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The Art of Medicine

A Christmas gift

Maurer, Brian T. PA-C

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Journal of the American Academy of Physician Assistants: December 2018 - Volume 31 - Issue 12 - p 58
doi: 10.1097/01.JAA.0000547752.15805.a4
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Unto us a child is born, unto us a son is given.

Isaiah 9:6

The mother sits quietly beside her husband, holding the swaddled infant in her arms. With pen in hand the father studies the form on the clipboard before him. Their 3-year-old son vies for his attention, then drops to the floor, whining by his feet.

“When did you leave the hospital?” I ask, as I sort through the five-page document from the birthing center in the medical chart resting on the countertop by the sink.

“Late yesterday afternoon,” the mother says. “We stayed an extra day. He had to go under the bili lights, and the weather turned bad with the snow, so they let us stay.”

“How are the feedings going? Is your milk in?”

The mother shifts in her chair. “It's in,” she says, “but he's having a difficult time latching on.”

“She's been pumping,” the father says, looking up from the clipboard. “We've been giving him what she gets through the supplemental nursing system, maybe 30 mL every couple of hours.”

“They told us at the hospital that he has a tongue tie,” the mother says. “He might have to have it clipped. Our other son had to have his frenulum clipped too.”

The 3-year-old has now taken to riding the 3-wheeled stool across the room. He smacks into the wicker chest of drawers and begins to cry. The father rises from his chair and takes the boy in his arms. The boy sobs and buries his face in the father's shoulder.

“Someone else needs some attention,” I say, laying my pen down on the countertop.

“It will take some time for him to get used to his new baby brother,” the father says, running a broad rough hand through the boy's thick hair.

I examine the newborn, note the short lingual frenulum and the jaundice midway down the abdomen, review the feeding protocol, and ask the parents to schedule a follow-up appointment in 2 days to check the infant's weight.

“I think he'll come along fine,” I tell them. “I'm not convinced that he'll need to have that frenulum clipped at this point. The jaundice should continue to recede as the number of daily stools picks up.”

I offer them a smile and a handshake as I leave the room.

“Do you know that family?” a colleague asks, as we sit at the desks in the back office.

“Not well,” I say, jotting my notes in the newborn's chart. “I see that both parents have type 1 diabetes. At 37 weeks gestation, this was a big baby, almost 9 pounds.”

“The older son has diabetes as well. He was diagnosed right about the same time as their other boy.”

I pause and look up from the chart. “Oh, I thought they only had one other child.”

“Their second son died from a rhabdoid tumor of the liver.”

I push back in my chair and drop my hands in my lap. “When was that?” I ask.

“Last year,” she says. “He was 9 months old. They practically lived at Children's Hospital the last 3 months of his life.”

I think of the oldest son, sobbing in his father's arms a short while ago. “How was it picked up?” I ask.

“Abdominal mass,” she says. “I still remember that day. I was late coming in. Before I could take off my coat, one of the other practitioners snagged me in the hallway. ‘Feel this baby's belly,’ she said. The liver was huge and hard. I called oncology. We sent them in through the emergency room. That was a bad day.”

Both parents with diabetes, one child with diabetes, and a new baby: survivors of the premature death of another infant.

I make the final entry in this newborn's chart under family history: a one-word diagnosis—such a trite turn of phrase.

But the family history is much more than a mere list of members and diagnoses. Fleshed out, it becomes a never-ending narrative of pain and suffering—and sometimes, in the midst of it all, newfound joy.

Copyright © 2018 American Academy of Physician Assistants