Monday, June 9, 2008

Unfit for Duty

The pediatrician diagnosed Squirtlet (age 7 months) with an ear infection today. ‘Yup, left ear looks really red. That probably hurts.’ She’s been sick for 5 days. I keep telling my husband that it’s just a cold, a virus, and will get better. After all, look at all of the goop draining from her nose. Last night she screamed for half an hour, despite motrin, tylenol, and the panacea for all things, nursing. This delightful episode triggered the inevitable call to the pediatrician’s office, where Sue, the efficient RN who triages sick appointments, got right to the point. ‘Does she have a fever? Is she pulling at her ears?’ We were deemed worthy of a visit, although I got the sense that Sue could make this diagnosis over the phone.

In the interest of full disclosure, I work in an emergency department. I diagnose otitis media several times daily. In kids. With confidence. Yet, I find myself curiously unable to make clinical judgements for my own children. Is that ear really red? Did he just scratch his face, or is it impetigo? (answer: impetigo).

I feel like I need to find the ‘right’ time to take the kids to the pediatrician – that day when the cold turns into the ear infection, or the fever has gone on just one day too long. Yet, I become a victim of my own anchoring bias: if I waited too long last time and the ear infection got really bad, then THIS time I show up on the pediatrician’s doorstep for a temperature of 100.1 and an isolated sneeze. She reassures me in her best Doctor-to-Mommy voice that my wee one will be just fine, while I apologize profusely for wasting her time. On the way home I resolve, yet again, to exercise my clinical judgement the next time around. This sets me up neatly for another episode like today’s.

Tonight I am combing the internet for the perfect pediatric first aid kit to keep at home in case of a Real Emergency. I hold out hope that, when something serious happens, I will know what to do.

3 comments:

  1. I've found that my objectivity goes completely out the window when it comes to my kids. The role of 'mother' gets in the way. Usually, it's an inner dialogue between the minimizing doctor and the maximizing mother.

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  2. I'm not a doc but I keep an otoscope at home and I make sure to check ears when they're NOT sick...just so I know their normal anatomy. It makes it much easier when they are sick and I can ask "Can Mama look in your ear?" and then I can look without a fight and I have a good idea of abnormal conditions. I also am careful to note symptoms on a calendar.

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  3. I've started a first aid kit and I don't even have kids yet. My kit includes things like scalpels, suture, and sterile gloves, along with lidocaine and various other stuff. Because when my husband gashes his leg open with a saw, I'm going to take care of that at home, right? I admit it's insane, but makes me feel somewhat better for some reason. And then I quizzed an ENT attending on what emergency supplies she had at home -- and indicated my surprise she didn't have an intubation kit. What if her 12-year-old suddenly needed to be intubated before EMS could arrive? She indicated her surprise at my insanity (it's ok, we're friends). I'm going to be a neurotic doctor-mom, I'm already sure.

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