Tuesday, August 14, 2007

Tell Me Where It Hurts

A seven-year-old girl was rushed by her mom to the Emergency Room of a known tertiary hospital because of episodic abdominal pains. After the initial diagnostic work-up of the attending physician, a bowel cleansing prior to a radiographic procedure was deemed necessary. A Fleet enema was ordered, to which Sitti (not her real name), the nurse-on-duty, carried out.

The child, lying on the hospital bed, was placed in Sim’s position. Sitti inserted the enema nozzle in a dreadfully wrong opening. Instead of the child pooing, the child bled profusely.

Fleet enema (Image from Lippincott Williams and Wilkins Supplemental Site)

When the pediatrician arrived, the enema nozzle had just been removed, the pediatrician inspected the child’s perineum, and yup, the hymen had just been accidentally torn and was beyond repair. To make the matters worse, the child’s mother happens to be a pediatrician as well.

It was unknown as to whether the hospital administration offered an out-of-the-court settlement or a legal case was filed.

Aside from the insta-rape incident and a newly formed carunculae mrytiformes, the innocent child was likewise guaranteed with a broken childhood and traumatizing emotional scar. While the brainless nurse is still roaming the hospital halls, planning to victimize new patients with her new uber-ludicrous tricks on hand.

Thank heavens, I'm not the pediatrician mom. Or else...


A practical/legal opinion would be helpful. Images from Flickr, links direct to either Wikipedia or Lippincott Online.


† alleicarg † said...

di ako makapagcomment sa topic na to..

no comment.
peace po..


Daizuke said...

Poor girl.. She will likely experience physical and emotional symptoms that would lead to difficulty in future relationship... Though I believe it CAN be healed as far as the emotional facet is concern..

The Nurse should be inserted with enema nozzle with the same wrong procedure... To let her know how painful it is for the girl..

cory said...

SUSMARYOSEP! naka sim's na't lahat mali pa din ang napasukan! hindi ba bumulaga sa mukha nya ung ahole nung poor girl? eh napaka distinct naman ng pagkakaiba nun!

napakasaklap naman talaga nun na ma-divirginize ng dahil sa catheter. i dare not say that I'm a perfect RN-to-be pero come on naaaamaaaaaan! if she were here in the states, she'd definitely lose her license. lintik lang ang walang ganti!!! nakupo't pediatrician pa ang mom nung pt.

interesting story though n thanks for sharing... hmm, san mo nakuha tong story na to? intriguing ha... :D

more power nurse ruff! love ur posts...

kc said...

ack! that's so bad. isn't it a ground for license revocation?

i feel sorry for the child. she's in her formative years pa naman. sitti took away the little girl's childhood.

if she's not that experienced, sana she asked for assitance from her seniors. or if she's unsure of what she did, she should've asked someone knowledgeable to check it.

may this be a lesson to all. like what one of my CI's taught me, when in doubt, don't. ask for assistance.

Kiks said...

if this happened in the philippines, the hymen is a big issue.

nevertheless, anywhere in the world, i personally think the nurse should still be penalized for doing something stupid yet so dangerous and traumatic.

You sure you're not this nurse, Ruff?

cory said...

@ KC: haha cnong CI ngsb nyan? I'm sure hindi si Olivar/Vitug yan! lmao.

Actually I don't think she had any doubt at all regarding where to poke the catheter. Maybe she was bothered by something, not thinking clearly, absent minded, lacked sleep, only God knows...But it was a very very terrible mistake nonetheless.

[ k r y k ] said...

wah. nurse ruffn.n huhu
wawa naman yung lil'girl victim ng negligence *sigh*

Q The Conqueror said...

Ok... That nurse was exceedingly dumb. I know that the hospital has to defend the nurse, but really, do they have to still let her work there? Can't they like... Send her to Saudi Arabia to insert enema tubes up the asses of Arabic rapists or something?!

icka said...

jusmio...jusmio..stupido.absent kya c nurse nung topic nila eh reproductive system sa ana/physio?

and for d lil girl. sigh. it must be very traumatic for her.an enema tube was her first exprnce

Myk said...

Clearly it is a case of malpractice. The nurse may not have had enough orientation regarding the three holes in the perineum of a female human. But then again, the nurse was a female too, right? Hmmm...

mister said...

And she's still working in that hospital? What the f---?! That's just so wrong. I do hope the girl's parents sued the idiot.

ruff nurse-du-jour said...

@ALLEICARG: No problem, either that post was incredibly shocking or you're just completely caught off-guard is both acceptable. I was ghastly dismayed too upon hearing that news FIRST-HAND. I was utterly speechless.

ruff nurse-du-jour said...

@DAIZUKE: Yeah, I feel terribly bad for the child too. That event will be forever ingrained in the child’s memory that is for sure. Though I’m not in the position to predict what might happen to the child, pediatric psychiatry dictates that future consequences of that crisis is catastrophic—relationship-issues, basic trust-mistrust, disturbed body image are assured among others. I wouldn’t elaborate more as the list definitely goes on.
And as for the nurse, I’m keeping my mouth shut na lang. Hehe. Baka mabasa pa niya to. Your suggestion, however, is worth considering! By the way, how did you know about my *other blog? =)

ruff nurse-du-jour said...

@CORY: Thanks for the sweetest, nicest compliments. Glad to hear that you’re liking my posts, and my site as well. Would you think it’s weird if I admit na marami pa akong alam na similar cases? I hope not.
Perfectly said cory! Knowing that the patient was a young girl, cyempre that girl’s perineum is spotless (hairless and wala pang masyadong folds), distinguishing the anus from the vaginal introitus is really easy. Tsaka sa Sim’s naman ay exposed talaga yung anus, ewan ko na lang talaga sa nurse na ito.
I get your point cory. We’re not perfect naman talaga, and we’re allowed to make mistakes during our practice pero prudence naman when performing nursing tasks. Little mistakes could be tolerated, but that kind of negligence, that’s a different story.
By the way, a friend works in the same hospital, the incident happened before her shift. It was endorsed to her. There was a huuuge commotion daw sa ER—the medical director, nursing director, etc. were called immediately after the incident to come to the ER. Hindi ko maimagine ang kaguluhan!
Thanks for always visiting cory. Balik balik. =)

ruff nurse-du-jour said...

@KC: Yeah, the child was in her formative years and look at what happened. It was like she’s molested or something. I was hoping that the nurse will be suspended and her license revoked but as of the moment, the nurse was just reassigned, and guess where? The Medical-Surgical Ward of the same hospital.
I know that the ER environment is fast-paced and everyone is expected to work amidst tremendous pressure but that *fact does not exclude or exempt her from doing her job injudiciously. And yes, this should be a lesson for all of us. In her case, I guess that was sooo well-learned. Might as well revoke the license of the clinical instructor who taught that to her. =)

ruff nurse-du-jour said...

@KIKS: Unfortunately, yes, kiks. Dito po sa Pinas ang mga nangyari. And a torn hymen is always a big issue, especially sa culture natin that equates virginity as someone’s honor/reputation.
I agree with you kiks, I wouldn’t want that nurse not castigated, or penalized for that matter. Strictly speaking, she could be guilty of negligence and reckless imprudence, and such cases are valid, unmistakable grounds for license revocation. I don’t know if the act legally constitutes rape (or something less grave), but I think more legal offenses could be extracted from the act.
And I’m sure kiks, hindi ako yung nurse. Hahaha. Kaw talaga kiks oh! Forte ko yata ang ganyang interventions. Just kidding. =)

ruff nurse-du-jour said...

@CORY (additional): Actually that was an interesting perspective. The pressures of working in the ER is tremendous and she might be in a vulnerable/susceptible position on that exact time; or she might not be in the best physical/psychological condition to act, but I’m sticking to my guns: that circumstance WON’T EVER, AS IN EVER, excuse her from doing her job imprudently.

ruff nurse-du-jour said...

@KRYK: when I first heard about that incident, we have the same sentiments. The only consolation for the little child was that her mom has the expert medical knowledge to protect her. Kung hindi doctor yung nanay niya, I’m 100% sure that case will be non-existent. “Parang walang nangyari.”

ruff nurse-du-jour said...

@Q THE CONQUEROR: Ideally, the nurse *might be* guilty of negligence, reckless imprudence, and other legal stuffs to which I’m not familiar of, upon which may be grounds for license revocation. But we all know the political system here in the Philippines, right? It’s close to hopeless.
On another viewpoint, if ever the nurse was found guilty, by virtue of respondeat superior, the entire hospital administration might be liable as well. And we know how medical matters are handled here in the third world—either cases are dismissed (as necessary evidences are withheld or tampered) OR the respondents offer the complainants with money in an out-of-the-court settlement. Either way, laging lose-lose ang situation. If I was a politician or something, siguro pina-salvage ko na lang yung nurse, or pina-behead ko sa mga MILF sa Basilan. Talk about “an eye for an eye and a tooth for a tooth.” Ooops, that’s just mean.

ruff nurse-du-jour said...

@ICKA: I’ll let you in a little secret icka, I know the school where she graduated from. Okay that was just wrong, and unethical if I might add. But I’m giving the school the benefit of the doubt. After all, ultimately it’s the nurse’s responsibility naman talaga yung alamin ang isang *extremely basic nursing procedure of using Fleet enema, which could be summarized into 3 uber-simple steps (1) Remove enema cap from the nozzle, (2) insert the nozzle in the ANUS, and (3) press till the fluid are in. It couldn’t be any simpler.
I wouldn’t be proud too in saying that an enema tube was my first experience either by the way. Haha. As if. =)

ruff nurse-du-jour said...

@FRANX: Terima kasih franxbudi. It’s always a pleasure reading your entries. Very inspirational and moving, especially after reading entries like this one right?
And thanks too for the compliments. I’m not that great franx, I’m just a-bit-above-the-average nurse, hehe. And yup, yup, I will stay away from her. Be careful of nurses like her too. Take care always frank. Hope I could visit your beautiful place. =)

ruff nurse-du-jour said...

@MYK: Yeah it is. That was quite weird right? A woman not knowing the basics of perineal anatomy. Is that plain stupidity or what? I admit that I might be the best nurse to ever grace the land but at least I know the difference between the A and the V. On another note, baka nga may ibang iniisip si Nurse Sitti, like what she’ll be having for dinner, or whether she should broke-up with her bf, or something else. We’ll never know.

gorjess said...

ohhh kawawa nmn. san po nangyari toh?

ruff nurse-du-jour said...

@MISTER: Ooooh. Scheez you’re back!!! I miss you sooo much, you transferred to Wordpress right? I’m so happy for you scheez. Hope you’re doing really well. Long time no see ha!
By the way, yeah, she was just transferred to another ward. Talk about injustice. And as of now I don’t have enough information about what happened (settlement vs. legal case) but the moment I get some relevant facts, I will be posting it here. Syempre para hindi naman tayo lahat mabitin. =) Glad to see you back mr scheez. Smooches from me to you.

ruff nurse-du-jour said...

@GORJESS: Hmm, tertiary (ie., large/specialized) hospital po here in the Philippines. I'm not in the liberty to disclose details eh, baka ako ang ma-sue ng ospital. Hehehe. Sowie. =)

Marcus: Bading Down Under said...

shet. that nurse should be shot. serious.

niki said...

i would totally go ballistic if i was the girl's mother.

kc said...

yeah you're right, ruff. the fast paced atmosphere in the ER doesn't give nurse sitti an excuse for not to give an immediate but efficient nursing care.

i may not be in the position to say this, considering that i'm not so perfect myself, but i think that she shouldn't have been transferred to the MS unit. pinagseminar or train na lang muna siya or something on administration of enema. even if she's deprived of sleep, food or whatever, she should learn that the patient's safety is our priority.

thanks for this post. i'll keep in mind to check everything before i perform procedures.

@ cory: sino pa ang magsasabi nyan? eh di ang CI namin sa PGH-OR..syempre, ayaw nun na pumalpak kami kasi, "the patient is open for all the world to see". nyahaha!

ruff nurse-du-jour said...

@MARCUS: thanks for the dropping by. not only shot, but beheaded as well. she is such a pathetic excuse for a nurse. we share the same sentiments, i guess. =)

ruff nurse-du-jour said...

@NIKI: i was thinking of the same thing. knowing that the child's mom is a pediatrician gives me the comfort that whatever's going to happen to the child will be fine. that incident definitely brought that child insurmountable amount of trauma and unnecessary suffering, and as a mother, that thing being experienced by her child is extremely unbearable.

ruff nurse-du-jour said...

@KC: That was so true. I'm also a firm believer in common justice. The nurse should be penalized/punished for committing that *grave albeit negligent offense. She might walk the hospital halls offense- and consequences-free and all, but i'm definitely sure that the *guilt brought about by that incident will definitely haunt her for her entire nursing life.
konsensya na lang nya ang bahala sa kanya. don't worry, i'll keep you guys posted about the happenings. i might get an update in a week or two.

and about that pt, "open for all the world to see," hmmm, that incident is also relatable. =)

Anonymous said...

ghad. this situation must've been very traumatic to the part of the poor girl.

what was the reaction of the hospital officials? nalaman ba nila ang whole incident? gosh.

seriously, nakakaawa ung bata.

† alleicarg † said...

history.. =)

† alleicarg † said...

there's a button on the bottom right of my page which links here:



cory said...

i read from ur post @icka na u know whr the nurse works. hala...san kaya sya grad? pag sa schl namin mamamatay ako i swear to God.

at bongga ang nurse ha naassign pa sa ibang area. i bet super chismis ang abot nya! naku kawawa naman. hnd ba pwedeng sa mejo mas trivial ung work like sa OPD, sa MS pa talaga eh...

oh yeah whn i said pala that maybe she was deprived of sleep n such i ddnt mean to make up an excuse for her naman (hnd ko sya friend) haha...i was just speculating but yeah she can't get away from the fact pa din naman na mali sya. una pinasok nya sa maling lugar. pangalawa sinaksakan pa nya nung fluid. kung hnd ba naman talaga... double jeopardy!

ur welcome nga pala nurse ruff n tnx din for the frequent visits n comments... ^_^

ruff nurse-du-jour said...

@JACKIE: Thanks for the visit. You're at the Gulf pala. =)
The problem is that most people hear, but they do not listen. On another viewpoint, those who hear reply by speaking, and those who listen, by talking. Knowing which from which is the real dilemma. =)

About this case: Actually that hospital was notorious for incriminating nurses, but by some unexpected twist of fate, the verdict was in favor of the nurse this time (when it should be otherwise). The institution seems to have a twisted sense of justice. But that's just me.
In such cases, the institution is most likely to offer a settlement. The hospital lawyer used to ... and ... is close.... Ooops sorry. Could not divulge further. But yeah, the child must be truly devastated.
Thanks for stopping by.

ruff nurse-du-jour said...

@ALLEICARG: Thanks for dropping by. Ooooh, was that Marcella Chester's blog? She's got some really must-read entries there. Sure sure, I've already bookmarked her page. Will try to contact/keep in touch/participate in her crusade.

"I wish I could trigger a device... when people try to take something not meant for them. What doesn't kill you makes you stranger."
-Marcella Chester

ruff nurse-du-jour said...

@CORY: She graduated somewhere from the North. If I'm not mistaken, she's either batch 2005 or 2006 graduate. Will try confirm that. And yeah, MS ward pa talaga. And about the chismis, yeah, it was known all over the hospital *daw. I was thinking of either license revokation/dismissal, or siguro retraining at least, pero the fact na na-retain cya at the same institution is *sooo appaling. Hindi na nawalan ng *hiya. I will try to confirm kung ano na ang progress sa case. Pero I was really thinking that a settlement was made. Babae pa naman siya, hindi man lang niya nalaman ang sarili niyang anatomy. What kind of nurse was that! =( Oops that was mean.
You're always welcome cory. You know naman na I love TV/celeb chismis and the pop culture. Thanks for the frequent visit. And yeah, batch '06 nga pala ako. =) I'll reply at your post maybe later/tom. My laptop batt is almost out. =(

Q The Conqueror said...

@ruff - Yeah, i kinda remember this from Grey's. Hehehe. But it was the doc that screwed up. Send her nga to Arabia. With recommendations pa!

savante said...

How in the world could they have mistaken the vagina for the anus? Sigh.

ruff nurse-du-jour said...

@CONQUEROR Q: Yeah, I think it was Dr. Burke. Hospital screw-ups are such a big deal, and cases rarely go to court. I have an MD-lawyer friend who admitted that *this particular case would be better settled out-of-court as such cases slowly progresses in the Philippine courts.

What happened to the Libya AIDS trial is synonymous with what happened to this nurse--only in this case, children's future and well-being have been put into jeopardy. My take on this, relentless pinpricks and human vivisection should be her fine. Of course, aside from the Arabian trip.

ruff nurse-du-jour said...

@DR. SAVANTE: Thanks for the visit DOC. =) I'm sorry that you have to hear such terrible news. Actually, I couldn't really answer your question. My guess? Plain stupidity, too much stress at work, inattention, family/relationship problems... hmmm.. and so much more. That was just an isolated incident doc, I'm praying that nothing like this would ever happen again.

And about Chris Evans? Hmmm. I would love love love to savor that backyard scene. =) Wanna transfer to a new neighborhood?

bingskee said...

hi, ruff..wow! it's only now that i had successfully opened your comment box and be able to comment! what's the problem with blogger kaya?

would want to echo what mr savante said How in the world could they have mistaken the vagina for the anus? really disturbing. i would not allow that the nurse go 'unscathed', as in unpunished, because of the damage that was inflicted. she has to face the consequences of her irreponsibility. again, i would like to reiterate for all those who want to be nurses but does not have the heart for it, dont pursue. this kind of mishap cannot just happen, if only that nurse is alert and responsible.

kc said...

hi ruff.. i can't log in. there's something wrong with blogger yata.

anyway, i agree with you about the konsensya thing. if she realized the implications of her negligent act, she should've submitted herself for a greater "punishment". umm, like, being suspended for a month or so.

eh kung hindi, i think it'll get the best of her in the long run.

i'm still thinking about the kid and what would happen to her psychologically after the incident. she doesn't deserve that. imagine, she unconsciously lost her childhood. sus!

yes please ruff, do keep us posted. thank you! :)

ruff nurse-du-jour said...

@BINGSKEE: Thanks for the visit Bing. Long time no see my dear friend! Sorry if I wasn't able to reply immediately bing ha, I think something's wrong with blogger nga. =(

Well, I guess that, indeed, is the most pressing question. And I definitely could not provide an answer to that query. Aside from speculations, what she has written in her Incident Report is off-limits to outsiders like moi. It's just that I think whatever her reason might be for doing *that act, it is truly unjustifiable and if justice is to be served, she must have been punished/penalized for doing something (1) unprofessional, (2) unethical, and (3) immoral, and even possibly (4) criminal. But as we all know, JUSTICE is not always SERVED, and not everything in this world is fair.

To add to what you have said, hospital administrations should provide stricter rules and regulations to all its employees--clinical and non-clinical staff alike. If those kind of incidences would be left unpunished, its workers would become more lax and complacent and might even jeopardize the safety of their pts. If she had only performed her job prudently, then nothing this evil could have happened. And now everything is just too late. =(

ruff nurse-du-jour said...

@KC: Hi KC, thanks for the visit. Really appreciate you following through.

Yeah, that was an interesting perspective. If the hospital couldn't even impose a stricter punishment to her, she shouldve had the initiative to submit herself to what she think is right and just. But then again, what if she doesn't even have the ethical conscience to begin with? THAT is the bigger question.

And that child would be forever scarred with a fault not even of her own. Im just praying that the nurse who did that will be forever haunted with that terrible mistake and the consequences her actions brought to the child. Im hoping that the child has the enough courage to overcome this adventitious experience.

And of course, I'll keep you guys posted. =)

chase said...

daming post dito oie. hehe
ano ba yan?! napasok sa wrong hole?
even i, an eccentric gayman, know the holes of the female specie.

ayoko ng enema.
pwd mo i-check prostate gland ko ruff? hehehe

ruff nurse-du-jour said...

@CHASE, don't worry chase i promise i wont. =) I aced my anatomy classes when i was still in college. Your "whole body" is safe with me. =)

No enema for you, then.. Do you know that there is a mental-sexual disorder about obsession and deriving sexual pleasure from enemas? Klismaphilia is the medical term. Its weird right? Sexual disorders are my favorite psychiatry topic kc. Everything sexual in nature, I seemed to have the expert knowledge. Hehehe

And about the prostate gland, just tell me when. Haha. Just kidding. You do the honor (I mean, you to me.) =) Haven't had it checked in quite a long time. Hehehe. Kaw talaga chase. Pilyo. =)

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