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Family doctoring -- it's a three-ring circus
SOMETIMES MY work as a doctor feels like a regular three-ring circus. Three rings under the big top, each with something compelling going on.
You dare not take your eyes off ring No. 1 for fear of missing something. But the lion tamer is strolling into ring No. 3, and this is going to be good. Then the clowns in their police car and oversized shoes flop into the center ring. Can't miss that.
But wait! Over in ring No. 1, the jugglers on stilts are beginning their act . . . and so it unfolds on a Friday afternoon.
Doctor, why is my baby crying? She just won't stop. Please, is there something you can do?
Let's have a look. She seems OK to me. Maybe it's just gas.
But, doctor, I know my baby. There's something wrong.
Well, let's have another look. It's not easy, you know. I mean, she hasn't stopped crying the whole time I've looked at her. I think she doesn't like me.
But that's a different kind of cry. That's because she doesn't know you. When she cries at home, it's, well, different. I know there's something wrong.
But you've told me she is eating and has no fever, that her breathing is fine and she sleeps some of the time. Is there something I am missing?
When she crawls, she doesn't use her left arm as much, but I don't know why that would happen. Then, when we put her down, she cries even more.
What else can you tell me? A runny nose or cough? Does she pull at her ears?
She just acts different.
(Doctor, you're getting behind. I've just put Mr. Elkins in Room 6, and Mrs. Holt has been waiting for half an hour in Room 5. She's getting antsy.
Tell them I'm on my way.)
Now, about your baby. Let's have another look. No bruises. Arms move fine. Fusses when I put her down. For that matter, fusses when I pick her up. Maybe she's been having colic.
Do something, doctor.
Let's send her for an ultrasound of her tummy. A twisted gut would account for her fussing; we don't want to miss that.
(Doctor, about Mrs. Holt. She is getting pretty irritated.
I'm on my way. Why don't you pop in and tell Mr. Elkins I'm running behind and I'll go see Mrs. Holt. I hope she doesn't have her usual laundry list of complaints.
Doctor, I've been waiting a very long time. What kept you so long? My appointment time was 45 minutes ago, and we've got a lot of things to talk about.
I'm sorry, Mrs. Holt. It's been a hectic day, had some very sick people who needed a little extra time.
Oh. Well, you're here now. Let's get started. I've brought my list.
Your list? We may not be able to get to all of your concerns. After all, you were only down for a quick 10-minute appointment. We may need you to come back to address the rest.
My co-payment is $25, and I'm going to get my money's worth.
(Doctor, Mr. Elkins is having trouble breathing, could you come see him, please?
Excuse me a moment, Mrs. Holt. I'll be right back.)
Larry, your breathing sounds horrible. I heard you wheezing the second I walked in the room. How long has it been this bad?
Several days, but I kept hoping it would get better and it hasn't. I didn't want to bother you. I know you're busy.
Well, it's never a bother. Besides, with your emphysema and the pollen count and your allergies -- that's a wicked combination. We'll get a breathing treatment started. While you're at it, give some thought to quitting smoking.
Yeah, doc, I know. Like you haven't told me that before.
Now, Mrs. Holt, where were we?
My sinuses are stuffed up and I've been feeling dizzy a lot. My muscles ache and I've been having trouble sleeping. Oh, and my arthritis is acting up something awful. I've got a couple of moles I need checked, and there's those pesky warts on my feet that I'd like frozen off. And I've been constipated.
We'll see what we can do. But Mrs. Holt, you've had this dizziness for years. And I've told you that the arthritis will continue to be a problem. You may need to see a specialist for your dizziness; we've discussed this before and I don't seem to be making any headway.
Now, about your baby. She may have a bladder infection. Let's see about getting a urine specimen from her.
It may be a little uncomfortable for her when we put in the catheter, but I think it is important. She's crying, but we need to figure out what's going on. I need to pop in to another room real quick, but I'll be back soon.
Doctor, as I was saying, my constipation is horrible. Haven't had a good bowel movement in two days. Then there's this dizziness and a whooshing sound in my ears, like the 6:45 Amtrak going by.
Sometimes it's hard to give all three rings in the big top your undivided attention. Why is the baby crying? Poor Mr. Elkins needs to breathe. (Don't we all?) And Mrs. Holt. I know she's had these concerns before, but I can't dismiss them. Besides, I recognize that these are social visits as well. What this lonely widow really needs is someone to listen to her and offer a kind word and support. (But why does she pick the busiest times to come in?)
Time to catch my breath. I've addressed most of Mrs. Holt's concerns (albeit in a rather cursory fashion), Mr. Elkins is no longer huffing and puffing, and I've packed the baby off to the children's hospital's radiology department for an abdominal ultrasound. A rash, fever and sore elbow come in at a manageable pace.
Then we're back in the big top again. The radiologist calls back and tells me that the abdomen looks fine. I know what Mom is going to ask: Then why is her baby crying? So I ask him to get an X-ray of the baby's spine. Once again, all fine.
I tell Mom the good news. She's not mollified. She knows her baby, and that cry just isn't right. Oh -- and she adds another piece of information that she didn't think was relevant before: The baby had fallen out of her crib a few days earlier. Could that have anything to do with how she's acting, doctor?
We X-ray the arm. And sure enough, there it is, a fractured wrist. The radiologist kids that he's never seen a broken wrist start as abdominal pain before. Good thing he doesn't know we catheterized the kiddo as well!
As the day nears its end, the baby sports a fresh cast, Mr. Elkins is feeling better -- and Mrs. Holt is so satisfied, she already has made an appointment for next week. I guess she still has a few items on her list.
As for me -- well, it is Friday afternoon and I have an appointment of my own at Luisa's Mexican restaurant right next door. I can't wait.
Reach Dr. Steve Dudley, a family physician in Seattle, at email@example.com.