So the night after writing "moon walking" a friend of mine who is now one of the head residents, a "chief", calls me wanting to know specifics on a kid I treated as an intern, she is giving a lecture for morning report (doctor's lectures to other docs). As she is retelling what she knows of this patient, a little cute girl, Emily, comes into my mind, she's sitting in bed with pink jammies telling me, "My belly hurts". She's one of those kids that you hope that you would have someday, cute and sharp as a button tack, she loved to play soccer, she was 4 or 5 at the time. She came in with abdominal pain and occasional headaches, we did a quick workup culminating in a endoscopy and colonoscopy by the gastroenterologist which showed an odd finding, as they scoped her the very mild stress of the procedure on the colon was causing bruises and hematomas (collections of blood). We didn't have a clue what was going on. Then, my golden weekend came and I left for home to ponder what was wrong with her wondering what they would have found when I returned but, when I did come back the attendings had discharged her to continue the work up for her problem in outpatient, as she was medically stable and not in danger.
As time went on, I'm ashamed to say she left my mind, this girl in pain that we couldn't help. Now a year later, my good friend, tells me that what had caused all this was hypertension (high blood pressure). I looked at and wrote down her blood pressures every damn day! The high blood pressure was causing the headaches and the bleeding and the stomach pains....and later as she went on over a YEAR undiagnosed and untreated it started to affect her vision...it started to affect how she thought...she eventually was so debilitated she no longer could play soccer. When she told me what had caused the pain, I cursed. When I asked how she was doing, my friend tried to soften the blow, but I looked up her records...and I know that if I'd just been better I could have caught it, such an easy catch...and yet it went undiagnosed for over a year, with high blood pressures documented at every visit, sick and well, just one doctor recognizing a single number was high could have changed her life. The problem lies in that childrens blood pressures are much lower than adults. An adult BP (blood pressure) is typically normal at 120/80...she had the misfortune of having a blood pressure too close to the adult normal, and as such she was overlooked until her BP got higher than the adult norm.
As I thought of that little girl sitting at home sick for a year, sitting out of games, and crying in pain, it really started to wear on me...her sight almost lost...I found myself crying on the way to work, this was only supposed to be a job!!! What kind of job hurts people when you screw up?!?! If I didn't realize the gravity of my job before, I do now, I don't even know if you should call it a job, it's something else entirely to me now. For every "moon walking" story, how many of these stories are slipping passed me quietly? Whenever I think of that girl, I feel a great regret and a mistake that I can't fix no matter how I try. I went to the computer people where I work and got the computer to recognize age and height specific blood pressures, it should be working within the month, within a month this kind of error won't be possible again...it doesn't seem enough. I don't care if I save hundreds kids from her fate with that fix...I didn't save her. I'm already thinking up more schemes to improve the system, but when I get down to it, I don't think I'm ever going to get rid of her skipping around in the back of my mind, weeks later it still stings when I think of her...when I think of my son, should he endure a similar fate. I've thought about calling the mother and apologizing but I shy away from it the second after...I come up with excuses (bla bla legal bull crap bla bla your not the only one to blame bla bla is the apology for you or her? bla bla bla)...I don't know if my cowardice will allow me...maybe in time, after I feel that I've in some way made up for it (if that ever happens)...I don't know...Whatever happens in the end my mind will work her memmory over till her rough stone in my stream of consciousness becomes smooth as a river rock but, regardless how I wear down the sharp edges, she's a part of me now and likely forever. Like I said, occasionally I find my feet on the moon but it doesn't take long till I find them slapped down to earth again, reciting my mantra, trying to clear the pain of my mistakes from my head, "I'll do better next time...I'll do better next time...I'll do better next time...God, Emily, I'm so sorry."
Newbie Doc
