I'm at the pediatrician's office with my teenager. She's been complaining about something for a few days. She's had no response to the mild OTC interventions we've tried. I'm concerned but not alarmed.
The doctor seeing her today is not her primary, but a familiar member of the practice. He's kind and smart.
The bright young pediatrician is full of vigor and calmly focused in spite of this visit being late on a Friday afternoon. He is also perplexed.
His brow is furrowed. My daughter's symptoms and presentation are not fitting neatly into a box. I recognize this phenomenon immediately.
My teen is having a comfortable exchange. I go back and forth with a series of questions to attempt to break through the flummox. The doctor is giving me non verbal signs of his uncertainty without sharing his process.
Her primary is different. She and I are partnered up and a well oiled machine. She gives a lot of information. She narrates her line of thinking. She goes three steps ahead without my asking. She goes to the worst case scenarios, none of which are ever terrible.
She treats me as a colleague.
This doctor answers my direct questions. Her heart sounds fine. Her lungs sound fine.
The meds we were giving her are apparently a joke. We gave them to her because we knew it would never hurt her I said. We laugh.
He gives us a line of treatment. This treatment would also serve as a diagnosis. When you give this medication, something different and stronger than the one we were using before, you should see some improvement after three days. The medication working would serve as a reasonable diagnosis even though some of her symptoms point to this and some don't.
If we see no improvement after three days, we should bring her back.
My daughter seems fine. She's gathering her things and getting ready to leave. She's comfortable with what the doctor has said. She can deal with taking a pill twice a day.
An emergency is brewing. This one is mine.
I recognize the signs, less frequent than they used to be, but unmistakable. I'm feeling lightheaded and standing now would be inadvisable. A sense of unreality has crept in and is gaining momentum. I am out of my depth.
I am clear headed and quick in a crisis, including my own.
I have not studied method acting, but know its basic principle. I tap into the part of me that remembers being competent and calm.
In a performance worthy of Meryl Streep, I smile at my daughter and the doctor. I ask her to meet me in the waiting room because I have a private matter to discuss with the doctor. It's about her brother.
She's used to this. Sometimes I actually need to discuss her younger brother, who is healthy but larger than life. But sometimes, it's something else. This is one of her primary doctor's favorite methods. It gives the two of us a chance to talk about the child privately.
The door closes. I lied, I say. I know, he says.
I come clean.
I'm having a panic attack and some PTSD. I say. If I don't have this conversation with you now, I'm going to pass out. I don't want any of this happening in front of my daughter.
He sits down. I have his full attention.
My eldest child died. I say. He had a rare form of pediatric cancer. It is nothing like what we are experiencing here. The presentation was completely different.
The doctor is surprised and sympathetic. I see his demeanor shift. He's starting to straighten up. He's taking charge.
As a result of this trauma, I say, ambiguity is sometimes an issue with me. That's why we need this additional conversation.
I have delivered my one minute elevator speech honed by years of taking care of children in the wake of what happened to Jacob.
The doctor nods.
Do kids have heart attacks? I ask. Is she going to need to see a cardiologist?
He is definite. No. There is no heart attack happening. There is no cardiac concern.
I'm glad you said something he said. It's probably in the chart but I apologize that I didn't look.
That's no problem I say. I mean it. I spent 40 minutes watching this doctor rush from one exam room to the next. Most of the kids were screaming.
Thank you for taking the time. I say. I'm honored to do it, he says. He means it.
I feel the blood rushing back to my face. I know I'm pinking up. The conversation turns ordinary.
This child feels everything intensely I say. Sometimes things clear up on their own and we never really know what they are. She reports things other kids wouldn't necessarily notice.
Chances are, when she feels she is being addressed, her symptoms will improve, I say. She'll take some of the meds and frankly it will most likely work.
The doctor feels this is a reasonable assessment. He reiterates that he feels there is nothing critical or urgent happening with my child. He also mentions that he is on call this weekend if I want her seen again or need to talk on the phone.
I know what is going to happen after I leave. Even though he's had a busy day - exhausting really - he'll phone our primary or the senior member of the practice. He'll run it by them.
The next time I see him, he will remember me and my story. He'll anticipate that I may have extra questions. Since he seems to be a fast learner, he may even fill in the blanks when I haven't asked. He'll be extra careful even when he doesn't need to, and I'll appreciate the effort.
I may have gained a new colleague. It's okay if he's not. Not every doctor needs to be a hero as long as some of them are.
In a In a couple of days there will continue to be something in the situation that is more grey than black and white. She'll be improved but not all the way. There will be will be a lot rolling around in my hopper.
I'll I remember every single mom from my support groups. Most of the moms in this group had kids who died from cancer. But one of them had an issue that initially presented with something like this only more severe, It congenital and uncommon. The kid kid died stunningly fast.
I'll think about this. As a concern it won't take on its own life. My daughter wwill be hearty, bright eyed and not exhausted. She'll be too energetic and wholly herself to have this problem. Just like today.
Some things need some extra days to truly show themselves. They take on clarity with time and the only thing to do is wait. I'll check back in with her often but not too often.
There might be an additional phone call. There could be a visit with her primary or a specialist. Or this could be the end of the road. The symptom will disappear as mysteriously as it arrives.
None of these scenarios involve a watershed day where life as we know it changes forever. It's possible, but very, very improbable.
This I know. Nobody else can teach you this stuff. It's experienced, amassed, cataloged, saved then accessed. It's sorted, pruned re-sorted and re-experienced.
Hindsight and present day are deft in their collaboration. Eighteen years at this job has taught me a lot. Thanks to these doctors-slash-colleagues, I'm hitting my stride. I'm doing this thing and I'm up for the task.
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