REAL WORLD EMERGENCY MEDICINE

An ER Doc Takes His 3-Year-Old Son to the Emergency Department

Navigating the system as a doctor

About 25 years ago, when my son was just three, we moved to Durham, North Carolina so I could join the Emergency Medicine faculty at a famous university healthcare system there that shall remain nameless.

At the time this incident occurred I was a new faculty member and not yet well known, or even known at all, to most of the Emergency Department personnel.

Here’s how this fun one went down.

My 3-year-old son Shawn, who had been happy and healthy until about a day or so prior, awakened my wife and me with his crying. He’d gone to bed early that night with a slight fever. Not one to complain, he’d gotten some fever-reducing medicine and had fallen asleep easily and peacefully.

He was not peaceful now. In fact, he was crying, but gently.

When I went to check on him, Shawn felt blazing hot and was obviously in pain. He got another dose of a fever reducer and his temp soon returned to normal. His crying continued.

I did what a doctor dad does when his not-critically-ill child is ill. I examined him.

In general, he looked okay, passing the eyeball “not-critically-ill” gestalt test. His head and neck moved easily without causing any more discomfort, so meningitis seemed highly unlikely. His throat and tonsils looked normal, not red, or angry, like “strep throat” or even like a viral illness might. His little heart was racing but otherwise normal. His lungs were clear. His belly non-tender. He had no swollen joints or skin rashes.

I didn’t have the equipment at home to examine his ears but I thought that’s where the problem might lie.

So I was faced with a conundrum. Do I take my son to the Emergency Department in the middle of the night for what seemed like a non-serious febrile (fever-related) illness or do we tough it out at home and call his Pediatrician in the morning?

Shawn decided for me.

His cries steadily increased in intensity.

Parents know their children, or should, and I knew mine. Shawn was not a complainer but he was complaining something fierce at this point.

So, off we went, at 3 AM, to the place where I’d just started working.

At check-in, a nurse, who will go down in history as looking like the person voted most likely to chew the head off a live bat, greeted us.

And by greeted I mean Cinderella’s evil stepmother said, “what’s your problem?”

We got through the rest of the initial assessment and registration while I held my tongue and my wife clutched her own throat (metaphorically). Shawn continued to wail piteously.

Nurse Xtreme-Grump took no notice. Nor did she notice my University MD ID, even when I casually waved it inches from her frowning face.

“You’ll have to wait like everyone else.”

Everyone else, I thought, there’s hardly anyone here. I could barely scare up enough players from the waiting room for a game of 2-on-2.

But, being the newb, and not wanting to create waves or anger a work colleague, I made the decision to wait, to not push it.

Shawn wasn’t comfortable, but he wasn’t dying either. Kids cry when they’re in pain and Shawn was crying.

We waited.

And, we waited.

And, we waited some more.

Shawn’s cries went from whimpers and tears to wails, to shrieks, and then beyond shrieks.

Then they crescendoed at screaming-bloody-murder.

The granite-hearted prison guard at the check-in desk assiduously ignored all the warning signs of impending doom.

At the screaming-bloody-murder stage I snatched up my son and moved swiftly toward Nurse Wretched.

Then, with Shawn in my arms, it happened.

Pus shot out of his right ear and onto his shoulder.

I stopped in my tracks, surprised.

Shawn’s screams stopped, suddenly.

We turned to Shawn’s mom.

“I know what this is,” I said to her. “We can go now. Shawn will be fine.”

“What just happened?” asked his still-concerned mom.

I answered “he had otitis media (a middle ear infection) and his ear drum just ruptured. Now that the pressure is relieved he’ll be fine. His ear will drain. His ear drum will heal. We can go.”

And we did.

Before we left I made sure that Checkpoint Charlie, RN (Really Nasty) tore up our check-in paperwork and extracted a sworn oath from her that we would not get billed.

We did not say thank you or exchange phone numbers.

Shawn saw his Pediatrician later that day who agreed with my assessment and non-plan of a plan. “Come back if he has a problem,” she said.

Shawn slept like a baby the rest of that night.

So did I. Right after I thought up exactly 1,000 ways to poison the check-in nurse while escaping criminal prosecution.

Shawn’s mom, being a better person than I, dreamt up 1,001 ways.