The big fish in a little pond

March 2006

On a dreary, drizzly December morning in central Kentucky, I jumped out of my Volkswagen Passat and scrambled for the shelter of our local strip mall’s Radio Shack to purchase some batteries. An SUV roared up, blaring its horn behind me, sending my sympathetic nervous system into overdrive.

Jim, the driver and an acquaintance from the office and local entrepreneur, rolled down his window and exasperatedly blurted out: “Doc, we’ve been up to the emergency room. It is so crowded that they said it would be a three- or four-hour wait. Little Amos has been screaming and crying for the last six hours. I didn’t think that we could wait that long. I tried Doc Jones who is on call for your group, but after five minutes I got no response. You gotta help me.”

As the drizzle soaked my thinning hair and chilled my scalp, I contemplated my alternatives in front of the store. I could run for shelter inside the door and ignore him. I could politely say that I am not on call; try the doc-on-call again. Or I could say the emergency department docs are fine docs, and a little “watchful waiting” never hurt anybody, especially a child. Or, I could do the “right thing,” and help him.

I chose the last one, because I have definitely learned over the years that my self-induced pediatric angst becomes overwhelming when I do not follow the golden rule of pediatrics: “treat all families as you would want to be treated yourself.” When I have NOT followed this pithy aphorism, many a waking hour and night has been needlessly disrupted with anxiety and guilt about what I should have done.

So, I asked him if he would mind meeting me at home, where I had some medical instruments and, more importantly, some Dylan-esque “shelter from the storm.” Radio Shack, although carrying quite an extensive inventory, does not carry otoscopes and stethoscopes to my knowledge. Unfortunately, all my medical equipment was still at the office and not at my house, as is my usual habit. So we made a second stop further down the road at my office, where I quickly discovered this youngster’s malady — a bulging acute otitis media. I delivered some antibiotic and ibuprofen samples from the office cabinet to tide them over until they could obtain a prescription the next day. (Yes, I firmly believe that bona fide acute otitis media should be treated.)

“How much do I owe you, doc?” Response: “Oh, don’t worry about it. Some day, I may need your help.”

Although most people respect the physician’s private time, desperate times sometimes call for desperate measures, especially from frantic parents. As a physician practicing in a small town who frequently sees his patients every day in passing, we often try to remove ourselves from the uncomfortable process of billing and collections. Propriety, cordiality, nice guy, call it what you will, it remains a task considered too mundane and crass to perform personally by many doctors. However, as he walked out the door, he spontaneously offered to pay me in free video rentals from his store for a few months, perhaps Patch Adams or Doc Hollywood. Consider it continuing medical education, I suppose.

I still had this problem with dead batteries, which were not amenable to medical intervention, nor free delivery from Radio Shack.

Curbside consult, literally

I often have difficulty getting my essential exercise with my hectic office and family schedule. On a cloudy cool autumn night, strolling along the sidewalk with my wife and my friendly, leashed mutt, a Taurus suddenly screeched to a dead halt just 20 yards ahead of me. My friend, the painter, screamed “You gotta help us, Doc! Junior here choked on a barbecued rib a few minutes ago, and has been choking and crying that he can’t breathe!”

With my ACL-deficient knee and frantic gregarious dog, I hobbled over to the car to find a calm 8-year-old boy. First, my never-met-a-stranger canine quickly hopped into the back seat of the car. Once I jerked her back on her leash and prevented the additional deluge of dog drool, the little boy said his chest was hurting beneath the sternum and it really hurt him to swallow.

Yes, he spoke quite eloquently and he could still swallow and drink fine, but he could not really breathe (allegedly).

I poked my head into the back seat and found a well-perfused calm youngster in no distress, whose breath sounds from his mouth were smooth and steady. His neck and chest wall exam were normal to palpation. (What? Did you expect a complete examination during a “true curbside consult?”)

I offered words of calm reassurance: probably scratched his esophagus from the hard meat; breathing and speaking normally means no major airway obstruction; no cough means no aspiration; give lots of fluids; try some Mylanta; several teaspoons; several doses tonight and tomorrow; let me know if anything else worsens.

“Boy, doc, you just saved us an expensive trip to the emergency room, and a long wait. I tried to tell that boy to slow down and chew his food.”

My wife just shook her head, and my dog just wagged her tail. The stroll continued. Doctor Heimlich would have been proud.

A rock and a hard place

The night of my daughter’s big rivalry game arrived after a full schedule of sick children in the office as influenza was taking its toll in our community. As the lead cheerleader for the boy’s varsity basketball team, her parents’ attendance was expected, particularly by my daughter. I had missed half of her games this season, for the community was in the throes of an exceptionally bad respiratory epidemic and our office rarely shut down before 7 p.m. My promise: tonight I will attend your game; Daddy will be there.

I arrived home in time to grab a 20-minute sit down dinner and prepared for the trip to the game.

The phone rang. My skin crawled. My wife answered. It was our friends, the Holyfields.

We occasionally dined and shared social outings and war stories with this family. I had been the primary physician caring for their family of five children for a decade. This night, their 8-year-old boy had sustained a laceration of the scalp when he fell on a rock, they explained. The phone conversation was terse. I was already late for the game and almost out the door.

“Doesn’t sound too bad. Would you mind taking him to the emergency room tonight? I am really in a hurry.”

“Sure.”

“I am sorry.”

Click.

The Big Chill has never really thawed.

I suppose it was my fault, in part, as I never really explained why I was in a rush and why I could not find the time to partake in the vital “cranial sewing class.” I rationalized that any parent would surely understand that sometimes even the doctor has other family commitments. Otherwise, I would have missed the father-daughter outing.

I realized months later that I was the recipient of a social brush-off, and the children were no longer seeing me in the office. But did I need to justify my needs to a friend somewhat in need?

Such a nice enjoyable family too, and such a tangled web we weave. That cut really hurt.

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• Dr. Block has a pediatric practice in Bardstown, Ky., and is a member of the Infectious Diseases in Children editorial board.