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A Close Call

Op-Med is a collection of original articles contributed by Doximity members.

Fear and anxiety can present enormous hindrances to a physician’s ability to deliver quality medical care. Undoubtedly, fear, coupled with panic attacks in situations of medical emergencies, can compromise the ability of a doctor to render efficient medical services. The anxiety kicks in, mostly when a physician encounters a circumstance that is unique and challenging. A situation not only in which they lack experience and expertise but to which they have no immediate reaction.  

However, it is worth noting that as a pediatrician, I am endowed with substantial knowledge and vast experience in attending to newborns with fever. Fever in the newborn often hinges on the age and symptoms-based risk stratification, among other criteria. Whereas newborns below the age of 28 days have a broad array of diagnostic mechanisms, including chest X-ray, lumbar puncture, blood and urine culture, and blood work, their older counterparts’ options are uncertain. 

Here is my story of an incident that happened during a momentous night of my service in the ED. That evening remains vividly clear in my mind, as I started my 10th shift as a new attending physician. Primarily, I was assigned to assist in the graveyard shift, which generally began somewhat slowly contrary to most of my other ED shifts. For clarity, most ED shifts often start on a high note, especially on weekends. In doing so, it marked my initial dismay because of the lack of the pace and adrenaline rush to which I am accustomed. 

I had left the medical ED for a moment to caffeinate myself while having a short break.  My return was met by an emergency involving a 29-day-old male baby who had been diagnosed at home with a fever of 101.5 degrees Fahrenheit. Their temperature in the ED was 99.8 degrees Fahrenheit without the baby having any medication administered. The age of the child guided us in conducting a diagnosis on the child to ascertain the specific medical condition. “Please get everything ready for a full sepsis workup, as I examine the baby,” I told the nurse. Turning to the mother, I inquired, “What is your angel’s name?” “Liam,” she replied. “I noticed his fever today. He kept crying through the morning,” she continued. While reassuring the mother that we were in control, we proceeded and carried out both historical and physical examination of the child as well as the bloodwork, among other analyses. 

The outcome of the medical examination uncovered that the patient exhibited a lot of congestion, thereby reinforcing our initial intuition of a possible viral infection. Nonetheless, I had to conduct additional bloodwork because of the heightened temperature, although such a process is not mandatory. While it is always necessary to reassure patients of hope, I was right by upholding such expectations, primarily based on the non-criticality of the patient’s history and my physical examination. 

After following the recommended algorithm and performing the necessary blood work, as well as obtaining a respiratory pathogen panel (RPP), I suspected a bacterial infection. Thus, the procedure required of me was a lumbar puncture. Although a colleague was on standby to accord me the necessary support, I concluded that the procedure was not ultimately necessary as we could establish the presence of rhinovirus/enterovirus using the RPP. Unfortunately, I admit unsuccessful attempts at the lumbar puncture, an issue that made me very anxious. 

Swift decision-making remains not only fundamental but also an integral factor in the medical fraternity, particularly while handling medical emergency cases. It came in handy in my situation, where I had to make a vital decision from two crucial and sensitive options: administer antibiotics or admit the baby without antibiotics.

The first option was complicated since it characterized a broad array of procedures, whereas the latter option was more straightforward but also not devoid of disadvantages. In case of admission for further observation, the baby would benefit from constant monitoring by staff, who would continue to examine various body parameters, including temperature, as well as administer antibiotics when necessary. On the flipside, such admission is sometimes characterized by prolonged hospital stay with repeated attempts of lumbar puncture procedures. 

The challenges attributed to admitting and observing a 29-day-old baby with a bacterial infection, without antibiotic treatment could be fatal, an issue that scared me. Nevertheless, after careful consideration, and thorough analysis of the baby’s history and physical examination, I, collectively, along with the parents opted to admit the child for observation, a decision I stand by to date. 

After two days of observation by the hospital team, Liam was discharged. I followed up on his progress post-discharge through phone calls. Undoubtedly, the mother was delighted the last time I called her, expressing her satisfaction not only with our medical help but also her baby's stability several weeks after discharge. 

Similarly, I was glad that Liam had fully recovered. Reminiscing over that situation right now, I am growing optimistic day-by-day while discharging my duty of attending to patients to the populace.

What close calls have you had? How has your knowledge, experience, and instincts saved patients' lives? Please share your superhero moments!

Adil Manzoor is an internal medicine/pediatric physician practicing in New Jersey. He's passionate about mentoring the next generation of leaders. In his free time he writes for local newspapers, mentors youth, reads voraciously, and most important of all, spends time with his wife and their daughter. And when time finally permits, binges Netflix! He can be found on Twitter at @Manzooradil2. Adil is a Doximity 2019-2020 Fellow.

All names and identifying information have been modified to protect patient privacy.

Illustration by Jennifer Bogartz

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