Friday, June 17, 2016

An Extraordinary Case of Pink Eye

The most difficult job as a pediatrician is combing through the finer details in a sea of “pink eyes”, to ensure a more serious illness is not lurking beneath.  Patients often want physicians to call in medications without seeing them.  Maintenance medications are very different than antibiotics or other types used acutely to treat a condition.  My policy is not to call new medications over the phone until laying eyes on the patient.  Below is one such exceptional experience where a little boy’s life depended on it.

It was a cold winter afternoon many years ago when an experienced mother of three called in because her son had pink eye.  She asked me to call in antibiotic medication because it was snowing and they had to drive 20 minutes to get to my clinic.  I felt guilty refusing her request, as if I was placing this family in danger asking they come to the clinic for such a ‘simple’ problem; yet I insisted seeing her son was necessary.

Upon entering the exam room, her son looked paler since I had last seen him.  He had been sick on and off a few weeks with fevers and a reduced appetite.  His eyes were definitely pink.  I listened to his heart and lungs, laid him back, completed a full examination, and then asked him to sit up.  He was holding his neck rigid and would not turn it without moving his torso at the same time.  He did not have signs of meningitis or other identifiable infection.  His throat was slightly red; a few swollen lymph nodes were present, but nothing else on exam to aid my diagnosis.

A neck x-ray was ordered and the radiologist called to report his pharyngeal area looked hazy.  She recommended a CT scan.  I agreed.  She called a bit later worried and concerned.  There was a large abscess in his neck and his airway was tinier than it should be.  She did not want to release him back to my clinic without an ambulance.  I called the family and she called for ambulance for transport to the hospital. 

I relayed the information to mom, who was amazingly calm, cool, and collected.  I explained she should not leave the radiology building; an ambulance was on the way to get her and her son.  He was very ill and required transfer to the nearest children’s hospital 45 minutes away.  She followed my instructions and arrived at the tertiary care facility an hour later.  He had surgery that night for a neck abscess that was 4 x 5 cm in size.  Thinking about the diameter of a child’s throat, there is little room for error with their small airway.

Afterward, the surgeon spoke with mom and informed her it is unusual to see an abscess of this size; the odd shape kept it hidden, making diagnosis difficult.  He wondered how she determined there was an infection in his neck.  She said she thought it was a case of ‘pink eye’, but her doctor refused to call in an antibiotic without examining him first.  He commented that decision had saved her son’s life.

This sweet brunette boy is now a tall and lanky teenager; every time I see him I am thankful for the decisions we made that night.  To refuse calling in an antibiotic without laying eyes on a child is the “right call” for me as a pediatrician and mother.  Some families have left my practice because they feel this rule poses an inconvenience.  There is NO substitute to evaluating my patients with my OWN eyes and there never will be.

I practice in my hometown and see patients in public regularly.  A father of a different patient stopped me at a birthday party my children attended to ask why I would not call in an antibiotic for pink eye without seeing and evaluating his child. (He was offered an appointment and declined.)  I smiled and informed him that was my policy and briefly told him the story. 

Medicine is both an art and a science.    

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