The Yale Journal for Humanities in Medicine

Notes from a Healer

Grave Error

Brian T. Maurer
btmaurer1@comcast.net

“This is the third time we’ve had our son to this office in the past four months for the same thing, Doc.  We’ve got to get to the bottom of this.”

The father speaks in a concerned voice:  anxious, not angry.  I acknowledge him with a nod and continue my questions.

“These spells that he gets—they typically occur while he’s at school?”

“For the most part, I’d say yes,” the father agrees.  “And it’s usually on a Monday.  “He gets these sudden episodes where he breaks out in a sweat, feels hot inside.  Sometimes he gets dizzy.  Today he almost passed out.”

“Almost passed out?” I say.

“I reached out and caught hold of a nearby chair before I fell,” the boy explains.

“What time do the episodes occur?”

“This one happened at nine o’clock in the morning,” the father reports.  “They were watching a movie in class, right?”  The boy nods.  “Then he felt it come on.”

I flip back through the boy’s chart.  Four months ago I saw him for complaints of recurrent headache accompanied by vomiting and dizzy spells.  An extensive battery of blood work revealed no abnormalities at that time.

“Let’s have a look,” I say.

As part of the examination, I check the boy’s blood pressure as he reclines on the table, immediately after he sits upright and again when he stands.  There is no significant drop in the readings during these maneuvers.  The remainder of the exam is normal.

“Are you still having headaches?” I ask him.

He nods his head.

“How often?”

“Maybe every other day.”

“Where?”

“Here.”  He points to the back of his head.

“Any vomiting with the headaches?”

“Sometimes I feel sick to my stomach, but I usually don’t throw up.”

“What do you think, Doc?”  As the father’s eyes meet mine, I struggle to hold his gaze.

“The symptoms are somewhat vague and inconsistent, but the spells persist,” I muse.  “I think it would be wise to do an imaging study of his head, just to make sure everything is O.K. inside.”

“Good.”  The father seems to relax a bit.  He says to the boy:  “Wait for me outside, will you?  I want to talk to the doctor alone.”  Dutifully, the boy departs, closing the door behind him.

“You see, Doc,” the father begins, “I’ve got to get to the bottom of this, once and for all.  Right now he’s failing all of his subjects at school—everything except gym class.  He’s a great athlete: agile, coordinated, quick.  But academically, forget it.  I’m inclined to ride him hard, but I don’t want to come down on him if there’s something medically wrong, you know what I mean?”

“I understand completely.  That’s why I suggested doing the imaging study.”

“I appreciate that, Doc.  You see, we lost his older brother to leukemia three years ago.”

Stunned, I can only stammer in a whisper:  “I’m sorry to hear that.”

“Yes, those days we lived at the hospital.  He watched his brother die.  We all went to counseling afterwards, but I don’t think he ever got over it.”

“And now you think—“

“I don’t know what to think, Doc.  That’s why I brought him in to see you.  I don’t want the same thing to happen again.”

“I understand.  Based on his symptoms and previous blood work, I don’t think you have to worry about leukemia this time round.”

“It’s not leukemia I’m concerned about,” the father says.  “You see, our last pediatrician kept telling us that our older son had asthma.  When he didn’t get better on inhalers, she accused us of not giving him the medicine properly.  Our son told her that she didn’t know what she was talking about—he said he didn’t have asthma, that there was something else going on, ’cause he was getting worse, even though he took the medicine every day.

“I chastised him in front of the doctor, told him he had to apologize for his remarks, told him he had to go back to school and quit playing games.  A week later he was in the emergency room, unable to breathe.  The cancer had infiltrated his heart.”

I let out a long slow breath, and wait in silence.

“To this day I ask myself why I didn’t listen to him instead of the doctor.  If I had, maybe he’d still be alive.”

“There’s no guarantee of that,” I say, as gently as possible.

“No, there isn’t,” this father says.  “But I was wrong once, and I’m not going to risk being wrong again.  This boy is the only son I’ve got left.”

About the Author

Brian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades.  As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine.  Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care.  His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of fifty-seven patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice.

Published: March 30, 2008