Agraphia Medical Tragicomedy


Why We Have Attending Physicians

Tonight in the Pediatric Emergency Department I saw a 3 year old girl for acute onset of headache and fever.

Fever in a kid is one of those roll-your-eyes-what-the-hell-is-wrong-with-them things, but fever plus a headache leads you, scarily, down the path to meningitis. You do not want to miss meningitis, because it moves fast and kills often.

The problem with meningitis is that the test for it is a spinal tap, which carries its own share of complications. Plus... it's a big fucking needle in your spine. Kids† don't respond well with big needles in their spines.

So, carefully, I examined her, trying to rule out meningitis as a diagnosis. No neck stiffness, which was a good thing. Brother had the sniffles at home, which was a strike against. I noticed a small red dot on her hand that looked like a bug bite, but nothing else jumped out.

As a resident, you ALWAYS have an attending physician - someone boarded in your specialty who has finished residency - watching over you. So, I told my attending the story, and she nodded, "I agree, from that story we can't rule out meningitis. I'll go take a look at her."

A few minutes later she came back to the doctor charting room, a huge smile on her face.

"You don't have to 'tap her," she grinned, "she's got a subtle finding you may have missed. Did you get a good look at the back of her throat?"

In fact, I hadn't. I'm still hesitant to do things patients don't enjoy: sticking tongue depressors in kids' mouths, doing pelvic exams on skittish women, performing rectal exams on healthy young trauma victims.

So, with her supervision, I went back in and really pulled the girl's tongue out of the way. Sure enough, that same little red bump I had overlooked on her hand was in the back of her throat. Pulling off her shoes and socks revealed one of them on each foot.

Hand, foot, and mouth disease. Classic presentation. Common symptoms include fever, headache, and rash. Treatment is simply ibuprofen for her fever and water for dehydration.

Attending physician, you rock.

† (also, adults)

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  1. Awesome . Now I’ll always remember H-F-M Disease :)
    Well, yeah. Doing things to kids is really the scariest part of a Pediatric examination- with the kid kicking, screaming and, at times, biting! You were lucky that the girl was sensible enough to not do so.

  2. “As a resident, you ALWAYS have an attending physician” – thank God, right?!

    Anyway, when you have a child with fever, always look ear and throat, always.

    PS: your blog is great.

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