Friday, September 23, 2011

The Day I Declined A Procedure

Disclaimer: This is an account of our visit to the pediatrician and mentions my son's private parts, amongst other things. If this could offend you, please do not read.

Remember my post about the importance of questioning everything? Well, this week my words got put to the test. I didn’t much enjoy it, but I feel even more strongly about the necessity of being informed and protecting your children.
Unfortunately, my son was sick. He had a fever of 102 on Tuesday. We gave him some Ibuprofen in the evening to help him sleep a little better and the fever was still gone when he woke up on Wednesday morning. I assumed it had just been a little bug and was glad that it had passed so quickly. In the early morning hours on Thursday, E was burning up again with a fever of around 103.
Because the fever had gone away completely and returned, I got a little uneasy. Usually, I like to stay away from the doctor’s office. Not because I don’t like doctors in general, but because I’m always afraid the kids will catch even more nastinesses there. However, with the intermittent fever, I thought it best to have him checked out and made an appointment for the same day.
I loaded both kids in the car and headed over to the practice. We didn’t have to wait long and were seen about ten minutes after our appointment time. So far, so good. The doctor was also a little concerned by the course the illness had taken and wanted to check E’s blood. They pricked his big toe (which is still so little…) and took a small sample. He didn’t even cry.
The doctor came back and informed me that his white blood cell count was high. She said that she wanted to exclude certain infections and said that they would have to take more blood and a urine sample. The first thing out of my mouth was: “How are you going to get urine from a baby?” She informed me that they would put in a urinary catheter to collect the sample. For some reason, I assumed we would have to come back for the tests, but they were to be done right away.
I was completely overwhelmed. I hadn’t really expected much- I thought the doctor would check for ear infections, maybe do a quick strep test, but not more. Also, at this point we had already been at the practice for around 45 minutes and my daughter had started bouncing off the walls, asking to go home (I kept telling her that I wanted to go home, too…) Dr. H saw my despair and comforted me, saying that it would be fine and that I didn’t have to see anything, they would just take him away and I would be waiting outside. Off went my first alarm bells! I told her that I would not be leaving his side under any circumstances. Already, I felt like the difficult parent. At first, the doctor asked what I would do with my daughter in the meantime. When I informed her that I would call someone to watch R, she suddenly offered for one of the nurses to watch R. Dr. H left the room to get the nurse.
My head was literally spinning. (Did I mention that I was also sick? I also had flu like symptoms and was completely exhausted…) I thought about the procedures the doctor had just ordered for E and immediately felt that the catheter was not something I wanted. When the nurse entered, I asked her what the catheter would entail and if there was any retraction of the foreskin involved (my son is intact, i.e. not circumcised) I don’t think she was expecting questions. She explained that there would be some retraction in order to clean the area, followed by the insertion of the catheter. I told her that I did not want his foreskin to be pulled back. Slightly flustered, she went out to get the doctor.
Dr. H came in, visibly irked, and explained the importance of the cleaning procedure. I told her that I just wasn’t comfortable with the thought of it and that I didn’t want it to be done. She told me that they wouldn’t be able to give E an antibiotic shot (which I wouldn’t have wanted anyway) without a sterile urine sample and that the only way they could get it was via catheterization. I told her that that was fine. She was not happy with me, but agreed to have the blood drawn that day and have me bring E back in for a reevaluation the following day.
My relief was only temporary. My poor baby had to have blood drawn. Because of all his beautiful chubbiness, it was really hard for the nurses (there were three) to find a good vein. First they tried in his foot. He cried and cried; all I could do was hold and kiss him. They were unsuccessful. Then they had to try in his hand. After much poking and maneuvering, they finally found a vein and drew the blood they needed. My poor baby was so upset! I nursed him right away and he calmed down relatively quickly. They brought my daughter in to me, we gathered up our things, and got out of there- after an hour and a half of unpleasantries- as fast as we could.
I thought about the catheter for the rest of the day. The threat of it loomed over me. The more I thought about it, the more I disliked the idea. The first thing that occurred to me was the lack of alternatives given. So I tried to come up with some myself. I called the doctor’s office and spoke to the nurse, asking her if we could just collect urine in a sterile cup, like they do for adults. I was more than willing to chase a naked baby around with a cup. She asked me if I meant “one of those bags”. Bags? I didn’t even know that they had bags. As I then found out, they have collection bags for small children that can be taped around the penis to collect urine. I was overjoyed! I asked her if such a sample would be acceptable. She called me back after consulting with the doctor and declined any other collection beside the catheter, stating that any other method was unsterile.
 I did what I always do when I am unsure about something- I talked about it, I read about it, I asked about it. I researched my head off to find some answers. I found out a lot of different things. Among the information I uncovered was the fact that most doctors did in fact use the bags to collect urine samples (why else would they exist, right?) I also found out that retraction was not necessary for the correct insertion of a urinary catheter in infants. The more information I gathered on the subject, the more certain I felt that this was not a procedure I wanted my son to undergo.
As someone who has had a tear in her urethra, I was- and still am- particularly surprised that I was never informed of any possible risks involved in the procedure. Though catheters are mostly put in without any problem, there are risks of injury and infection that I was never made aware of.
I went to bed with the conviction that I was not going to let my son be catheterized for the sole purpose of being able to exclude a urinary tract infection, for which there was no indication. I was equipped with knowledge and alternative suggestions to present to the doctor. It was wonderful to have my husband on my side, who also did not like the idea of the procedure.
Morning came and my son’s fever had gone down to a low 100.2. I was very happy. Then I saw a small rash on his belly. I was even happier. The possible bacterial infection was suddenly looking like just another virus. I went into the doctor’s office and the doctor- who thankfully did not hold a grudge- felt confident that we were dealing with a virus after all. No catheter was ever mentioned again.
I am so happy that I didn’t have to go to battle with my son’s pediatrician today. Even though I was prepared, I really do hate confrontations. I learned a lot from this experience. First and foremost, I learned that my gut feeling can be trusted. If something does not sound right for my child then I am their only defense and it is my duty to speak up, even if it is unpleasant for me. When I spoke to my father, he was very concerned about the procedure, but then said: “At the end of the day, you have to rely on the doctor’s advice. What else can you do?” This mentality has been true for generations and is still widely the same among my age group. However, I am always going to ask questions and get informed. If one opinion doesn’t sound right to me, then I will seek another one. After all, nobody knows my children better than I do. I am their mother and I will always look out for their best interest.


  1. When I saw your question the other day, tons of emotion came rushing back to me! My son had been "sick" - we didn't know his diagnosis and all his sky high WBC counts were what led me to cave in on the decision to use the catheter... but that was after a couple of hours of trying to get him to pee in the bag! I had to help hold him down and I can remember his whole body shaking and him screaming- he seemed to have gained superhuman strength; it was tough to hold him down. It was his LAST catheter & I still feel guilty about it. However, I lied to you - I said I would never put another child through that... I must have blocked out the time my daughter had to have one. She was diagnosed with the same disorder my son had - so at this point, it was difficult to turn away procedures when I thought it had to do with her vitality. Thank God that is all behind us now - you can rest assured I will opt out of any future catheter procedures. Looks like YOU made the right choice in trusting your gut! you are right - momma knows best! I always tell my "1st time mommy" friends- Be careful who you seek advice from and remember that nobody spends more time with your baby than YOU!
    Sorry you had to go through all of that & glad everything is better :)
    ~Rhenee Berger

  2. Great job! Your boy is lucky to have you looking out for him! Thanks for sharing and inspiring others.

  3. Wow! Straight to the catheter? Here they give you a pot and a protective sheet and you have to catch it in the pot when they go.

    Catheters are last resorts. I've done the pot thing with both my kids.

    How awful for you all to have gone through this to make the decision. Oh, and there was no need to clean my son before they took his sample either.

    Hugs for you all and hope you all feel better soon. X

  4. Very nicely written. I felt I'm with you in the doctor's office. Of course, this reminded me of J's sicknesses and the few visits to his pediatrician although I was almost positive about his diagnosis before the visit based on my evaluation. I went with Samar twice in the beginning to inform everyone in the practice (indirectly) that the dad is a "lung doctor" so no crazy stuff will happen. I'm a paranoid father after all.
    Your story is especially inspiring to me as a deep reminder of the humanity of the people we see in our work (hospital....) on daily basis. Unfortunately, something we need to be reminded about in this material world...
    Thank you Vivien. Kisses to R & E

  5. Great Blog Viv and your an amazing mother who stands up against all odds for what is best for your children. Your right to follow your gut because those feelings are whats given to us mothers to protect our children even from their doctors when they forget about us as people and look at us as numbers and just another patient sometimes!

    Over the years I have been put to the test with my children too since they have inherited my medical condition. It was not easy to stand my ground with them but I always told them when we were trying to get diagnosed that any procedure they were going to do would be on me and not my children no matter what!

    I hope you all feel better soon!!!

  6. Great post & GREAT example of trusting your "mommy" instinct to protect your child. I am always wary of a doctor who jumps to the invasive procedure & offers no alternatives when it's not a life-threatening situation.

  7. Have you considered changing practices? I know you've been very upset with this office before. E and R are blessed to have a mom who isn't afraid to ask questions. Viruses can scare the hell out of a parent! If you need a good pediatrician that you might feel more comfortable with I have a great one for my kids. Lily gave us a leukemia scare early on in her life and this doctor was a blessing to our frail nerves. Lucy