Baby Girl And The Wrong Diagnosis

The patient had a conventional name, such as "Jane Smith." She did have an unusual alias, though. It was Baby Girl. If she were a newborn, I could understand this, but she's an adult. I'm not sure if our records are mistaken or if she's really known as "Baby Girl Smith."

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With some patients, you can take one look at them and know that if they don't develop a pressure ulcer, it will be a miracle. But with this patient, he had almost no risk factors for pressure ulcers. He was ambulatory and he got up every few hours to walk. He was in good health, his skin had normal elasticity, he wasn't especially old and he was here only for elective orthopedic surgery. Now, about half of his buttocks are gone. They've been eaten away down to the bone. What happened?

It started out as massive blisters across his buttocks that caused his skin to fall off. A wound care specialist was brought in and after ranting and raving about this hospital acquired pressure ulcer, she decided that he also had a yeast or bacterial infection in the wound and so gave us an order for dressing changes that involved anti-fungal creams and topical antibiotics.

That turned out to be a major mistake. Over the weekend, black necrotic tissue formed across the buttocks. It was the weekend, there was no access to "experts", so the problem had to wait until Monday. On Monday, a doctor removed the dead tissue and took with it about half of the buttocks muscle tissue.

A dermatologist was also brought in and he said that it wasn't a pressure wound, a fungal infection or a bacterial infection. It was herpes. We're now treating him for herpes, but the missed diagnosis and delay in treatment cost the patient his butt.

Of course, everyone is upset and looking for someone to blame. The people higher up the food chain are, naturally, blaming the nurses. The nurses are pointing their fingers at each other. I'm not saying that anyone committed malpractice, but the missed diagnosis by the "expert", in my humble opinion, is the real cause here.

Anyway, work is stressful and ugly now with the investigation in progress. I'll be glad when this is over, but it won't be any time soon.