Confessions of a Young Doctor Post-Call

Olivia reoccupies her childhood landscape

-written by Olivia in January-

Bill Cosby once said, “Give me one hundred two year olds, and I could conquer the world.” They are tenacious and indomitable creatures.

Over last weekend, I was the doc on call. The siren of fear in my head started several days before, and grew to an all-out wail by Saturday morning, when I was up at 5:30 AM to start morning rounds in the well newborn nursery. After finishing rounds, I worked the rest of the morning at the office, seeing sick visits. I had a few hours at home in the afternoon, waiting for the siren to subside. It didn’t.

In fact, it got louder all weekend. The only thing that made it stop was when my beeper went off. My heart would jolt, and the siren would quiet long enough for me to punch in the phone number requesting my reply. I got all kinds of calls, everything from a baby who didn’t want to poop at 11:00 PM, to another baby with a “fever” (temp of 100.2) who was cooing and laughing at 1:00 AM. His Mom wanted to know if she could give Tylenol. I felt like I was turning stones over in the woods, desperately, at breakneck speed, searching for a *real* concern, listening for that tone of voice that might mandate further action.

One six year old’s father called Saturday afternoon. I had seen the little guy a few days earlier, with high fevers and a sore throat. “He is still having high fevers. He is looking tired,” his father said in a pleasant PA farmer tone. I remembered the little Mennonite boy who smelled like dairy cattle. I offered to see him that afternoon before evening rounds. He came into the office, still smelling like a dairy farm, and looking awful. His liver and spleen were huge. “Oh man,” I thought to myself, “my first leukemia diagnosis so early in my career.” The parents were self pay, with no medical insurance. I told the mother we needed to admit him. I sent them to the local hospital with orders for tests that would either raise or confirm suspicions for leukemia. I spent the evening waiting about in the ER for his test results. Somehow it was more comfortable there than at home. At least no one in ER was hoping I’d play a game or make a craft with them.

Sunday morning, the little boy’s test results were negative for mono, but they certainly didn’t support leukemia, either. I was puzzled. I called a specialist and welcomed his input.

Sunday afternoon, I transferred a baby to Geisinger for further eval of some dusky episodes she was having. Her color changes were scaring the nurses. I didn’t have a good explanation for them. I wish I had been a little less hurried when I spoke with her parents.

On Monday, still on call, I went in to the office for evening hours. I was slamming through the rooms (overturning stones), when I entered a room with a Mom and a 2 year old girl. The little girl was pale, greenish pale, but she still wondered curiously about the room, exploring. “Her belly is big,” her mother said. “We didn’t want to come earlier because we didn’t want people to think the bruising was from us.” Bruising? The little tyke climbed up onto the table. Her liver and spleen were huge. She had bruising over her belly and legs. I sent her mother to the local hospital with orders to start some testing.

A few rooms later, I entered the room of a little 2 yr old boy with vomiting and diarrhea for 24 hrs. His siblings were sick too, with the same thing. Sounds like viral gastroenteritis, I explained to his grandma, who trusted me fully as we joked about the amount of laundry she’d been doing that day. His pulse was elevated, but the rest of him looked good to me. He climbed perkily up onto the table. His eyes were bright. His grandma said he had been starting to keep fluids down a few hours before. I sent them home with instructions to follow up with any changes.

After wrapping up the office work at 9:30, I headed to the hospital to check on the little girl and her Mom. Her lab results: very suspicious for leukemia. I called the local specialist, and we transferred her out around 1:30 AM.

I went home, trying to calm myself down for a few hours of sleep. When I walked in the door, Matthew was cleaning Lyric and Maggie’s vomit out of the bedroom. They had caught the same bug as half of my patients. We spent awhile getting the girls back into bed. I think it was 3:00 AM when the siren finally silenced enough to let me drift to sleep. At 4:30 AM, my beeper went off. This time it was the ER. The two year old boy with vomiting and diarrhea had arrived hardly responsive. His labs? Very suspicious for new onset diabetes! He perked up quickly with the help of the ER doc and some IV fluids.

I had diagnosed a new leukemic and missed a new onset diabetic all in one night.

The hardest thing was getting out of bed a few hours later to shower and go back into the office for evening hours on Tuesday. Matthew was manning the fort at home, running load after load of laundry. I vented to my empathetic office staff, poured over the chart of the 2 year old diabetic, and started overturning stones for yet another night.

Yesterday, I got some results for the little 6 year old boy with a big liver and spleen. Looks like he has mono after all. The specialist taking care of the two year old girl with a big liver and spleen says it looks like low risk leukemia. Jokes on me, I guess, but who’s laughing?

I am eternally grateful for the resilience of two year olds everywhere. I respect their ability to take on life and all of its foibles with unbridled curiosity, despite huge livers and spleens, and no platelets. I am thankful that their bodies have enough life left in them to be forgiving of missed diagnoses. Two year olds don’t seem to be bothered by what their doctors do and don’t know. In fact, most of the time, they give me a royal fight before they give me what I want when I’m trying to examine them. I suppose I shouldn’t sulk over my own limitations, but should learn a lesson from my patients and get up and face the day, exploring and throwing temper tantrums at Life. A cream filled donut never hurts, either.

P.S. Who says Gen Peds is boring? The six year old with suspected mono is still having fevers. This is his fourth week of fevers. His labwork is looking suspicious for hemophagocytic lymphohistiocytosis, a very rare complication of mono with a poor outcome. The problem with Gen Peds is not that it is boring, but that it appears to be. I am on call again next week and my neck muscles are tensing just thinking about it.