WORDS BY WHICH TO LIVE

If you ever want a good dose of fear, become a doctor or a parent. I have certainly had some very scary moments during my medical career and most of them involved young patients (unlike my current practice of prostate cancer patients) who had very serious but potentially reversible illnesses (e.g. a 20 year-old asthmatic to whom I gave medicines to paralyze him, in order to facilitate placement of an endotracheal tube and mechanical ventilation, whose vocal cords I could not quite visualize for 60 seemingly interminable seconds in the middle of the night during residency, a 27 year-old whose fruity breath from across the room, due to the accumulation of ketones, and whose slow, deep Kussmaul's respirations betrayed a diagnosis of new onset diabetes and life-threatening ketoacidosis, and my own son whose audible wheezing and shortness of breath at the age of 5 months taught me to respect the virulence of Respiratory Syncytial Virus. I cite these examples not for dramatic effect but rather to highlight the incompatibility of life with inadequate oxygen content, abnormal pH, or inadequate perfusion of one's tissues.

Last night, I had a scare of a very personal nature. Little Cate had been having loose stools for about 4 days. She had been drinking okay, but her appetite for food was poor. Yesterday, however, she began to refuse even bottles while her diarrhea continued. A babysitter watched her during the day, and when I returned home, the sitter said she had not had any wet diapers, although she had had plenty of loose stools. To anyone in the medical field, there are a few simple nitrogenous credos, "no urine, no life," "urine is golden," etc, etc. I feared that she was severely dehydrated and that she would not be able to make up for her GI losses by taking food or drink by mouth. Thus, I threw her in the car and headed to the ER.

I was met by Kathleen and Nicholas there, and we were quickly taken back to a room. The nurses attempted to stick the little one for blood work and placement of an IV. First try, no success. At that point, I decided to take Nicholas out of the room in order to not make his rejection of the medical profession 100% certain (currently at around 99%). We came back in 30 minutes, and 3 additional tries later there was still no IV access. Cate took a few sips of water, and the senior nurse suggested we simply encourage her to drink more and re-assess in 1 hour. Mind you, I am a pretty diplomatic guy and physician, but I flat out told her that that was stupid. The patient was clearly volume-depleted and had not been taking enough in by mouth for several days. No amount of oral consumption was going to ameliorate the situation... fast enough. I told her that we needed to try again. A different nurse was called in (it is funny but the best nurses for procedures always seem to have some goofy article of clothing, and this nurse was no exception in his Sponge Bob tie over his scrub top). He was able to secure an IV and obtain labs after his second attempt, and the re-hydration commenced.

I took Nicholas home after that and Kathleen stayed with the baby, who was admitted to the Peds unit. Little Reese (Cate's middle name) was kept overnight, and about 7 hours after IV fluids were started, she finally made urine and wet her diaper. I was not aware of this until this morning... after a night of little sleep and much worry. I have never been so happy to hear that she needed a diaper change; again, urine is golden! Cate was discharged today and is taking food and fluids better. Although her illness, a case of Enterovirus gastroenteritis, has not completely resolved yet, we expect it to run its course in the next few days.

I suppose I never realized the parallels between medicine and parenthood, both of which should be about helping people by identifying problems and their gravity early and then instituting the appropriate courses of action to solve/prevent said serious problems. This may be encapsulated in a simple phrase from the Hippocratic Oath- "First, do no harm!" Harm can occur as easily through acts of omission (not placing the IV for a clearly dehydrated child or not teaching one's children about safe sexual practices) as it can by acts of commission (performing an unnecessary procedure, which leads to a poor outcome, or spoiling one's children). The answer in this situation was not to take an inferior course of action, a seemingly easier course of action, and to hope for the best; we all knew the baby needed an IV, but it's placement was not easy given her dehydrated state and poor veins. The answer was to do the right thing, the hard thing, which was the only tenable solution to the problem. That is how I have tried to practice medicine, and that is how I try to raise my kids. "First, do no harm!" Words by which to live.