Notes from a Healer

A Lot Can Happen in a Year

Brian T. Maurer
btmaurer1@comcast.net

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"He seems like such a nice boy," the medical assistant says as she hands me the chart.

I open the medical record and glance at my notes from the prior physical exam one year ago. At that time I had jotted down the father's new diagnosis under the family history section on the problem list.

"He had a little trouble with the finger stick," the assistant says, "but we got through it okay. No shots today."

"Did the mother mention anything about his father?" I ask.

"No, she didn't say anything."

Maybe that' a good thing, I muse to myself as I walk down the hall to the exam room.

"You grew a beard!" the mother says.

Momentarily shocked, I devise a comeback. "Yes, I quit shaving six months ago, and this is the result. How have things been with you folks?"

"Overall, fine," the mother says. "But I do have some concerns."

"She's got some concerns," the boy says from his perch on the exam table. He's lying on his side, stretched out the entire length of the table. I can see that's he's grown quite a bit since last year.

"She does?"

The boy nods his head and waits for his mother to speak.

"The moodiness is the worst thing," the mother says. "If we're out at a restaurant or in the mall and he gets anxious, he says that we have to go home so he can pee. He won't use a public restroom, so we end up rushing home. Nine times out of ten he doesn't go when we get there. I think he just gets upset for whatever reason and doesn't know how to interpret his feelings."

"How are things going at school?"

"Pretty good. He's had the same para-professional for the last four years. He does well with her. She's very attentive and keeps me informed."

"Do you like your para at school?" I ask him.

"She's nice," he says.

"Sometimes he gets agitated there too. Usually she can talk him out of it, but there are times when it doesn't work. I know we've tried a number of medicines when he was younger with disastrous results. He certainly didn't do well on the stimulants. Rather than helping him to focus, they just made him more agitated."

"One of the SSRIs might be helpful," I say. "They were formulated to be used as antidepressants, but they do have some anxiolytic effects as well. I've had some success in using them to treat other children who fall on the autistic spectrum."

"Let me talk with his para and see what she thinks. Maybe we could try it toward the end of the school year."

"That would be fine."

We proceed with the exam. The boy is remarkably compliant, although he doesn't want to open his mouth at first. "He's not going to put the stick in your throat," his mother says. "Pretend you're at the dentist. Open up big so the doctor can see your teeth." Finally, he does.

We finish up with the heart, lungs and abdomen. I ask him to stand up and bend forward so I can check his spine. At six feet in height, he towers over me. Everything looks good. Despite his disabilities, he remains a healthy boy.

"How often is he seen in follow up for the cochlear implant?" I ask.

"He goes every six weeks to have it recalibrated. He's eligible for an upgraded unit every three years. The state is supposed to cover it. This past year I had to pay out of pocket, then wait for reimbursement. It costs $6,000. It took six months, but they finally paid me.

"It's been a long row to hoe," she says.

"I can see that," I say. I hesitate, then ask about the boy's father.

"He passed away last summer. Didn’t you know? Kidney cancer. He only had one kidney, so there wasn't much they could offer him. Funny, I thought we had seen you since then."

"No, your last visit was a year ago for his annual exam."

A lot can happen in a year. You might raise a beard, you might grow two inches taller, you might lose a spouse or a parent to cancer.

A lot can happen in a year, and sometimes those changes last a lifetime.

 

About the Author

  • Photo of Brian T. MaurerBrian 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 patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice. Interested readers can read more of the author's writings at his website and blog.

  • Published: May 11, 2012