Waiting to Exhale

This case goes one step beyond the last post…not only did the patient present HER diagnosis regarding her 3 year old daughter, but she was so distraught over the diagnosis she had come to that she couldn’t even talk to me without crying.

I realize to some of you reading that this whole story may sound callous and I apologize, but this is another illustration of what I tried to explain before. I don’t want my patients to be ignorant or play stupid, but I do need them to cooperate with me enough so that I can gather the important historical elements about the current illnees that I need to make a diagnosis…and not to make the diagnosis for me.

Anway, the cheif complaint (refer to last post for definitions) was “Siezure after a fall”. Sounded a little odd to me. The girl was a toddler who started vigourously crying after having fallen at daycare. Mom picked her up, and while crying, she took a big breath, then her eyes rolled back, her wrists curled up and she did’n’t breath for about…thirty seconds. (Times like this seem liek an eternity to parents, and it was likely less). She woke up, began crying again, them began behaving completely normally and interacting with the paramedics who eventually arrived. By the time she got to the ER, she was her usual self.

Many of you will recognize that this was NOT a siezure. This was a breath-holding spell, which is fairly common. As soon as she passes out, she’ll start breathing again. She had similar episodes to this, both related to times when she was crying her head off, then she passed out. Nothing to worry about, she’ll grow out of it eventually.

My frustration with this episode is not that the mother brought her daughter in to be seen. My frustration is that the mother was so convinced that this was a siezure that she broke down in tears every time she tried to tell me what happened. The longer it took her to get the story out, the longer it took me to deliver the news that she needed to hear to calm her down. I was tired and hungry and had a headache and just wanted to get the story about what happened. I didn’t want to hug her, console her, pat her back, give her a tissue, offer her a chair or any of that stuff. I just wanted the story.

After I had reassured the parents and the girl, and my attending had also interviewd and examined and reassured and come to teh same conclusion that I had…I had to convice the mother that this was not a febrile seizure as a result of an illness she had 3 weeks ago that she was completely recovered from…the triage nurse put that idea into her mind.

I realize that if it had been my mother or my father or my nephew who had had some wacky episode that I would probably also be distraught and worried, but at least I would try to give the doctor as much factual information as possible so that the exprienced and knowledgeable physician who has spent the last 7 or 8 years (or more) of her life doing little else but reading medical books and journals to be prepared for this very encounter could make a diagnosis.

Heck, even when I WAS the patient in an ER in north carolina, I told the doctor my symptoms and let him make the diagnosis, even though I already knew it.

Nuf said.

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