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When care goes beyond the patient

Maurer, Brian T. PA-C

Journal of the American Academy of PAs: July 2019 - Volume 32 - Issue 7 - p 58
doi: 10.1097/01.JAA.0000558384.16481.f3
The Art of Medicine
Free

Brian T. Maurer has practiced general pediatrics for more than 30 years. He is the author of Patients Are a Virtue and blogs at http://briantmaurer.wordpress.com. The author has disclosed no potential conflicts of interest, financial or otherwise.

Tanya Gregory, PhD, department editor

Figure

Figure

“Your first patient is ready in Room 7,” the nurse informs me.

I check my morning schedule: this 1-month newborn well-child check, with no additional patients booked for the next half-hour, is certainly a satisfactory start—but in this business, without warning, things can go south in the blink of an eye.

Quickly, I review the infant's growth parameters, scan the nursing notes, and step into the room.

The father stands by the examination table, arms folded across his chest; the mother is seated on one of the chairs at the far end of the room. She rises to her feet as I extend a greeting. An empty infant carrier rests on the examination table.

“And the patient?” I ask, with a playful look of feigned concern.

Momentarily, the father shifts his body, exposing the infant wrapped in a baby blanket fast asleep on the table behind him.

“Ah, there she is!” I say. “For a minute I thought we had lost her!”

A slight smile forms on the father's lips; less so on the mother's. Today she's wearing ruby red lipstick; her thick black hair has been cropped short, just above the shoulder.

I motion the mother to sit down, then proceed with my questions. “So tell me, how have things been going?” I ask.

The father turns to the mother; they trade a fleeting glance, then the mother says: “She's gassy, a bit fussy; especially in the evenings. She stools once every 3 days and seems to be quite uncomfortable before she passes her bowel movements.”

“I see. What do the stools look like?”

“They are soft and green; a good amount.”

“Any vomiting?”

“No.”

I show the parents the growth chart and point out the plots. “She's gaining appropriate weight,” I say. “She's growing well.”

“I have some questions,” the father says. He proceeds to ask about taking the child outside for walks, the use of a motorized infant swing, when she will develop better head control, how much tummy time is appropriate for this age. Point by point, I address his concerns. He listens quietly, nodding his head.

“So we don't have to worry—everything is fine?” the mother says.

“You've got a healthy baby,” I say in my most reassuring voice. Both parents smile, albeit briefly. “By the way,” I say, “did the nurse give you a form to fill out—the EPDS?”

Silently, the mother hands me the completed Edinburgh Postnatal Depression Scale form. I glance at the entries, mentally adding up the score. “How are you feeling about things these days?” I ask her.

She offers a quick nod. “Better,” she says. “I have spoken with my obstetrician, and she has prescribed me a small dose of Zoloft, which seems to be helping. She has also advised me to go out for walks by myself, which I do.”

“Has she suggested that you see a counselor?” I ask.

“No, nothing like that. I am better now. It's just that—” she steals a glance at the father “—just that, well, I like to be home by myself with my baby; I don't like to have other people interfere, telling me how to handle the baby or what to do; because it is my baby; I know how to care for her, because I am her mother.” Once again her eyes glance at the father, then return to meet mine.

“It is perfectly natural for a mother to want to care for her baby,” I say, “and you are doing a good job. I know your husband has been concerned about you because of everything you have been going through—”

“He and his mother,” she says.

I pause, somewhat taken aback.

“Everyone has an opinion as to how you should mother your child,” she says. “That is why I prefer to be alone with my baby; and that is why I take long walks by myself when I can't be alone with my child.”

In this business, things can go south without warning in the blink of an eye.

Cultural norms go deep; so does postpartum depression. In a new country, a new culture, there are always growing pains—not only in infancy, but in adulthood as well.

Pediatrics, that arbitrarily defined branch of medical practice that purports to deal with the care of children, sometimes encompasses much more than the feeding and nurturing of the infant.

Copyright © 2019 American Academy of Physician Assistants