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• W1720896543 abstract "Friday. The end of the first week with a new clinical clerk: her first rotation. Unlike previous clerks, who were experienced and cocky, she is just beginning. Already we’ve covered everything from the indications for influenza vaccination to childbirth. I’ll never forget that delivery: the laughter as I showed the grandmother how I could teach the baby to stick out her tongue, and the tears as the family’s thoughts turned to an infant cousin, born prematurely with all the textbook complications, who was dying at home. And so this birth was a joyous occasion tinged with sadness. Little did I know how much sadness. Less than 24 hours later a call came from the nursery: the baby seemed dusky and had a heart murmur. By the end of another 24 hours she had been rushed to neonatal intensive care, then to the cardiac care unit at another hospital, and finally to Toronto to undergo emergency cardiac surgery. Five days later they declared the procedure a success, and I looked forward to a new week. A normal one, I hoped. Monday. As we were seeing patients a call came in from the baby’s cardiologist. I excused myself and left the clerk to carry on. I was expecting a routine update. The cardiologist told me about the transfer and the surgery. “Honestly!” I thought. “Don’t these guys know we family docs are a bunch of mother hens who follow our baby chicks closely? Why is he interrupting my office hours to tell me this?” Then I realized that he knew this wasn’t news to me. And so I heard his next words before they left his lips. The baby had died, suddenly and inexplicably, “just a little while ago.” After the first shock wave I called to speak to the parents, only to find that they had already left the hospital. There was nothing to do but carry on. I returned to the examination room, mouthed the word “died” to the clerk and continued with the patient as if nothing had happened. Later that day Maureen came in. Her case is perhaps the saddest I’ve ever dealt with. Even her oncologist feels the same way, so I know it’s not just old emotional me. Almost a year ago on routine prenatal lab work in her third trimester I discovered what proved to be non-Hodgkin’s lymphoma. Worse was yet to come. After a bittersweet delivery 3 months later, the baby had nonspecific feeding difficulties — nothing particularly worrisome. But, examining the infant’s abdomen when she was 4 weeks old, I felt a horrible panic welling up. This was the largest liver I’d ever felt in a baby. She had neuroblastoma. Now the baby was doing well, but her mother had suffered setback after setback. No therapy had had any effect; the cancer had spread relentlessly to her bones, brain and breasts. She had come in, my last patient of the day, to tell me she was now deemed “palliative.” I talked about what I could offer, suggesting that I could do house calls and take over her care at any point: palliative care was family practice epitomized. But she didn’t want that, partly because she lives quite far out of town and partly, I suspect, because house calls would define her as dying. As long as she could make it to my office she couldn’t be “that sick.” After she left I dragged myself to the phone to call the parents of the baby who had died. An hour later, drained and disheartened, I came out into the waiting room to find Maureen sitting there looking forlorn. There’d been a mix-up; her husband hadn’t come to drive her home. I picked up her child carrier and headed for the car. Time to make an unofficial house call. Time to show her it isn’t hard for me to do. It’s funny, the little ways that patients can affect you. My car hadn’t been running very well for some time and made a terrible knocking sound. As we approached her house Maureen admonished me, “Dr. Despard, your car is in worse condition than ours!”, implying that as a highly paid professional I ought to get it fixed. I figured she was right. Experience" @default.
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• W1720896543 title "A WEEK IN NOVEMBER" @default.
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