The God Complex
A healthy, athletic boy had been having neurological symptoms for two weeks when his breathing turned labored. His worried parents called 911 and he was taken to the hospital for evaluation. His mother directed the ambulance to a teaching hospital that happened to be the only facility in town with pediatric neurologists. They did an MRI of his head and ran blood work. He was released without being admitted.
The neurological symptoms worsened; and before they could get into see the doctor, another breathing incident occurred. This time the child stopped breathing altogether and was unresponsive for a full 20 seconds. The father, a policeman with emergency medical training, assessed the child and instructed the mother to phone 911. He was taken to the same ER. There was no neurological consult. The attending ER physician consulted the pediatrician by phone, who said he'd be fine to send home.
The next morning, the mom received a call from the pediatrician's nurse. The nurse did not call to check on the child. The pediatrician told the nurse to call this family to instruct the parents they were not to call 911 or go to the ER again unless the child was without breathing for at least one minute or unless he turned blue. The mother asked if this would not put the child one minute into oxygen deprivation and increase his risk of brain damage. The nurse simply responded that children are remarkably resilient.
A third trip to the ER by ambulance resulted in an admission, a few days of testing and a diagnosis. The child is now getting the care he needs. His symptoms were obvious enough that a friend of mine who is not even a neurologist was able to make the correct diagnosis without even seeing him. She was confident that if the neurologist had been called in on the first ER visit, the child would have received the care he needed from the beginning.
The ER docs had the patient in front of them. They could see him and touch him, yet they failed him. It is easy to get to a place where we have seen so much that we forget to listen. Sometimes our ears are our most valuable assessment tool. Don't forget to use them.