Saturday, September 13, 2008
I think I can confidently speak for the majority of my colleagues in medicine when I say that something like the above summarizes why we did it.
Back in my early twenties I knew full well that, while academically prepared for medical school, I was hardly mentally prepared. I tried my hand at a few other professions, dabbling with the Law and taking the Armed Forces standardized test which screens for their pilot programs. Something in me would not rest, however, unless and until I got my MD.
About five months ago now, at the height of my anger and exhaustion with the ER (as it was in my former hospital), I had an epiphany. This little gal pictured above came into the ER one morning at about 2am. She was a wheezer and was working really hard to breathe. Her mom, a hard-working young woman fighting back tears, was so worried.
Turns out her daughter had been wheezing since birth and, after many visits to the pediatrician, was not getting any better on steroids and nebulized albuterol. Something was amiss. I did the standard ER workup and didn't get any smarter by it, but then two things happened.
First, the mom asked if I could watch her child while she went to the restroom. Hence the picture above. As I held the child I heard that still, small voice that we all hear from time to time saying the following... "Doc, get a picture... this is why you did it... this is why you went into medicine."
Not one to argue with suggestions from above (or, for you nonbelievers, from somewhere deep inside my noggin) I asked one of the nurses to take a picture of me with my patient... this little four-month old girl.
Following the Emergency Medicine axiom of thinking of the worst possible diagnoses and ruling them out I thought this young gal had an obstructive pulmonary process that was more than your simple 'reactive airways disease' or 'asthma' of childhood. And, like any good ER doc ,I did what we all do, I called the Mecca and told them that I thought this kid was sick and needed a more thorough evaluation by the pointy-heads. So, this is what I did.
Not only did the mom break down crying, but she came up and hugged me. "We've been trying to get her there for two months and we keep saying the medicines aren't working but they won't send us."
This is not a ding on my friends in pediatrics, it's simply a different way of approaching patients. This child should have had wheezing from a common source, but she didn't. What she had was a growth (non cancerous) which was encircling her trachea and esophagus and was causing not wheezing, but a combination of wheezing and stridor.
She was cured by a pediatric Cardio-Thoracic surgeon a few days later who took her to the OR and removed the growth. To become qualified to perform this surgery he did at least 8 years of residency and fellowship training (after four years of college and four years of medical school) working, on average, over a hundred hours a week during that time.
I called the Mecca a few times to talk with the mom and she told me that as soon as the little gal came out of the OR the noisy breathing was gone. She was home a few days later and she should do just fine. She will not remember the trip down to the Mecca and all the needles and all the worry.
This is why I did it. These kind of patients are rare, but this little gal let me know, through her wheezes and coughs and the way she rested comfortably on my shouler, that I had been an important part in her young life. The mom's hug let me know too. I thank them.
Posted by 911DOC at Saturday, September 13, 2008