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12.19.04 Overtreatment by Jon Worley I'm trying to write this column as objectively and dispassionately as I can. That's difficult, though, because with every keystroke I keep seeing needles being jammed into my 4-day-old son's back. And I didn't actually see said needles. I merely heard his screams. But I'm getting ahead of myself. Last Tuesday, Samuel Barrett Worley arrived in the world. The labor was short (five hours) and intense. And rather than act as ice chip boy (you can read my column about the birth of my son Max, if you like), this time I actually got to help my wife Barbara work through the contractions and do a small amount of work myself. We'd planned to do an epidural, but just as Barbara demanded one, Sam decided to come out. A couple pushes later, he did. Barbara felt so good that we went home Wednesday, spending just one night in the hospital. Sam was a bit jaundiced by the time we visited the doctor on Friday. Our doctor wasn't terribly concerned, but she tried to allay Barbara's worries by taking a blood test. When the bilirubin level came back moderate, she ordered us a "biliblanket," something like a flat flashlight that is placed on a baby's back. The blanket wasn't really necessary, but hey, it wasn't hurting anyone. Our doctor also scheduled a follow-up visit on Saturday to make sure the bilirubin didn't spike and that Sam's weight was stabilizing. Barbara and I kept Sam up all of Friday night trying to get the kid to eat. He did eat, but he wasn't enthusiastic. And, of course, the way you keep a baby awake when you're trying to get him to eat is to strip him down, wipe cool washcloths over his face and body and otherwise try to shock the baby into alertness. So it wasn't that surprising that his temperature was a little low at the doctor's visit Saturday morning. Still, all that work did the trick. Sam woke up often enough, and ate enough, to gain four ounces between Friday and Saturday. I didn't know any of this, of course. While our older son Max had behaved quite well at Friday's doctor visit, the next day he acted his age--2 1/2 years old. Which is to say he was in the middle of throwing a tantrum about something or other when the doctor called us back. So Max and I walked around (and around and around) the doctor's office while Barbara and Sam went back for the exam. An hour and a half later, the doctor flagged us in. She walked me back to the room and announced that Sam had to get to the hospital immediately to be tested for bacterial meningitis, among other things. I said okay. Obviously, Barbara has as well. So we did. I took Barbara and Sam to the emergency room (which is where they were to be admitted) and drove Max over to the house of some sainted friends who most graciously agreed to watch Max for as long as necessary--certainly overnight. Then I drove back to the hospital. I got to the room just as the doctors were trying to get a spinal tap. I heard Sam's cries, and Barbara walked out of the room, her face ashen. "They keep trying," she said. "And they can't do it." A couple hours (and 10 to 15 needle stabs later, depending on whether I ought to believe the nurse or the doctors), there was still no spinal tap. "I told them that they had to call [the real doctor, as opposed to the residents doing the stabbing]. And he said that you often can't get spinal fluid out of a four-day-old." They'd spent some 3 1/2 hours (including a stint in radiology trying to stab him using an x-ray as a guide) jamming needles into Sam's back, and they finally figured out that you probably couldn't get anything from such a young child. This still angers me, of course. But truthfully, other than the immediate pain, Sam doesn't appear to have suffered from the multiple tap attempts. He doesn't complain even when the prick marks are touched. Babies have an immense capacity for healing. So I am angry, but the residents obviously didn't know better, and I hope that Sam's shrieks will be enough to drive this particular lesson home. Whenever we asked whatever doctors we saw (and between the emergency room and the children's ward, we saw a lot) what they thought about the need for all these tests and procedures, to a one they said, "Well, better safe than sorry." That "well" was often drawn out a few seconds. Not one said, "This was absolutely the right thing to do." Not a single one of them. It's never good to question another doctor's judgment, but the lack of enthusiastic support for Sam's hospitalization was telling. As you might expect, the nurses weren't so reticent. They see sick children all the time, and they know the difference between a sick baby and a healthy baby. And all of them knew that Sam was fine. He was acting normally. There was no reason for him to be at the hospital. But there we were (and, as of this writing, there he and Barbara are still). Sam's blood and urine were cultured to test for bacteria. If nothing has grown by about noon on Monday, then Sam and Barbara will be able to come home. No one--not even the doctors--expects anything to turn up. Sam is feeding, gaining weight, pooping and doing all the things that a baby should. We spent the night seething. I woke up seething; Barbara woke up tired. Sam woke up hungry. Another doctor from our doctor's practice came by on rounds. Saturday's doctor had called him to ask for advice--putting him in a terrible position. He couldn't very well dismiss her concerns without seeing the child himself. That would open him up to all sorts of malpractice claims. So he didn't dissuade her from ramming us into the hospital. But Sunday morning, after seeing Sam for himself, he was apologetic. He tried to explain what had happened, and he insisted (and I believe him) that these decisions aren't made lightly. He said that Sam's moderately low temperature at the visit combined with one he'd had at the hospital worried the first doctor. That Barbara's tearful comment that Sam didn't breastfeed as well as Max (which is kinda like saying Carlos Beltran isn't quite as good a hitter as Barry Bonds) was disturbing. And that the doctor on Saturday had thought Sam seemed out of it and lethargic in the office. Then he examined Sam, muttered "This baby isn't lethargic," either to himself or to us--I don't know which--and continued to apologize without really apologizing. He couldn't really apologize, of course, without opening the practice up to a malpractice suit. But he also didn't say, "Well, better safe than sorry." He left the strong impression that he wouldn't have sent Sam to the hospital if he'd been in the office on Saturday. I believe him, mostly because I'm sure that our own doctor wouldn't have sent us to the hospital, either. She's fairly laid back, and not prone to jump to paranoid conclusions. That's why we chose her and the practice as a whole. And, in the end, that's what bothers me the most. It's not the pain Sam suffered. While intense, he's already recovered from that. As long as there are no long-term consequences from the needle stabs--and there shouldn't be--I can accept that, even if it still makes me angry. I'm also not excessively concerned about the cost to us. Our insurance plan isn't the greatest, and we'll probably have to cover a good amount of the costs involved. That doesn't make me happy, but we can handle it. What I'm really mad about is that the doctor who sent us to the hospital didn't listen to Barbara. By all accounts--including her colleague's--she seems to have been motivated by Barbara's distress as much as anything else. We trust our doctor, and all the doctors in the office, to do whatever they can to avoid such unnecessary interventions. To us, overtreatment can be just as damaging as undertreatment. The thought that her tears sealed Sam's fate haunts Barbara constantly. But this hospitalization wasn't Barbara's fault. The doctor should have taken the time to understand what Barbara was worried about, rather than simply read her tears (and with the post-partum hormonal imbalance in full swing, a new mother can cry at the sight of a ladybug or the thought of a margarita or whatever). She didn't. And she didn't consider the exculpatory evidence--in particular, the fact that Sam gained a quarter of a pound in one day. That's a big gain for one day. Even the ol' fat Max, who could put away vast quantities of milk, rarely gained that much (a rate of gain that translates to seven-and-a-half pounds per month, almost unheard of in infants). She didn't consider the fact that we'd been cooling Sam for a day trying to get him to eat. And she obviously didn't examine Sam well enough to figure out that he's an alert and active child--when he's awake. Normal babies can sleep up to 20 hours a day. Obviously, she caught him when he was sleepy. No, instead she rammed Sam into the hospital, indirectly causing the spinal tap horrors and generally making a mess of our lives. Yes, it's nice to know that Sam doesn't, indeed, have meningitis. Glad to hear it. Of course, as one nurse noted, Sam had as much chance of having any of these diseases as Barbara or I do. Left unsaid, of course, was that we hadn't been subjected to these tests ourselves. We plan to talk to our doctor and explain our concerns. We will want any future non-emergency admission to be run past her first, and we also want it made much more clear that we actually have a choice in all of this--as, of course, we did. We were so freaked out that we didn't make a choice, but we could have. I should have asked if we could simply monitor Sam's temperature at home and then have him checked out at his next scheduled visit on Monday. But I didn't. And the doctor didn't offer it as a choice. She should have, even if she also felt that it would be better to go to the hospital. I'm tired, and I'm still pissed off that Sam and Barbara are in the hospital. I can't do anything about that. But I do plan to make sure that the doctor who put us there reconsiders her actions. This admission and these tests were no small things, as she seemed to see them. She needs to understand that it takes more than some sort of gut reaction to shove a four-day-old baby into the hospital--where a person with a limited immune system (like, say, a newborn) is much more likely to contract something nasty. She needs to understand that she shouldn't jump to conclusions, and that she should listen to the protests as well as the tears of her patients. I don't like paying for other peoples mistakes, but I can accept it when that happens. I just want to make sure that this person actually figures out she made a mistake. That way another family, one that might well be without the financial resources to pay for all these unnecessary procedures, doesn't get put through the same wringer. It's not much, I know, but I'd like to see something positive come out of this mess. There's got to be more than imagining what my four-day-old son felt as two inexperienced doctors repeatedly stabbed his back in search of something they couldn't find.
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