Tuesday, November 29, 2016

Sometimes We Are Heroes and Sometimes We Are Villains.




My last story about a patient ended in sadness, so I am sharing one with a more uplifting outcome this week.  Two months into my private practice career, I was assigned a “No Doc” patient, a term referring to a child without a regular physician.  This one, in fact, did have a pediatrician, who called me to say “the family fired our group because we have not been able to diagnose the illness in their six week old son. He is your responsibility now.” 

If I have learned anything over the last 15 years, it is that our job is not an easy one.  That is not to make excuses, rather to emphasize the fact that success or failure can depend on circumstantial timing, making physicians look like heroes or villains.  Most doctors are doing the best we can, but sometimes it is not enough to heal an ailing patient.  It is the ambiguous nature of practicing medicine, and it is our perilous reality.    

Prior to that phone call, I had been on my way to the gym.  I was 27 years old and not much for formalities, which is still true today.  Dressed in a sweatshirt (clean), shorts (modest), and tennis shoes, I had my hair pulled back in a classic ponytail and wore no makeup when I first met these terrified parents. 

Studies have shown 75% of medical diagnosis is contained in the history, 10% in the physical exam, 10% on tests and 5% where there is no answer.  As I began to take the history, their six week old son started coughing.  He coughed and coughed until he turned blue, at which point I placed oxygen on his face and became more worried.  I knew all too well, he most likely had whooping cough.

Physicians can be “sugar coaters” who hide their concerns while gently reassuring patients and “bottom liners” who share the brutal truth (sometimes more abruptly than they would like.)   I try hard not to talk so much, but I cannot help myself.  Many patients like my “level with you” approach, but occasionally, eyes glaze over as I share diagnostic possibilities while brainstorming out loud.     

This is one of those times I was a definitive “bottom liner.”  As I managed his airway and called for help, I explained their son likely had pertussis (whooping cough) and required transfer to the local children’s hospital for pediatric intensive care.  As I discussed logistics, the father interrupts “How the #%&* do you know what is wrong with my son after less than 2 minutes?  He has been coughing for more than 3 weeks and doctors far older and smarter than you could not figure it out!”  He was extremely angry, which is understandable.    

My top priority was to arrange for transport to the closest intensive care unit quickly, so I reassured this father I would answer questions after stabilizing his son.  After speaking with the pediatric ICU, I returned to find both parents crying.  I had previous experience treating pertussis in this age group and knew a whooping cough spell when I saw one.  These parents understood the gravity of the situation watching me provide bedside airway support and answer their questions waiting for help to arrive. 

Timing has a role in everything and in this case, was on my side.  Their son’s symptoms advanced to the point where the diagnosis became more clear for me to look like the hero.  In a twist of fate, this same father was working in the ER when my husband got a piece of steak lodged in his esophagus which required invasive removal.   Life sometimes has a sense of humor and suddenly, he was our hero.

Every year when this child comes in for an annual check-up, I think back to the moments when I seemed like both hero and villain. This fragile infant recovered and has grown into a young man.  It is important that physicians be intelligent, caring, empathetic, and work hard, but sometimes timing can make all the difference.  While I do hope my future holds more days as a hero than a villain, this young man is a constant reminder for me to be grateful to those parents who place their precious children in my loving hands. 

1 comment:

  1. You said "Studies have shown 75% of medical diagnosis is contained in the history, 10% in the physical exam, 10% on tests and 5% where there is no answer." Can you please point me to the studies that you are referring to?

    ReplyDelete