His mother brought him into the ER.
Here in New York.
Into a well-respected emergency room.
She told the triage nurse he had pain in his scrotum for hours.
She told the resident he had pain in his testicle for hours.
Nobody hit him.
He wasn't in an accident.
He didn't fall down.
This was spontaneous.
This was painful.
Mom didn't know what to do.
She didn't know it was serious.
So, she told him to take a warm bath.
She hoped that would solve the problem.
It didn't.
She tried to put him to bed after his bath.
He couldn't sleep.
His testicle was too painful.
Mom didn't know what else to do.
She called a cab and took her son to the closest emergency room.
The young doctor in training, known as a resident asked her lots of questions.
"Did he fall?"
"Did he hurt himself?"
"Did anyone kick him there?"
"Was he injured at school?"
One of his questions suggested the possibility of abuse.
Mom was offended by that question.
"When did the pain start?"
"What did you do in response to his complaints of pain?"
She gave him some children's tylenol and put him in a warm bath.
Again he asked, "When did the pain start?"
Mom didn't know it, but if a twisted testicle is suspected or proven, the doctors have a very limited window of opportunity within which to save the testicle.
If they miss their opportunity, the blood flow is cut off and the testicle will die.
To his credit, the young doctor in training suspected that this young boy had a twisted testicle.
Medically, it's called a testicular torsion.
The testicle must be untwisted.
Often it requires surgery.
Surgery to untwist it.
Surgery to attach the cord to the scrotum to prevent this from happening again.
Remember, the clock is ticking here.
This young resident only suspected that this boy had a twisted testicle.
He needed to run tests to make sure.
He ordered a sonogram.
There was no urgency associated with this test.
That was problem #1.
He did not relay to the radiology department how time urgent this test was.
Even though every test issued by doctors in the emergency room are technically urgent, the staff often gets complacent with 'urgently needed' tests all day long. All of this urgency results in routine complacency.
The resident also needed to reach out to the pediatric urologist who was on call that night.
He was not in-house at the hospital.
He had to be located.
Promptly.
Then the doctor would need to come in immediately to evaluate the boy.
By the time the pediatric urologist finally made his way into the hospital, much time had elapsed.
He realized that nobody had ordered a color doppler flow test.
That's an ultrasound test to see whether there's any blood flow to the testicles.
That incurred additional delay.
The pediatric urology surgeon needed the results of that test to decide whether to operate.
Was it too late or could he still save the testicle?
By the time the results came back, they did not look good.
He still held out hope and told the parents he'd try to save the testicle.
However, the color doppler test showed no blood flow to one of his testicles.
The one that was twisted upon itself.
By the time the surgeon went in to operate, the testicle had died.
It was dead.
The window of opportunity had passed.
There were many delays here.
Delays that inevitably led this child losing his testicle.
The defense wanted to blame mom.
They wanted to show that she caused much of the delay.
That was a painful argument.
They did have a point.
However, she was blameless.
She didn't know.
She didn't know her son had a torsed testicle.
She didn't know he required surgery.
Mom did what any good mom would do.
Try and reassure her son and see if something simple would work.
Our medical expert felt mom was not at fault here.
Instead, the hospital staff should have accepted full responsibility for the multiple delays.
Had they not delayed in diagnosing this problem, this child's testicle would have been saved.
Had they not delayed, they still would have been within their window of opportunity to save his testicle.
The triage nurse delayed calling a resident.
The resident delayed calling a pediatric urologist.
The resident delayed getting the correct test, the color dopper ultrasound.
The resident failed to let radiology know these tests were extremely time urgent.
The resident failed to ask the pediatric urologist to get to the hospital forthwith.
To learn more about testicular torsion, I invite you watch the quick video below...
