of oxygen in. No wheeze, but I was thinking either acute asthma or
some sort of anxiety” “Panic at being back in the hospital again?”
“That, or just the mother’s distress rubbing off on her.”
“Was the mother showing a lot of overt distress?”
“Not really, but you know how it is with mothers and kids-the vibes.
On the other hand, I wasn’t ready to rule out something physical. A
baby passing out is something to take seriously.”
“Sure,” I said, “but it could also have been a tantrum gone too far.
Some kids learn young how to hold their breath and pass out.
“I know, but this happened in the middle of the night, Alex, not after
some power struggle. So I admit her again, order allergy tests,
complete pulmonary functions-no asthma. I also start thinking of rarer
stuff: membrane problems, an idiopathic brain thing, an enzyme
disorder. They’re up on Five for a week, real merry-go-round, consults
by every specialty in the house, lots of poking and probing.
Poor little thing’s freaking out as soon as the door to her room opens,
no one’s coming up with a diagnosis, and the whole time she’s in, there
are no breathing difficulties. Reinforcing my anxiety theory. I
discharge them and the next time I see them in the office, I do nothing
but try to play with her. But she still won’t have anything to do with
me. So I gently raise the anxiety issue with mom but she’s not
buying.”
“How’d she take that?” I said.
“No anger-that’s not this lady’s style. She just said she couldn’t see
it, the baby being so young. I told her phobias could occur at any
age, but I clearly wasn’t getting through. So I backed off, sent them
home, gave her some time to think about it. Hoping that as the baby
approached one year and the SIDS risk dropped, mom’s fears would
diminish and the baby would start to relax too.
Four days later they were back in the E . R croup, gasping, mom’s in
tears, begging for an admit. I put the baby in but ordered no tests.
Nothing even remotely invasive, just observation. And the baby looked
perfect-not even a sniffle. At that point I took the mom aside and
leaned more heavily on the psychological angle. Still no sale.”
“Did you ever bring up the first child’s death?”
She shook her head. “No. I’thought of it but at the time it just
didn’t seem right, Alex. Overloading the lady. I figured I had a good
feel for her-I was the attending doc when they brought the first child
in dead. Handled the whole post-mortem. . . I carried him to the
morgue, Alex.”
She closed her eyes, opened them but focused away from me.
“What hell,” I said.
“Yeah-and it was a chance thing. They were Rita’s private patients,
but she was out of town and I was on call. I didn’t know them from
Adam but I got stuck doing the death conference, too. I tried to do
some basic counseling, gave them referrals to grief groups, but they
weren’t interested. When they came back a year and a half later,
wanting me to take care of the baby, I was really surprised.”
“Why?”
“I would have predicted they’d associate me with the tragedy, a
kill-the-messenger kind of thing. When they didn’t, I figured I’d
handled them well.”
“I’m sure you did.”
She shrugged.
I said, “How’d Rita react to your taking over?”
“What choice did she have? She wasn’t around when they needed her.
She was going through her own problems at the time.
Her husband-you know who she was married to, don’t you?”
“Otto Kohler.”
“The famous conductor-that’s how she used to refer to him: My husband,
the famous conductor.”” “He died recently, didn’t he?”
“Few months ago. He’d been sick for a while, series of strokes.
Since then, Rita’s been gone even more than usual and the rest of us
have been picking up a lot of the slack. Mostly, she attends
conventions and presents old papers. She’s actually going to
retire.”
Embarrassed smile. “I’ve been considering applying for her position,
Alex.
Do you see me as a division head?”