refer to if they didn't remember anything I told them. The parents asked all kinds of appropriate questions and verbalized understanding of all of the information provided. They left cheerful and grateful and I thought their discharge was all tied up with a bow.

I asked our case manager to follow-up with the parents on Monday in case they had other needs (like the wheelchair rental - the paperwork to get one is a pain in the ass). This is not something I had to do, but I figure it would be a nice touch. When the case manager called, the mother stated that she was very frustrated with the care they received because no one explained pain control, how to care for the cast, who to see for follow-up care, and that they were sent home without crutches or information about getting a wheelchair. When the case manager told me this, I wanted to cry. I ended up staying 2 hours past the end of my shift to help this family, and now they are either blatantly lying about their experience or all of my effort went into a black hole.

There are cases where I try to provide teaching and I realize that the patients and/or caregivers are not understanding what I am telling them. Often this is due to a language barrier, and the problem is remedied after I find an interpreter. Sometimes it's because my target audience is less intelligent than I assumed, and it's necessary to take my language down a peg and use other tools for teaching, like visual props (instead of just telling parents that they can give their babies 120mg of Tylenol...or 1.2 mL... I have to get a medicine dropper and tell them to fill it three times), or just frequent reinforcement of the information I am trying to convey. Once the patient/parent starts asking appropriate questions and can verbalize understanding and can paraphrase at least part of what I told them, I feel assured that they understand what I am telling them. On rare occasions I encounter a patient or parent who does not care about what I have to teach them, or they are very set in their ways and aren't interested in changing them, and in those cases I do the best I can.

I am not sure what happened with the family on Friday night. The emergency department physician who cared for this family with me is stellar and spent about as much time as I did providing discharge instruction. The case manager also contacted him about this family's attitude about their visit, and I think he was as frustrated as I was.

I am so tempted to call this mother to find out what I missed with all of my teaching, but that would be bad form. I should just let it go, and I will after I've slept. I am afraid that next time I have a family who needs this kind of teaching, I am going to slack on it for fear that this kind of thing will happen again - that all of my effort will go to waste.


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