#16 How Becoming a Mother Made me a Better Doctor

The apprenticeship we go through during internship and residency teaches us a lot about infections, injuries, and patient interactions.  What teaches us even more are the experiences we go through in our own lives. When I hurt my back picking up a stack of old-fashioned X-rays (children, this was something we had before digital images), I learned a lot about how to treat a lumbar sprain and strain. It wasn’t until I placed myself flat on my back, at bedrest, did I start to get better. After that experience, I had no problem selling my patients on the most effective treatment of a lumbar strain and sprain.  I believed so fiercely that my medical advice would work because it worked so well on me.

Not that one has to have experienced a certain illness to advise her patients.  I’ve never had an asthma attack but I can imagine how uncomfortable it must be to feel like you can’t draw a breath. I don’t have those body parts but I can conjure up the extreme discomfort of epididymitis or orchitis. As an emergency physician who takes care of children, my perspective changed by about 180 degrees when I became a mother.

I thought I had empathy for the mothers and fathers who brought their crying, inconsolable children in at 3:00 in the morning. I saw that panicked look the parents had on their faces as their seizing child lay on the gurney in the emergency department. The nurses and I would look at those parents with the calm and assurance of people who saw this very same thing two or three times a week. We knew what to do.

But oh, when that crying comes from your own child.  When nothing you try seems to relieve their colicky discomfort, then I felt a mother’s pain. My premature twins woke up every three hours for feeding. And all the time while one of them wailed, I worried, would she would wake up her twin brother who slept in a crib in the same room. I fretted about that for two years and IT NEVER HAPPENNED. How much angst and time did I waste over worry about that one thing.

I did four years of residency and several years as a full-time attending physician in a busy suburban emergency department until one pesky little parenting problem absolutely stopped me in my tracks.  I could not get my son to swallow medicines. Whenever any food with texture or solid matter would touch his soft palate, he would bring it back up.  I mean bring up everything, all the contents of his stomach. I had written hundreds, perhaps over a thousand prescriptions by that time for young parents to give the common antibiotics pain relievers, or myriad other medications to their infant children.  My nurses dutifully instructed the parents how to give the weight-appropriate doses of acetaminophen or ibuprofen to the little darlings. I never gave too much thought about how they would do it.

I felt like the karma of the world was giving me back a tremendous jab in the eye. The doctor could not give her son his medicine. Fortunately, he was a healthy lad who mostly stayed at home with his twin sister and either the nanny or his parents. But then I started taking him to childcare at the gym or to play dates with the other kids in the neighborhood. He started getting viruses and inevitably some cases of inner ear infections that would require some sort of medication.

I had the hack all figured out for fever treatment.  Acetaminophen (trade name Tylenol) come in rectal suppositories that come in various potencies that could be dosed according to the child’s weight. If they are not stocked next to the oral medications in the pharmacy or supermarket, ask the pharmacists if they have them in the back. Sometimes acetaminophen suppositories are stored in the fridge.  The suppositories are composed of the medicine in some sort of a waxy substance that melt inside the body of the child.

Suppositories are super easy to insert in young children and most of us are in that vicinity when we change their diapers.  You just place a little lubricant (like petroleum jelly) over the entry to the rectum and place the suppository on the tip of your pinky finger. Just fold the legs up and place that little bullet shaped suppository inside the child’s rectum. If you don’t get it all the way in, the child can push it out. Just an inch or two in and voila, the child has gotten his fever or pain medicine.

 I would eventually advise all the emergency department parents to keep some acetaminophen suppositories in the fridge for when their children would need the fever or pain control but was either vomiting or would not willingly take medications. For about 15 years, if you checked the door of my suburban Alexandria fridge, tucked in the back behind four types of mustard, 6 different salad dressings, and a half-filled jar of capers, you would find a box of acetaminophen suppositories.

Then we had a big issue.  There were fevers and poor oral intake and something more going on.  This time it was enough that I actually brought my son to see his pediatrician.  The doctor did something he did not often do.  He actually checked a white blood cell count.  An elevated white blood cell count indicates a body stress, a response to infection, and a significant illness that needs to be addressed. I tried to be a “good patient.” My son’s white blood cell count (WBC) was 35,000. https://medium.com/@joannaidorf/how-to-be-a-good-er-patient-9ef77c2e1e6a

 If I were seeing this same sick child as a physician in the emergency department, I would have initiated a full septic work-up.  Sepsis is an infection of the blood stream resulting in a drop in a blood pressure, increase in heart rate and fever.  My actions as an ER doc would have included drawing blood cultures, giving an IV of saline to rehydrate him and administering an intravenous does of antibiotics. His officed based pediatrician simply handed me a prescription for oral amoxicillin.

I did my level best to be a “good” patient and to follow the doctor’s orders.  I have a great deal of respect for my son’s pediatrician who helped us through a number of challenges. But seriously, he never had to give young Benjamin a dose of medicine. I went home and I filled that prescription and I tried as best as I could, to give that child a dose of that antibiotic. It was not going to happen.  I could not get that medication into that boy.

My doctor’s brain swirled with visions of bacteremia and sepsis.  Those are fancy terms for bacterial infection in the blood stream and overwhelming infection. How would I tell his two Jewish Grandmas that his doctor mom could not get the medicine into her child? I had the best back-door hack of all.

I bought him to my emergency department. This was back in the day where you could do stuff and take care of each other without even registering. I had one of my colleagues take a quick look. My Jane (please see blog number #8) took little Ben and gave him the appropriate dose of IM ceftriaxone that would appropriately treat him. It would also take care of my guilt and worry.  My boy got better and that’s mostly what I remember from this story.

Why have I told this story?  I never thought one hot minute during all my years of training as to how the parents of my patients would give their children their medicine. This was another thing that we took for granted about our “good’ patients.  They took their medicines as prescribed ant they gave their children the medications that I prescribed for them. BUT WAIT, I could not even do that myself.

I didn’t even know this until I became a mother. In my upcoming book (Insert self-promotion here) I talk about how doctors an nurses judge their patients quite harshly.  Most young professionals have nary had any time to become parents themselves. How can we expect them to truly understand a parent’s point of view. They probably think, like I did, you just give the baby the medicine. Life teaches us all a few lessons along the way.  After learning this lesson about how hard it is to give kids medicine, I always asked if the parents knew how to give it and I tried to choose medications with the least number of doses possible. If giving the medication is difficult, the parents just won’t do it. The right medication won’t work if the parents can’t give it. (or if the baby throws it up)

Lesson learned.