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The Art of Medicine

Weekend call

Sifting the salient points

Maurer, Brian T. PA-C

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Journal of the American Academy of Physician Assistants: December 2017 - Volume 30 - Issue 12 - p 58
doi: 10.1097/01.JAA.0000526789.57518.fb
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“Every Friday [Dr. Joseph Bell] held an outpatient clinic at the infirmary....He was very successful in diagnosing the patient's conditions and sometimes their occupations, where they lived, and how they had traveled to the clinic.”

James O'Brien, The Scientific Sherlock Holmes

“We got a fax from the answering service,” the medical assistant says. “This mother called in before the weekend office hours. She's not our patient. She takes her daughter to one of the other practices we cross-cover with. Her baby's been cranky, had a fever since last night. I spoke with her, gave her the dose of Tylenol for the baby's weight; but now that I'm writing up the phone call, it doesn't make sense.”

The medical assistant fidgets in her chair and rolls the pen with her fingers. “She told me her baby was 27 months old, but now I'm looking at the birth date in the system...”

I lean over the desk and study the fax. I tap the child's birth date with my index finger. “This kid was born on the 27th of last October,” I muse. “She's 8 months old. How high was the fever?”

“She couldn't tell me. I guess she didn't have a thermometer. She sent somebody out to buy one. I told her to call back if there was a problem.”

I reach for the faxed form. “I'll call her back,” I say.

“Good luck—I was on the phone with her for 15 minutes!”

I retire to the back office and dial the number. A woman answers. I identify myself. “I know you just spoke to the medical assistant,” I say. “I wanted to check on how your little girl is doing. She's 8 months old?”

“Yes, she was born on the 27th...”

“And she felt warm to you last night?”

“Yes, she was so hot, and she cried and cried. I kept trying to put her to my breast, but she didn't feed well. It was a long night.”

“How is she doing this morning?”

“She ate a lot from my breast and then she fell asleep. She's sleeping now.”

“Were you able to take her temperature?”

Commotion on the line, voices in the background, rapid-fire staccato, then: “Yes, we take the temperature. It's...” she parses the reading slowly, “...98.8.”

“Ninety-eight point eight. How did you take it?”

“Under her arm.”

“That's not fever,” I say. I launch into a brief explanation of what constitutes fever in an infant. “It's best to take a rectal temperature,” I say. “If it's below 100 degrees, that's not fever.”

“No? I thought 100 degrees is high. But I'm worried about her; she's so fussy.”

I can tell that the only way to reassure this young mother would be to see the child. “Where do you live?” She tells me the address in a nearby community. “Could you bring her to our office at 11 a.m.?”

“Oh, no,” she says, “we are in California.”

“California! I thought you were here in Connecticut...” A person calling from a cellphone could be anywhere, I foolishly remind myself. “Is there a medical facility you could take her to out there where you are?”

“There is the hospital,” she says, “but I don't know if they take her insurance, because it's state of Connecticut.”

“You could ask. I'm sure they won't turn you away if your daughter needs to be seen.”

“Okay, I will try to take her there when we go to see my grandfather.”

I feel the frustration rising in my face. “Your grandfather?”

“Yes, he's in the ICU, dying.” She chokes up. “That's why we flew out here yesterday, to see him before he dies. They say he won't last the weekend.”

A dying grandparent, a 3,000-mile cross-country flight with an 8-month-old baby, a frightened young mother—suddenly, it all makes sense.

“I'm sorry for your trouble,” I say.

“Thank you,” she says. “Thank you for taking time to talk to me. Thank you for calling me back.” She's crying now. Then, through her sobs she says, “You are a kind man.”

I swallow hard against the lump in my throat, and my frustration evaporates like mist in the morning sun.

Copyright © 2017 American Academy of Physician Assistants