The Dog Ate My Keyboard
Perhaps it’s unfair to blame Gucci for my seven-month absence from my blog, but you see every time I’d try to write she’d sit on my lap or the keyboard and I just couldn’t do a thing. Pretty lame, eh?
Truthfully it’s been a rough year, probably for many of you as well. But it took a reprimand from one of my moms and a few quiet hours on an airplane a few weeks ago to get my writing itch going again.
My 42d anniversary in my Van Nuys practice just passed. A cynic might say I’ve not had 42 years’ experience, but one year’s worth 42 times. Not so. Practice is so much more than runny noses and tummy aches. Lately I’ve had a remarkable run of interesting challenges.
Yesterday started with a 2-year-old girl who celebrated Christmas by putting blueberries up her nose (mom had removed one and the other mercifully found its own way out). Before the day was over, I’d welcomed a new baby girl, seen a 3-week-old baby boy who’d already survived open-heart surgery for a severe congenital defect called transposition of the great vessels (a diagnosis made by ultrasound a month before birth!), done a checkup on a teenaged boy suspected of Marfan’s syndrome (Abe Lincoln had it – he does not).
The last patient of the day deserves his own paragraph. He’s 7, raised by a single mom. From infancy he had been markedly obese with behavioral problems that progressed to the extent that I expected him to have to be institutionalized. At school entry he weight 107 and was too unmanageable to attend regular school, but he had started seeing a child psychiatrist and the tide started to turn. Ordinary ADHD drugs did not work, but an old drug (Klonopin) and a new drug (Abilify) have been quite effective. Yesterday he had grown 5 inches in two years while remaining 107 pounds, still too much but a 17% drop in his BMI (body-mass index). More important, he could read at third-grade level and was delightful to talk with. His mom is married and expecting. She never gave up on him, which would have been easy to do. He may have Asperger’s Syndrome as the psychiatrist says, but his physical and social awkwardness keep improving. Whoda thunk?
Yesterday also featured a little boy with a serious elbow fracture, a little girl hospitalized with another urinary tract infection, probably her sixth, and a history of convulsions with high fever who probably has a defective bladder because of a hidden spinal anomaly, a delightful 3-year-old boy being checked for bronchitis whom I might not have mentioned except that four days after he was born, his father was diagnosed with leukemia which eventually took his life a year ago. It’s the context that makes every patient in a private practice so special; he’s not just a kid with a cough, he’s part of a family I know, with a lovely older sister, a heroic mother, extended families in Italy and the USA whom I met at Dad’s funeral.
The other day a new mom called about her second baby, who I knew had a heart murmur with a tiny hole between the major chambers. He was “very irritable and struggling to breathe” – no further questions were needed. The baby was at the office minutes later, inconsolable, ashen grey with a heart rate of about 280 (really uncountable). Fortunately the Emergency Dept. is a hundred yards away. His abnormal rhythm was corrected with a drug and after a nervous night in the hospital, he is home on digitalis and doing well.
Do you still think practice is dull? It is if you don’t look for challenges. To me every checkup is a chance to find something that can make a difference in a child’s life. I’m known as a good diagnostician, the outcome of wonderful teaching and my years at CDC and LA County/USC. The other night we were watching “Mystery Diagnosis” on TV and a teenaged boy was brought to an ED in Texas with a 105 temperature and a relentless pneumonia that threatened his life. He had been rock-climbing in Colorado with a pal. I like to impress my wife so I flippantly said, “Sounds like hantavirus.” What the heck is THAT, says she. I explained that it’s a mouse-borne virus recently discovered in that part of the country. Turns out he and his buddy found a mouse in their truck while eating lunch, and he indeed caught hantavirus, which is rare (34 cases in the country last year) but fatal 50% of the time.
I really should have gone on Jeopardy.