He comes back to me often: a young son in a family that had decided to use me – a fairly new doctor in the community. They were a fairly normal family, except for the fact that they had chosen me as their doctor – something for which I was still very grateful. The children had the usual colds, ear infections, and well-child checks. I thoroughly enjoyed my day-to-day interactions between me and this family.
One day, however, a seemingly trivial visit became one forever burned on my memory. It was late on a Friday afternoon and the mother had brought their youngest to my office with a fever. When I walked in, he looked like a child with a high fever – very tired and grumpy, but not significantly different than others I had seen in my short career. On exam, he had a bright red and bulging eardrum, which explained the fever and grumpiness and gave me an appropriate course of action. I prescribed what I thought to be \”strong\” antibiotics and told them to call me if there was any other problem.
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Monday arrived with a shock. I got a call from a shaken ER colleague who had seen him after me and sent him home with a shot of antibiotic (after confirming my diagnosis). A few hours later the child was back in the ER with a thready pulse and minimal respirations. Despite their best efforts to revive, he could not be saved.
Pathology results showed a meningitis that had spread from the ear – an obviously virulent strain of bacteria had bridged the short gap from the middle ear to the brain. He went into shock and died.
My heart hurt for the family – losing a young son so rapidly and unexpectedly. A young vigorous life had been stolen from their family, leaving them decimated and bewildered. I also felt for my ER colleague, who had also seen this child and sent him home hours before his death. All of my \”what if\” questions were nothing compared to those this doctor had to face. In a sense, his bad fortune had shielded me from the forever lingering self-doubt that comes from this situation.
No lawsuits were pursued, nor did the family stop seeing me as their physician. This amazed me – that they would not hold any lingering doubt about my part in this. I knew I had done my best, and had reacted appropriately, but I was humbled by their incredible grace every time they came to see me.
The image of this child\’s eardrum will forever be in my mind. I still see it. I remember the exam room I was in and remember talking with the mother about everything. Life hurts. Life is hard. There are no guarantees. Just how precarious we all are is sometimes brought into clear focus in moments that will never leave us. No matter how many lives you touch or even save, you are always reminded by these moments that we live on the razor\’s edge.
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This all comes to mind because I had another such encounter with a child just recently. This child was having what seemed to be a flu-like illness, but had just been acting \”odd\” according to her mother. When I saw her, I was uneasy and immediately sent her for further care. The diagnosis: meningitis that had spread from the upper respiratory tract. This outcome is far better – with the child getting appropriate care immediately and seemingly making a good recovery.
As I sit alone and think about it, I don\’t do much back-patting. I am extremely glad that there were enough signs for the mother and me to react quickly and appropriately. There will be few \”what if\’s\” in this case. But these moments don\’t bolster my confidence; if anything they serve as a reminder to me as a doctor that my job is serious. It is nice to feel liked and important, but you always need to remember that the edge of the cliff may await you in the next exam room.
It would be nice if we could go back and “do over” the mistakes we make in life, but we can’t. In a sense, each new case, each new patient is a chance to “do over”. I am grateful each time it comes out right. Take care, Dr Rob.
It would be nice if we could go back and “do over” the mistakes we make in life, but we can’t. In a sense, each new case, each new patient is a chance to “do over”. I am grateful each time it comes out right. Take care, Dr Rob.
I’ve said it before, and I’ll say it again. Medicine is, if nothing else, humbling.I’m glad things turned out well for your recent patient. Sometimes it’s hard to remember when seeing nonspecific viral illness after nonspecific viral illness that bigger badness can come along. Well done, Dr. Rob. Intuition is a voice to listen to.
I’ve said it before, and I’ll say it again. Medicine is, if nothing else, humbling.I’m glad things turned out well for your recent patient. Sometimes it’s hard to remember when seeing nonspecific viral illness after nonspecific viral illness that bigger badness can come along. Well done, Dr. Rob. Intuition is a voice to listen to.
What can I say? We’ve all been there at one time or another: you do your best and the outcome is not like you’d hoped. Even our best is sometimes not good enough.
Your writing here captures this eloquently, and given your attitude, it’s no surprise to me that the family still sees you. Obviously, they know you care.
What can I say? We’ve all been there at one time or another: you do your best and the outcome is not like you’d hoped. Even our best is sometimes not good enough.
Your writing here captures this eloquently, and given your attitude, it’s no surprise to me that the family still sees you. Obviously, they know you care.
Scary story, Dr. Rob. Meningitis is terrifying… and so fast! 🙁
Scary story, Dr. Rob. Meningitis is terrifying… and so fast! 🙁
“There are no guarantees”.
So true.
I for one feel very lucky to be alive today and every day is a day of joy for me. I don’t ask for guarantees, just ask for my physician to do his or her best.
I know losing a patient hurts, but such is life. And if you are going to be in the “life saving” business, you will lose a few.
“There are no guarantees”.
So true.
I for one feel very lucky to be alive today and every day is a day of joy for me. I don’t ask for guarantees, just ask for my physician to do his or her best.
I know losing a patient hurts, but such is life. And if you are going to be in the “life saving” business, you will lose a few.
Just a question, but did you accept payment from the family whose son’s death you caused? Do you still take $$ from them, even though they sacrificed their son’s life to further your medical education?
Just a question, but did you accept payment from the family whose son’s death you caused? Do you still take $$ from them, even though they sacrificed their son’s life to further your medical education?
Nobody “caused” that death. Even young people die sometimes.
If you expect doctors to make correct diagnoses 100% of the time, even in the early stages of illness, then you are expecting too much.
Nobody “caused” that death. Even young people die sometimes.
If you expect doctors to make correct diagnoses 100% of the time, even in the early stages of illness, then you are expecting too much.
Every doctor has at least one case that continues to haunt them. I am sorry that this was yours. Your write an inspiring post and it should make us all stop and appreciate when things go right.
Every doctor has at least one case that continues to haunt them. I am sorry that this was yours. Your write an inspiring post and it should make us all stop and appreciate when things go right.
curioua,
If payment for services in any field were held back because the person doing the service learned something while doing it, no one could ever get paid.
My own kids have probably had eardrums that looked very much like that child’s. The thing is, with the learning I have about ears and fevers right now, I probably wouldn’t take a feverish, grumpy kid in for several days. Unless there was something odd. I hope if I ever need to, I can pick up on the odd.
Anyway, when I first read this, I was going to say: that is one of the reasons I’m not in medicine. Thank you all for putting your psyches on the line to serve us.
curioua,
If payment for services in any field were held back because the person doing the service learned something while doing it, no one could ever get paid.
My own kids have probably had eardrums that looked very much like that child’s. The thing is, with the learning I have about ears and fevers right now, I probably wouldn’t take a feverish, grumpy kid in for several days. Unless there was something odd. I hope if I ever need to, I can pick up on the odd.
Anyway, when I first read this, I was going to say: that is one of the reasons I’m not in medicine. Thank you all for putting your psyches on the line to serve us.
I don’t think curioua really understands how crushing this is to the physicians. I tried to balance the emotion that surrounds this with an acceptance that these do happen. If that emergency physician had not been between me and the child’s death, then I am sure I would have struggled far more than I did, but to have someone else confirming what I thought was there made it far easier to feel I did all I could. I think the ER doctor quit not long after this event. This kind of thing can totally destroy a physician. Just writing it brought out a lot in me.
The bottom line is that we learn most from the hard things that happen. For me to point out the silver lining is in no way denying the dark cloud (which is far bigger than the silver lining, by the way). You must learn from this kind of thing. If you don’t, you are going to be a very bad doctor.
I don’t think curioua really understands how crushing this is to the physicians. I tried to balance the emotion that surrounds this with an acceptance that these do happen. If that emergency physician had not been between me and the child’s death, then I am sure I would have struggled far more than I did, but to have someone else confirming what I thought was there made it far easier to feel I did all I could. I think the ER doctor quit not long after this event. This kind of thing can totally destroy a physician. Just writing it brought out a lot in me.
The bottom line is that we learn most from the hard things that happen. For me to point out the silver lining is in no way denying the dark cloud (which is far bigger than the silver lining, by the way). You must learn from this kind of thing. If you don’t, you are going to be a very bad doctor.
This brings back a memory of when my boys were little. Our oldest son was 6 years old, (he is now 35.) He started complaing of a headache. My experience is that 6 YOs do not get headaches, then he began running a high fever. I called his Dr. who told me to take him to the ER. I did and he was diagnosed with a URI and given antibiotics. He cried in pain all night and then his eye began to swell. I took him back to the ER and again they called it a URI and told me he hadn’t been on the anitibiotics long enough for them to work. By that afternoon his eye was swollen completely shut, and he was screaming, with head and eye pain.
This time we went across town to the other hospital and the ER doc there knew something serious was going on. He told us “Kids use to die of this before antibiotics were invented.” I had no clue what he was even talking about. He called in a specialist and our son was admitted and placed on high dose IV antibiotics.
The bottom line is he had a serious sinus infection and it was explained to us that this sinus passage drains right beside the brain, which would cause meningitis if it spread to the brain. The fight was on to keep that from happening. It would be 6 days before we knew he was out of danger. I can’t even tell you how scared we were during this time.
I also did not blame the other ER docs. They had done what they thought was right. But, I knew my child was in far to much pain for a URI. I know it gave me a whole new respect for the term “sinus infection”. I never knew, before then, that they could be so dangerous. It still makes me ill when I think about what could have happened to him 30 years ago.
This brings back a memory of when my boys were little. Our oldest son was 6 years old, (he is now 35.) He started complaing of a headache. My experience is that 6 YOs do not get headaches, then he began running a high fever. I called his Dr. who told me to take him to the ER. I did and he was diagnosed with a URI and given antibiotics. He cried in pain all night and then his eye began to swell. I took him back to the ER and again they called it a URI and told me he hadn’t been on the anitibiotics long enough for them to work. By that afternoon his eye was swollen completely shut, and he was screaming, with head and eye pain.
This time we went across town to the other hospital and the ER doc there knew something serious was going on. He told us “Kids use to die of this before antibiotics were invented.” I had no clue what he was even talking about. He called in a specialist and our son was admitted and placed on high dose IV antibiotics.
The bottom line is he had a serious sinus infection and it was explained to us that this sinus passage drains right beside the brain, which would cause meningitis if it spread to the brain. The fight was on to keep that from happening. It would be 6 days before we knew he was out of danger. I can’t even tell you how scared we were during this time.
I also did not blame the other ER docs. They had done what they thought was right. But, I knew my child was in far to much pain for a URI. I know it gave me a whole new respect for the term “sinus infection”. I never knew, before then, that they could be so dangerous. It still makes me ill when I think about what could have happened to him 30 years ago.
Your post moved me greatly Dr Rob. I am sorry that happened and sorry the other doc may have quit. Hopefully he found his way back.
I didn’t realize meningitis could present this way. I thought the pt would have a stiff and painful neck? Also, for these cases…do you need to follow up with meds to prevent you from catching it? I remember the ED staff doing that when they felt they were exposed.
Meningitis is so frightening. When I work for SCARC…one of our residents was there because she contracted the disease and was left with permanent brain damage.
I think we live in an imperfect world and sometimes all we can do is our best…but still it’s not enough. The important thing is to learn from it. These kinds of events hopefully don’t happen in vane, but rather…serve to teach us so that we can then better help others as well as ourselves.
We never know who is traveling through our blogs and hopefully posts like this are helping someone passing through who very much needs to here your words.
Thank you for sharing this heartfelt post.
Your post moved me greatly Dr Rob. I am sorry that happened and sorry the other doc may have quit. Hopefully he found his way back.
I didn’t realize meningitis could present this way. I thought the pt would have a stiff and painful neck? Also, for these cases…do you need to follow up with meds to prevent you from catching it? I remember the ED staff doing that when they felt they were exposed.
Meningitis is so frightening. When I work for SCARC…one of our residents was there because she contracted the disease and was left with permanent brain damage.
I think we live in an imperfect world and sometimes all we can do is our best…but still it’s not enough. The important thing is to learn from it. These kinds of events hopefully don’t happen in vane, but rather…serve to teach us so that we can then better help others as well as ourselves.
We never know who is traveling through our blogs and hopefully posts like this are helping someone passing through who very much needs to here your words.
Thank you for sharing this heartfelt post.
A happy story–a “good catch” by a primary care doc, who I was on a date with on a Fri. night. I felt feverish and weak, but I had canceled once before, and I didn’t want to do it again, as I really liked him. I had had spinal surgery a few months earlier. He hugged me, I screamed, and he checked out my red, hot back. Love my surgeon, but he had told me to wait until Tues. for a office procedure. Cute doc took me to the ER, had surgery for staph and suture reaction, in the hospital many days. Happy ending, still love my surgeon, who felt way worse than I did.
A happy story–a “good catch” by a primary care doc, who I was on a date with on a Fri. night. I felt feverish and weak, but I had canceled once before, and I didn’t want to do it again, as I really liked him. I had had spinal surgery a few months earlier. He hugged me, I screamed, and he checked out my red, hot back. Love my surgeon, but he had told me to wait until Tues. for a office procedure. Cute doc took me to the ER, had surgery for staph and suture reaction, in the hospital many days. Happy ending, still love my surgeon, who felt way worse than I did.
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