20 May 2011

Too Many

I recently cared for a child who had celebrated nearly each month of her life with a visit to the Emergency Department. Not on any particular day, just as things came up. She had been seen for fevers, for scratches, the time a mosquito bite got red but not infected. She had been given tylenol and motrin and, on one occasion, benadryl. She had never needed antibiotics. She had never, except for the one time her family made three ER visits in 2 days, been admitted to the hospital. She stayed on the inpatient floor for twelve hours, which is how long it took her parents to calm down enough to realize she was okay.

Now this is a healthy child. She was born full term, has a good set of lungs, is no more prone to the viral milieu than the next kid. Was this all terrible bad luck? Does the nurse who fields after hours calls at her pediatrician's office suffer from a predilection for overreaction, telling everyone with questions that they should be evaluated in the ER? How many visits, in a normal child, is too many? When do you raise the proverbial red flag?

As it turns out, the family has a wonderful pediatrician, who has seen the child (still less than two) even more frequently than she has been seen in the ER. She speaks in calming tones. She tries to tell mom what to look for, what symptoms normally pop up with such and such a virus, when she should worry and we she shouldn't. It is this sort of pep talk that is meant to get frightened families through the night, with some medicine for the fever but no calls to 911.

I happened to see this girl in the ER after one such call. She had been knocked over by a dog but had not a scratch on her. She cried throughout the ambulance ride, but calmed down when Toy Story was popped into the DVD player. If her mother, a somewhat young but a reasonably smart human being, had waited only two or three more minutes before placing the call to 911, she would have realized her daughter was just fine. But she didn't wait. She called. She always called.

"I feel so stupid," she told me.
"Please don't worry about it," I reassured her. "It sounds like this was very frightening."
"Better safe than sorry, right? It's better to just make sure?"
And at the time I had agreed.

But maybe I shouldn't have. Maybe I shouldn't have been nice. Because she came back the next week and seemed almost excited to be seeing me again, dragging her daughter in at eleven pm to have me look in one beautiful and uninfected ear. Unfortunately it seems like somewhere between ER visit 1 and 17, mom took this better safe than sorry ethos and had it veritably tattooed across the child's face. If I was just a little bit mean, do you think I could break this cycle? We'll never know, since I'll probably never try.


  1. No wonder my insurance premiums are so high. I have to pay for people like this.

  2. You're not doing the kid a favor. She's headed for a shrink's couch someday b/c of her mother's ridiculous anxiety/overprotectiveness/and who knows what else, along with constant ER visits over nothing.

  3. So true! Unfortunately, when parents persistently demonstrate a lack of good reasoning skills, you worry that they will fail to bring in the child who really does need to be seen. I once cared for a girl who had had a seizure about thirteen hours before the visit. The first time she had a febrile seizure, her doctors were so reassuring in letting mom knew it might happen again that when the girl seized for a full twenty minutes, she didn't think twice, waited for it to end, and then put her to bed. Scary.