He comes back to me often: a young son in a family that had decided to use me - a fairly new doctor in the community. They were a fairly normal family, except for the fact that they had chosen me as their doctor - something for which I was still very grateful. The children had the usual colds, ear infections, and well-child checks. I thoroughly enjoyed my day-to-day interactions between me and this family. One day, however, a seemingly trivial visit became one forever burned on my memory. It was late on a Friday afternoon and the mother had brought their youngest to my office with a fever. When I walked in, he looked like a child with a high fever - very tired and grumpy, but not significantly different than others I had seen in my short career. On exam, he had a bright red and bulging eardrum, which explained the fever and grumpiness and gave me an appropriate course of action. I prescribed what I thought to be "strong" antibiotics and told them to call me if there was any other problem.
Monday arrived with a shock. I got a call from a shaken ER colleague who had seen him after me and sent him home with a shot of antibiotic (after confirming my diagnosis). A few hours later the child was back in the ER with a thready pulse and minimal respirations. Despite their best efforts to revive, he could not be saved.
Pathology results showed a meningitis that had spread from the ear - an obviously virulent strain of bacteria had bridged the short gap from the middle ear to the brain. He went into shock and died.
My heart hurt for the family - losing a young son so rapidly and unexpectedly. A young vigorous life had been stolen from their family, leaving them decimated and bewildered. I also felt for my ER colleague, who had also seen this child and sent him home hours before his death. All of my "what if" questions were nothing compared to those this doctor had to face. In a sense, his bad fortune had shielded me from the forever lingering self-doubt that comes from this situation.
No lawsuits were pursued, nor did the family stop seeing me as their physician. This amazed me - that they would not hold any lingering doubt about my part in this. I knew I had done my best, and had reacted appropriately, but I was humbled by their incredible grace every time they came to see me.
The image of this child's eardrum will forever be in my mind. I still see it. I remember the exam room I was in and remember talking with the mother about everything. Life hurts. Life is hard. There are no guarantees. Just how precarious we all are is sometimes brought into clear focus in moments that will never leave us. No matter how many lives you touch or even save, you are always reminded by these moments that we live on the razor's edge.
This all comes to mind because I had another such encounter with a child just recently. This child was having what seemed to be a flu-like illness, but had just been acting "odd" according to her mother. When I saw her, I was uneasy and immediately sent her for further care. The diagnosis: meningitis that had spread from the upper respiratory tract. This outcome is far better - with the child getting appropriate care immediately and seemingly making a good recovery.
As I sit alone and think about it, I don't do much back-patting. I am extremely glad that there were enough signs for the mother and me to react quickly and appropriately. There will be few "what if's" in this case. But these moments don't bolster my confidence; if anything they serve as a reminder to me as a doctor that my job is serious. It is nice to feel liked and important, but you always need to remember that the edge of the cliff may await you in the next exam room.