Notes from a Healer

Telephone Triage

Brian T. Maurer

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The call came in on Friday at 9:38 PM.

It had been an exhausting week at the office: an unrelenting barrage of patients every day.  I could barely think straight by the time I packed it in every evening and headed home.

I had dinner, checked my e-mail, lay down on the sofa to read and fell asleep instead.  The next thing I knew, my wife was handing me the phone.

The patient sounded distraught.  “I’ve had this pain all day.  It’s just getting worse.  I took something, but it didn’t touch the pain.”

I pushed up against the pillows, pressing the phone against my ear, striving to pull my scattered thoughts together.

“Where is it?” I asked, trying to get my bearings on the map of a human body.

“It’s in my back, below my shoulder blade,” she said.  “Maybe a little lower down, on the left side.”

“Does it change when you take a big breath?”

I could hear air moving in and out during the pause on the other end of the line.  “Not really.  It’s there all the time.”

“Have you had a cough or a fever?”


“Does the pain go anywhere, or does it just stay in that one place?”

“It just stays there.  It almost feels like a muscle spasm—but deep inside.”

I explained the zero to ten pain rating scale.  “What number would you give it?”

“A 7 or an 8,” she said.  “I feel nauseated,” she added.

“No belly ache?  Any change in the color of your urine?”

“No,” she sobbed.  “What do you think is wrong?”

“It might be a kidney stone,” I said.

“What should I do?”

“I suggest that you go to the emergency room and let them have a look at you,” I said.  “Does your health insurance cover emergency care?”

“I don’t know.  I’ve never had to use it before.”

“Look at the back of your card.  It should have a number for emergency services.”

Another pause on the phone.  “Here it is,” she said.  “You think I should call first?”

“It wouldn’t hurt to call, but I think you should probably go to the hospital anyway.  You need to be evaluated tonight.”

“O.K.,” she said finally.  “Sorry for waking you up, Dad.”

“It’s O.K.  That’s what fathers are for.  After they look at you, let me know what’s going on.”

Exhausted, I fell back on the pile of pillows and drifted into a fitful sleep, anticipating the follow-up phone call that would confirm or rule out my daughter’s diagnosis.

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: February 28, 2009