With Panicky Parents And Lingering Symptoms, Doctors Worry Too
By Dr. Carolyn Roy-Bornstein
I was having lunch at The Purple Onion with my girlfriends recently when my cell phone began vibrating. I ignored it. This was our sacred hour, after all, me and my girlfriends on a Friday afternooon. I heard the familiar bonk as the thing went to voice mail. We continued our meals and our conversations. My phone rang again. This time I rummaged through the junk pile that is my purse and checked the caller ID. My office. Strange. They never call me on my day off. I cut out of our lunch date early, distracted by the phone calls, an unease beginning to bubble up in my insides. Once in my car, I dialed up the office. Jennifer answered, her voice cheerful and friendly as usual.
“What’s up?” I interrupted her greeting.
“Oh, Dr. B.,” she began, the cheeriness draining from her voice like water from a colander. “Ginger’s mom called, all upset.” We have a small office. There’s only one Ginger. No need to identify her further.
“Yes?” I said, still not comprehending why she was reaching out on a Friday afternoon.
“She was crying. It was hard to understand her. We offered to have her talk to Dr. Moran, but she really wanted to talk to you.”
Scenarios ran through my mind: Ginger sick. Ginger hurt. Ginger dead.
“I got her cell phone number, Dr. B. I didn’t know if maybe you wanted to give her a call.”
I so appreciated my staff at that moment. In 3 ½ years they had never bothered me on my day off. But a crying mom had melted their hearts and broken protocol. I took down the number then sat in the Purple Onion’s parking lot and, with some trepidation, dialed up Ginger’s mom. It went to voice mail. I left a message saying that I understood she was trying to get a hold of me and to try again. I would try her back, too, which I did. Again. And again. An hour went by. I thought about Ginger, her developmental delays, her congenital abnormalities. Her worried mom. Had I missed something in Ginger’s work-up? Was someone else at this moment giving Ginger’s mom yet another diagnosis? Yet another reason to worry?
I dialed the local hospital to see if she was in the ER. She was not. I called admitting. No Ginger there, either. I called the tertiary hospital where she sees her specialists. Nothing. I called her home again. No answer. I called the office. Ginger’s mom had not called back.
I began interrogating Jennifer like I was Lieutenant Columbo. “Did she say anything? Anything at all? Anything that might hint at the problem?”
“Well, she did say something about Early Intervention.” Aha! A clue! I called the local EI office, but Ginger’s case worker was gone for the day. They asked me if I wanted to leave a voice mail. I did. Then, I was done. What else could I do? For the rest of that afternoon, I fretted. The idea of carrying this angst, this not knowing, around with me all weekend was a distracting piece of lead in my stomach.
Then my cell phone rang. It was Early Intervention. Apparently they had paged Ginger’s case worker. We had a long conversation. The team had had a meeting with Ginger’s mom and dad that morning explaining that she wasn’t really making progress the way they’d hoped.
“Do you think she’s autistic?” I asked. The thought had crossed my mind.
“We didn’t actually use the A word,” she replied.
I was relieved. Not that Ginger wasn’t making developmental progress or that she needed further evaluation or might be autistic. But that this was something we could handle together. That she wasn’t dead. Because I was worried. Because I was beginning to think that maybe she was.
Worry — Every Day
This same thing happens in my practice, though on a smaller scale, on a daily basis. Over the weekend I might get calls from a teenager with abdominal pain or the mother of an infant with a fever. I ask my questions. I give my advice. But then, I worry. Not about everything or everyone. Some things are pretty straightforward. Strep throats and ear infections. Fifth disease and hand-foot-and-mouth.
Some kids don’t have identifiable viral syndromes. I’ll see a slew of them in a row with high temperatures and the blahs. The little ones generally buy themselves at least a bladder catheterization. The older, verbal ones may complain of a headache. As long as they don’t have stiff necks or a petechial rash, I’m okay with sending them home with symptomatic care.
But some just look sicker than the average bear. I will sometimes get a CBC on a small subset. I might even throw in a sed rate. It won’t zero in on the diagnosis, but it’s reassuring if it’s low. Those kids I might check on that night or the next day. I leave my message on the answering machine.
“Hi. It’s me, Dr. Bornstein. Just calling to see how Jeremy’s doing. Call me when you get this, okay?”
Then I wait. And wait. Often, the return call never comes. I guess no news is good news. But still, a phone call would be nice.
Then there are the kids who don’t follow the usual course: the fever I thought would break and, even better, produce a roseola rash. It doesn’t. It stays up at 102. I’ve got the urine. I’ve got the blood. Now I’m thinking outside the box. Is there an abscess hiding somewhere? Is it not infectious at all? Maybe it’s Kawasaki Syndrome or something rheumatologic. Or worse, malignant. So I check on those kids, too.
“Hi. It’s me, Dr. Bornstein. Just calling to make sure Haley’s fever finally went away. Call me when you get this, okay?”
I see the parents at the scheduled follow-up visit and comment on the unanswered call.
“Oh, yeah. That was so sweet of you to call, Dr. Bornstein. But she was fine. We didn’t want to bother you.”
But it’s no bother. It’s actually a relief to hear from a parent that the temperature is now just low grade or that the kid just ate a half a bowl of macaroni and cheese, or (best of all) “she’s back to her old self.” Now I can stop generating differentials in my head. Now I can sleep better.
Ginger’s parents came in for follow-up the Monday after our frantic game of phone tag the previous Friday. They had had the weekend to digest the recommendations Early Intervention had made. They’d Googled and web-surfed and read up on the worst case scenarios and were feeling more prepared to take the next step in their daughter’s evaluation. We discussed various approaches and came up with a game plan. Everyone was happy. On the way out of the exam room, I broached the subject of my trying to return Mom’s frantic phone calls to the office. Ginger’s mom waved her hand dismissively.
“Oh, we were freaked out for a while, but we finally decided to go to the beach and relax.”
“Oh,” I answered, thinking of my own frantic hospital-calling.
“But it was sweet of you to call us on your day off.”
But my phone calls aren’t just public relations. We’ve got a web site for that. I suppose a call from one’s child’s pediatrician is good PR, but that’s not why I call. I do it for my own piece of mind. I do it because I worry, too.
Dr. Carolyn Roy-Bornstein is a Haverhill-based pediatrician who writes about health care. Her new memoir, CRASH! published by Globe Pequot Press will be out in October 2012.
This program aired on September 7, 2011. The audio for this program is not available.