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The Art of Medicine

Making it up as you go along

Maurer, Brian T. PA-C

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Journal of the American Academy of Physician Assistants: October 2018 - Volume 31 - Issue 10 - p 58
doi: 10.1097/01.JAA.0000545083.26377.8e
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“So I approach my patients intuitively, with my antennae trembling at every hint from body or speech, and when I have found out whatever I can, I do whatever seems to me to be the best.”

—Robertson Davies, The Cunning Man

“I give up; I can't do anything with this kid!” The nurse hands me the medical chart and throws up her hands.

I accept the chart as I would a FedEx delivery envelope and survey the chief complaint, duly recorded to the right of today's date in the chronological record of medical care: “Cough, congestion x 1 week; fever since yesterday.”

“He's pitching a fit in there!” the nurse goes on. “Won't even let me take his temperature. The mother's upset because she said they had to wait too long. It's only been 15 minutes.”

Silently, I smile as I approach the closed examination room door. I find the boy clinging to his mother's neck, sobbing. “Oh my, someone's upset,” I muse.

“He's not feeling well. It's his nap time, and we had to wait,” the mother explains.

I nod a smile and retreat to the countertop by the sink. “How long has he been sick?” I ask.

“He's had a cough and cold for a week,” the mother says. “I got worried when the fever came up yesterday.”

“How high was it?”

“I didn't take it, he just felt hot.”

“I'm not having it taken today!” the boy screams.

The mother rolls her eyes. “How about if we just measure how tall you are?” she says. “You must have grown since we were here last.” She peels the boy's arms from her neck and lowers him to the floor. Immediately, he bolts toward the door. She snags him by the arm.

“Let go of me!” he cries. “I'm not letting him take my temperature!”

“We're not taking your temperature,” I say. “We just want to find out how much you grew. Come, stand here at the wall and we'll measure you.” I beckon him toward the stadiometer mounted on the wall.

He looks up at me, then his mother, and slowly walks to where I stand waiting. I direct him where to place his feet, lower the horizontal bar, and read the result: “43.5 inches.”

“Impossible,” his mother says. “He couldn't be that tall.”

“You're right,” I say. “Let's try again without the shoes.”

The boy drops to the floor, pulls off his shoes, and assumes his former position.

“Well, what do you know: 42.5 inches!”

“That's more like it,” his mother says.

“While we're at it,” I muse, “could we check your weight too? Just step up on the scale here; it won't take but a moment.”

The boy moves toward the scale, steps up, and turns to face his mother.

“How much would you say?” I ask her, sliding the weight along the balance beam.

“Forty-five,” she says.

I tap the weight back and forth. “Let's see,” I muse. “We need to give it a few seconds to settle. Say, as long as we're waiting, why don't I just listen to you with my stethoscope? Step forward just a little bit. There.”

I pull my stethoscope from my neck and auscultate the boy's back and chest. “The scale is still checking your weight. In the meantime, let me check your ears for potatoes.”

The boy stands still while I glimpse each ear with the otoscope. “Chin up,” I say, as I peek into his nose. “Open wide.” Obediently, he opens his mouth and sticks out his tongue. “Great!” I say. “And now I'm just going to pass this magic wand across your forehead.” I pause to show the temperature reading to the mother. “And now the scale should be done: 45.5 pounds. You can step down now and put on your shoes; all done.”

“I'm not having my temperature taken!” he cries, as he drops to the floor. “I want to go home!”

“Certainly,” I say, “just let me talk to your mother for a minute, and then you can go.”

I explain the results of my examination to the mother, reassure her that all is well, give her a few instructions, and tell her to follow up if the fever has not defervesced within 48 hours. She seems satisfied; I usher the dyad out the examination room door.

The nurses wait silently in the central laboratory area. “Well,” the senior nurse says, searching my face, “what did you do in there to calm him down?”

“Trade secret,” I say. “Something I learned from my mother.”

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