22 September 2009

Merely posing the question was an act of pure optimism

The triage note on the chart sounded none too concerning, but was a little short on detail: 27 month male with fever to 104 degrees.  I went into the room to see the dad, maybe thirty-ish and clean-cut, well-dressed, with his happy two-year-old on his lap.  Dad greeted me politely and the child ignored me while continuing to methodically eat Cheetohs from a bag.

Uh-oh, I thought, this is not going to go well.

You may be wondering why I knew from the moment I set foot in the door that this was going to be a challenging interaction, but to me it was a clear as the day is long.

Well, I see Alex has quite a fever tonight -- 104 degrees.  How long has he been sick?
I'm not sure, doctor.  I was at work all day today.  I don't think he had a fever yesterday, though.
Has he had any other symptoms?
[blank stare]
You know, cough, runny nose, vomiting, that sort of thing?
Oh, I wouldn't know about that.  His mom was with him all day.
I see (looking around hopefully) and where is his mom?
She's at home with the baby.
Of course.  Has the baby been sick at all?
Ummm.  Not sure.
What made you decide to bring him to the ER?
Well, apparently he was having trouble breathing, and she called the on-call doctor who told her to bring him in.  That was just when I was getting home from work, so I took him.
Can you tell me anything about the trouble breathing?  Was he wheezing? Did he have a barky cough? Was he turning blue?
Sorry, I didn't see it.
So who is his primary care doctor?
He sees a pediatrician.
I might have guessed that. Do you know the pediatrician's name?
No, but he's at one of the downtown clinics.
But you don't know which one, do you?
Does Alex have any medical problems?
[blank stare]
You know, asthma, diabetes, any surgeries and the like?
I don't think so.
Does he take any medicines or is he allergic to any medicines?
Ummm. Not sure.
This is *your* son, right? You have met him before?  It's not just a street urchin you brought in on a lark?
Yeah, he's really my son.
Oh God, you're an idiot and I can't talk to you any more.  Can you call your wife so I can talk to her?
[cell phone call placed and real history obtained from mom]

As he put his son on the gurney for the exam, I noticed his jacket had a Microsoft Vista Development Team logo on the breast pocket.  It figures, I thought to myself. 

But that's being unfair to the Vista people, because one thing I have learned is that most if not all fathers who bring their kids to the ER are completely clueless about their kids' medical histories.  It's a universal thing.  Which is how I knew I was in trouble when I walked into the room -- mom wasn't there.  Dads like to be gallant, when mom has been home all day with sick kids, it's like, "Oh no, honey, you must be exhausted -- you rest, I'll take the kid to the ER." But they are, en masse, completely unequipped for the actual task at hand.  The kid doesn't just need a chauffeur to the ER, they need someone who can give me detailed observations and history.  They need a mom.

And just for reference, when my kids are sick, I let their mom take them to the doctor.  For the same reason.

Sadly, some of the above dialog took place only in my head.  It was actually a much longer conversation, and the dad literally knew nothing, nothing at all about his child.  For a while I was fancying I had wandered into the Cheese Shop sketch, posted here for your enjoyment:

1 comment:

  1. I despair: of fathers in general; of being both the woman and the one who makes the money; of my husband who, in this situation, would be exactly the same (he can't even give his own medical history succinctly: asthma, well controlled, takes him several minutes to say it).

    I've seen your patient before. And I despair.


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