Monthly Archives: February 2014

Keep Calm and Be Methodical – Pretend You’re Working in an ER

There was a brief scare in our neighborhood this past weekend. Our phone rang. Our friend, who lives nearby, asked if her 12-year-old son was at our house. He wasn’t.

The child had been gone for about 15 minutes. Their family had just returned from a shopping trip with a family friend, and that family friend had forgotten one of his items at our neighbors’ house. The child said, “I’ll run it out to him, Mom.” His mother said, “I think he’s already pulled away,” and the kid replied, “I can still catch him.” As the mother was putting away groceries, she realized it had been about 10 minutes, and she hadn’t heard her son come back inside. She called through her house, went outside and looked around, called her family friend (who had not seen the child since he left her house), and then called us. Her husband jumped in his car to look for their son.

All five of us headed outside while the mom called the police. My husband took one car and left to drive an east-west pattern, and our eldest son took another car to drive a north-south pattern. Our two younger sons went on foot to check local parks. Each of us had a cell phone. I walked to our neighbors’ house, and asked my friend for details of everything that had transpired in the past 15 minutes. Their family friend had returned to their house, and he and I went inside to search the house carefully as our friend spoke to the police officers who had just arrived (small city, quick response time).

I did not think that the boy was in the house. But I looked anyway. It’s a doctor thing. Listen carefully to the story. Figure out the most likely cause. Think of the potential life-or-limb-threatening causes. Respond in a systematic way so as not to miss anything important. Being methodical and systematic also helps keep panic from taking over.

From listening to my friend and knowing the child, my assumption was that the kid had just gone to the family friend’s house. My friend did not think so – it was a mile-and-a-half away, and she said he wouldn’t have any idea how to get there. I still thought it was the most likely explanation. The police thought it was most likely that or perhaps he saw a friend and went to hang out with the friend and forgot to call home. My friend was terrified that her son had slipped on ice and was lying unconscious somewhere or that he had been abducted. I’m a mom – I get it. Same thoughts went through my own head.

The first of her fears was not overly likely, since it was the first warm day in a while, lots of people were outside, and someone would have seen him lying unconscious and called the police. The second fear was statistically very improbable. But those were the possibilities that were most threatening, so people started searching immediately. Why search inside the house? I certainly didn’t think he was hiding, but what if our friend hadn’t heard him come back inside and he had fallen on the basement stairs or been reaching for something on a shelf and had something fall on his head? Not super likely, but you wouldn’t want to have a dozen people searching outside while he’s lying unconscious inside. So you’re systematic. You look. Even when you think someone’s chest pain is likely to be benign and coming from his esophagus, you still check an EKG because you don’t want to miss a heart attack. The kid was not inside the house.

I stayed with our friend, reassuring her that she would probably be scolding her child for his disappearance within the next few minutes. The family friend drove back to his house to look – and saw in his mailbox the item the child had run to return to him. He called. And at the same time, one of the police officers swung by to say that another officer had just picked up the kid and that they were on their way back. We called the driving and on-foot searchers, and everyone came home.

The child was missing for less than a half-hour, but it of course felt like hours to us. Our friends’ son learned the importance of telling someone when he’s going somewhere, and of bringing his cell phone with him. Our friends learned that their child could navigate his way around our town a lot better than they had thought. And we all had reinforced the importance of responding quickly, systematically, and appropriately (news crew hadn’t been called, no Amber alerts issued, just as a doctor wouldn’t go straight to a cardiac catheterization for that patient with chest pain without first checking an EKG and some other basic things).

Breathe. Call for help when you need it. Be systematic. Communicate. Ask questions. And remember that the most likely outcome is indeed the most likely outcome, but take necessary steps to address other possibilities.

A Helpful Slightly-Sick Day

Our 13-year-old woke up feeling lousy two days ago. He had a sore throat and sinus pressure, and felt really tired and generally icky. He didn’t look toxic – just a little tired. I gave him a Cold-Eeze zinc lozenge and told him to get ready for school – a method that generally can tease out exactly how bad one of my kids feels. He just sat at the table. We generally adhere to the “unless you have a fever, are actively vomiting, or have blood squirting out of your ears, you can go to school” policy, but there’s been a particularly hard-hitting virus going around the neighborhood, so I figured I’d keep him home – no need to infect others if he was in a particularly germ-effusing state.

He had awakened at 6:30, and by 7 he was back in bed. He slept until 11, and then got up, gargled with salt water, ate a little rice, and worked on a math assignment his teacher had e-mailed to him when we told her he would be out sick that day. Back to sleep by 12:30. He woke up again around 3:30, had some chicken noodle soup, was back in bed within an hour, and woke up again around 7, when he was feeling well enough to join the family at the dinner table (where his 16-year-old and 17-and-three-quarter-year-old brothers joked that we never would have let them stay home without a fever, to which my husband and I smilingly responded that that was obviously because we love the 13-year-old more). He went to bed for the night at 9:30, and woke up yesterday morning feeling completely fine.

He doesn’t normally sleep for 18 hours total in a 24-hour period, so my powerful doctor-sense (or “duh”-sense) tells me his body really needed some rest to fight this thing off. Or maybe it was the zinc lozenge. Or the salt water gargle. Or the chicken soup. Or maybe he would have been perfectly fine by yesterday morning even if I had made him go to school the day before. There’s really no way to “know” for sure – I can’t do a prospective, placebo-controlled trial of each of the possibilities on my child, so my medical decision making was not “evidence-based,” nor is my conclusion that I did the correct thing based on rigorous academic study. It is based on common sense. A generally healthy 13-year-old who felt yucky and exhausted stayed home and slept and felt better the next day. No need for antibiotics or any other “big guns.”

Much of the art of medicine lies in knowing when a little time and rest is needed, and when more is needed. Sometimes, as Voltaire said, “the job of the doctor is to amuse the patient whilst nature takes its course.”


(Note: Men may not appreciate this one)

This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it.

In my personal experience, mammograms have ranged from quite uncomfortable to downright painful. And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in tears. Other times, the plates have dug into my ribs or my sides, or my skin has been pulled too tight in various directions. A few times, I needed to repeat a shot or two because I was told that the radiologist needed another picture because the first wasn’t compressed enough.

Last year when I went, I wanted to avoid the need for repeat pictures. The tech told me to let her know when I couldn’t take any more squeezing. So I just gritted my teeth and let her keep tightening. And she kept going. My breasts felt bruised and sore for weeks afterward. And one of the views needed to be repeated anyway.

So I really didn’t want to go today. But I did. Although there is some controversy as to the ideal timing between screening mammograms at different ages, my doctors recommend an annual schedule and from the studies I’ve seen, I agree that that’s a reasonable plan for me.

So I went to my appointment. And when I went into the room with the technician, I followed the advice I give my clients and that I’ve always given my patients. I talked. I voiced my concerns. And I was lucky to have a fantastic person taking care of me.

As she led me to the room, she spoke to one of the nurses about what room we were going to and where we would head afterward so that I would be seen efficiently. I commented on how she really had everything streamlined. When we entered the room, rather than keeping my mouth shut and worrying about being seen as “a complainer,” I told her about my past painful experiences, because I didn’t know how to get the appropriate level of squish without being injured (believe it or not, they don’t teach us that in medical school).

She told me that the re-takes that I had done in the past were likely not because of inadequate compression. She said that when the radiologist sees a little something that doesn’t look quite right, they get another picture to make sure, but so as not to alarm people they tend to say something that indicates the positioning or compression for the film wasn’t good enough, and on the repeat views they generally determine there’s nothing worrisome. She taught me that maximum compression doesn’t mean the best picture – there’s actually an ideal level that you can tell by the firmness of the skin on the compressed breast.

She performed the most comfortable set of breast x-rays I have ever had. And nothing needed to be repeated. And I wasn’t even cold, because instead of having me remove the gown completely, she pulled off one sleeve at a time and tucked the gown into my waistband so that most of me was covered and warm. Did I mention that this person was amazing? 

None of this, by the way, was special treatment or “professional courtesy.” I never told her that I’m a doctor. We simply spoke to each other as we would want others to speak to us. I was honest. She was honest.

I have her card – and I’ll be sure to schedule next year’s appointment when she’s working. I also plan to relate my experience to the people who run the department. Everyone should have a mammography experience like the one I had today, every time. No need to freeze. No need to endure painful squeezing. But someone does still need to work on a lighter adhesive for the nipple markers…