“Checking because she was nervous about SIDS?”
“Exactly. When she wasn’t able to rouse the baby, she administered
CPR, got her going. Then they brought her into the E.R. By the time I
arrived she looked fine, nothing remarkable on exam. I admitted her
for observation, did all the usual tests. Nothing. After discharge we
set the family up with a sleep monitor and an alarm.
Over the next few months the bell went off a few times but they were
always false positives-the baby was breathing fine. The graphs show
some tracings that could be very brief apnea but there are also lots of
movement artifacts-the baby thrashing around. I figured maybe she was
just restless-those alarms aren’t foolproof and put down the first
episode to some quirky thing. But I did have the pulmonologists look
at her because of her brother’s SIDS. Negative. So we decided just to
keep a close eye on her during the high-risk period for crib death.”
A year?”
She nodded. “I played it safe fifteen months. Started with weekly
outpatient checkups, tapered off so that by nine months I was willing
to let them go till the one-year exam. Two days after the ninemonth
checkup they’re back at E. R middle-of-the-night respiratory
problems-the baby woke up gasping, with a croupy bark. More CPR by mom
and they bring her in.”
“Isn’t CPR kind of extreme for croup? Did the baby actually pass
out?”
“No, she never lost consciousness, just gasped a lot. Mom may have
been overreacting, but with her losing the first child, who could blame
her? By the time I got to the E.R the baby looked fine, no fever, no
distress. No surprise, either. Cool night air can clear up croup. I
ran a chest X-ray and bloodwork, all normal. Prescribed decongestants,
fluids, and rest and was ready to send them home but the mother asked
me to admit her. She was convinced there was something serious going
on. I was almost certain there wasn’t, but we’d been seeing some scary
respiratory things recently, so I admitted her, ordered daily
bloodwork. Her counts were normal and after a couple of days of
getting stuck, she was going hysterical at the sight of a white coat.
I discharged her, went back to weekly outpatient follow-up, during
which the baby would have nothing to do with me.
Minute I walk into the exam room she screams.”
“The fun part of being a doctor,” I said.
She gave a sad smile, glanced over at the food servers. “They’re
closing up. Want anything?”
“No thanks.”
“If you don’t mind, I haven’t had breakfast yet.”
“Sure, go ahead.”
She walked briskly to the metal counters and came back with half a
grapefruit on a plate and a cup of coffee. She took a sip of the
coffee and grimaced.
“Maybe it needs some steamed milk,” I said.
She wiped her mouth with a napkin. “Nothing can save this.”
“Least it doesn’t cost anything.”
“Says who?”
“What? No more free coffee for the docs?”
“Them days are gone, Alex.”
Another tradition bites the dust,” I said. “The old budgetary
blues?”
“What else? Coffee and tea are forty-nine cents a cup now.
Wonder how many cups it’ll take to balance the books.”
She ate some grapefruit. I fiddled with my pen and said, “I remember
how hard you guys fought to get the interns and residents in on the
freebie.”
She shook her head. Amazing what seemed important back then.”
“Money problems worse than usual?”
Afraid so.” She frowned, put her spoon down and pushed the grapefruit
away. Anyway, back to the case. Where was I?”
“The baby screaming at you.”
“Right. Okay, again things start to look good, so again I taper off
and terminate, set up an appointment in two months. Three days later,
back in the E.R two A.M. Another croup thing. Only this time the
mother says the kid did pass out-actually turned blue.
More CPR.”
“Three days after you terminated,” I said, making a note. “I’ast time
it was two.”
“Interesting, huh? Okay, I do an E.R. checkup. The baby’s blood
pressure is up a bit and she’s breathing rapidly. But getting plenty