Two Hats

Cap’n has a history of atypical febrile seizures (we have Valium in our house for these because his first one lasted over 20 minutes), with 102.5 axillary (about 103.5 oral) being the danger zone for this.  He's been as high as 105, but that was with the first one.

We’ve been to the neurologist after the first twenty-minute-plus ordeal (I drove him to the ED, still in status epilepticus, because he was breathing fine and I didn’t want to call an ambulance; he wound up getting IV valium and spending the night), on the recommendation of any number of pediatric specialists that I’ve had casual contact with.  His EEG is normal.   There’s a strong family history on both sides and so she felt that this was just a case of bad genes. 

We now take fevers very seriously. 

He had an ear infection with the first seizure, and since then he’s had three more ear infections and one more febrile seizure, so we went to see the ENT doctor of my choice to talk about getting tubes put in.  

Cap’n has flat tympanograms: his eardrums don’t move much because there’s fluid behind them.  They didn’t even do a hearing test, and it took the ENT doctor about ten seconds to agree with my assessment.  He also suggested I consider getting Cap’n’s adenoids out.   “Does he snore or mouth breathe?” 

“Oh, not really.  Only when he has a cold.” 

I hadn’t thought about the adenoids.  I went home and did some research, and read up on them.   And then I started paying attention to the symptoms.  That was when I started noticing how much mouth breathing and snoring took place in our household.  And also how many colds he really had.  It’s one of those things that makes you feel a metric load of retrospective parent-guilt, for not noticing. 

Surgery is scheduled for tomorrow and I have been a nervous wreck for a week already.  Then I got the call from daycare.  “Just letting you know he’s running a little fever, just 100.1.”  They gave him Tylenol.   An hour later it was 102.  We went and got him and I gave him the rest of the Tylenol dose for his weight and set to watching him and worrying.

He didn’t eat much dinner (although he liked the apples in the pork chop sauce) and whined more than usual (although he liked being pushed around on the tricycle), and then two hours after the Tylenol he started getting warm again.   My preoperative instructions said no NSAIDs for 2 weeks before the surgery, so I went to the other homegrown remedies and put him in the bath.

After 30 minutes in the tub, he was starting to shiver, and I couldn’t tell whether he was just cold or whether he was starting to get the tremors that presaged another seizure, so I took him out and checked his temperature, and he was 100.4 axillary still.  He was also still having tremors, so  in flagrant defiance of my preoperative instructions I gave him ibuprofen. Then I called and had the ENT paged at 8 PM so I could talk about whether we needed to cancel. 

There are some privileges that come with being a doctor.   Sometimes I use them.  I try not to abuse them.

He called me back and gave me his cell number.  "Call me any time."  I went over the physical exam with him (ears still dull and a little red, not acutely infected; snotty nose; lungs are clear) and asked if we needed to reschedule.  He said "maybe not."

We are tentatively still on for tomorrow morning, but it will be Anesthesia's call ultimately.   I want this done.  I want my son to be able to hear more clearly and sleep more soundly.  But I don't want to put him in danger to do it.

He’s cooler now; sleeping soundly in the middle of our bed where I can keep an eye on him as I type.  He’s allowed clear liquids until 4 AM so I will be making sure he gets his ibuprofen at about 3:45. 

I spent today reassuring parents and seeing patients.  Today, I was an efficient and effective family physician.  Tonight, I am a worried mother. 

It’s hard to wear both hats. 

Match Day

Today is Match Day.

Seven years ago today I was sitting in the big open central hallway of my medical school, next to my spouse, forgetting repeatedly to breathe.
At my school, they call you up one at a time and tear open the envelope and tell you where you're going to spend the next years of your life in front of the entire school. Until Match Day, your fourth year of medical school ends in a great gaping chasm; you don't know where you're going to live, who you're going to spend your time with, who's going to teach you.
You make plans, of course: everyone told me that in Family Medicine you get your first choice. You only rank the places you want to go. You know that if you didn't get called by the office in the days leading up to Match Day that at least you'll be going somewhere.


We'd gone house hunting in the city where my first choice was, and I had my eye on a pretty yellow dollhouse with crown molding and an airy feel. I knew the residents there, and the city, and it had the opportunities my spouse needed as well, to further his career.
But there's a giant computer somewhere that makes these decisions: it takes in rank lists from medical students and rank lists from residency programs, and it shakes them all up and it spits out the future.

And they called my name, and they read my program match, and I forgot to breathe. It was my second choice. Nobody gets their second choice in Family Medicine. Nobody but me. And in that moment, everything changed. We were going to a different part of the state, to a place where I didn't know what kind of house I was going to like, to a program that had been, dizzyingly, one of the first I'd interviewed at. For a moment I thought I'd heard it wrong. But I walked up and I took my envelope and I read it again and I sat down and I looked at my spouse and he smiled.

"It's got a great school for me to study at. And they have a rural track."

I don't know what would have happened at my first choice program. No one is ever told what would have happened, to cite C.S. Lewis, but I know what did happen. What did happen is that I was pushed, and pushed harder. I was given opportunities and training and encouragement, and I was left just enough on my own.
I have not looked back with regret on the decision the computer made for me, not even once, since the first day I started at the residency it chose. And I know that it made me what I am today, and I'm glad.