What Doctors Fear

After my intern year, I forgot that children survived routine febrile illness. Every fever was hemolytic uremic syndrome, myocarditis, sepsis, leukemia…never just a common cold. We saw the worst of the worst on the wards, and because of the way our clinics were structured I saw influenza more in the ICU than in the outpatient setting. I hated seeing sick visits in clinic because I was so terrified that I’d miss something crucial and harm a patient. This may be why I chose endocrinology! When our oldest daughter had her first fever at 9 months of age, she had blisters on her hands…feet…and mouth. I was a board-certified pediatrician and pediatric endocrinologist and couldn’t decide whether she was just teething or whether meningitis was causing her fever to 104–rather than the hand-foot-mouth she obviously had!”

~Jessica Lilley, MD (Follow her blog Consider the Lilleys)

 

Do I over or under worry about my kids when they are sick? This is the most common question I am asked at dinner parties. Like many parenting things, the answer is complicated, because it depends on the situation. There are things that make parents call my office in a panic, like lice or reflux, which aren’t scary to me because I feel confident in treating them. As my husband has learned though, there are a few key symptoms that get my blood pressure up. As an example, after I returned from a night out, my husband calmly told me that my three-year-old fell with a straw in her mouth and had a “hole” in the back of her throat. Given that she seemed well and ate dinner, he appropriately reasoned that she was fine. Having read about such traumas in medical school and residency, I was sure she was developing a deep neck infection or cerebral vascular thrombosis and had mentally booked her for a CT scan and ENT consult from my living room couch while she slept soundly upstairs. So the answer to how much I worry is dependent on what I fear most and penetrating oral trauma is high on that list.

As Dr. Lilley recalled, sometimes our perspective as physicians is skewed by what we are seeing most often. As a resident, one of my greatest fears about becoming a parent was having a premature baby. I had seen many premature babies, or preemies, with their early life struggles in the NICU as well as the long term sequelae as they turned into children with chronic medical problems, being admitted to our hospital over and over again. I worried about having my own preemie as I rotated through the NICU during each trimester of my pregnancy. While preemies were abundant in the hospital, how common are they really? Was I putting my baby at higher risk due to my long work hours and stressful work environment? My fears were mostly unfounded as only 1 of 10 births occur before 37 weeks. The fear about the effects of residency on pregnancy is harder to validate but in a 1990 NEJM study, women residents reported more preterm labor than controls (11 vs 6%), but were no more likely to report preterm delivery (6.5 vs 6%). Yet, I found myself in preterm labor at 31 weeks and delivering a high risk preemie at 34 weeks, making my greatest fears real in spite of the statistics.

When you spend an 80 hour work week seeing the “worst,” as Dr. Lilley described, it is hard to see yourself as immune from this tragedy when you become a parent. You fear that what should be routine Coxsackie virus will turn into the rare encephalitis. You worry that your child will become the teaching case for today’s residents. Most of all, you second guess everything despite your years of training and professional experience because as a physician parent, everything can be rationalized away or elevated to panic mode depending on the situation. We have fears just like every other parent, but ours may be more obscure due to our medicalized perspectives. So when wondering if your pediatrician has parenting worries, recall that many of us have thought a simple childhood illness was a life-threatening emergency. We call the nurse triage line, ask our pediatrician silly questions, and sit in the Emergency Department waiting room at 2 AM beside everyone else. Parenthood is complicated, whether you went to medical school or not, and sometimes you need to indulge your fears and follow your instincts. The rest of the time you need to stop googling.

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