Not a complaint. He is already sleeping.”
“Please call me back if that changes in any way. If this viral meningitis or encephalitis is just an ordinary ‘summer one’ as I often see, it should not give him or you any problems.”
Dr. Martin was already in his office in the morning by 7 am. His first scheduled patient would not be in till 9. So he worked on his papers and started a new folder on Eddy. At 7:30 Eddy’s mother called him:
“Doc, Eddy’s been somewhat restless in he last hour and he just threw up.”
“Does he have any discomfort or pain?”
“Not so far. Just that.”
“Put him back in the car and I’ll see you both again in the ER right away.
He got there before Eddy and his mother. At 8:15, after checking again his neck for ‘guarding’ he was repeating the spinal tap. It all went easy and fine as the evening before. And as then, he waited in the ER for the lab to call him back with the results….
Wow! Now, instead of the white blood cells in the spinal fluid being in the 50s as a few hours earlier, there were 2,030 WBCs, and now not ‘lymphs’ but mostly ‘polys’!!!
“Wow!” he told the ER attending now present (Dr. Bob Stein was by then off that morning). It seems this has turned into ‘bacterial,’ no longer viral meningitis. And probably very serious, judging by the number of WBCs…”
So he called immediately the pediatric floor to talk to the admitting resident. But they were busy ‘conferencing,’ giving the overnight report to the morning shift. So Dr. Martin waited for a few minutes with the phone pasted to his ear. Finally the actual chief resident came to the phone. He listened to Dr. Martin and told him he would come to he ER in person ‘right away.’ He showed up 20 minutes later.
Eddy’s repeat labs from his blood were also alarming, 15,000 WBCs, 80% of them polys. The chief resident called immediately ICU for a bed. Yes, they had one. He had brought down with him a 1st year resident who started on Eddy an IV with D5W fluid and penicillin and erythromycin. The two residents talked to mom as they wheeled Eddy down the long corridors to the adjacent hospital -the University Hospital- where the Peds ICU was located.
Eddy would be from then on in the exclusive hands of the ICU attending, a Bob… something, a guy with a pony tail, but known among equals to be difficult to talk to, yet a guy with a good reputation for smarts, at least among the Peds staff. He would also be helped by the infectious diseases peds specialist, also a tough guy to talk to (so often both docs critical of their ‘outside colleagues’ for not using the correct antibiotics or in proper doses, or for using them too often/too much).
[Incidentally, both of these guys were also known for often testifying -‘often for the plaintiff’- as experts in malpractice law suits against colleagues!]
Dr. Martin had then in his office a regular day seeing his usual lot of patients with headaches and school problems plus two follow up teenagers with seizures. He went to visit Eddy in ICU before going home at 5. Nothing unusual was reported to him by the resident, by the nurse, by the pony tail boss, OR by his mother. So he went home for supper.
It turns out that after 6 pm, things began to get hectic in the Peds ICU as Eddy’s blood pressure began to drop and he acted restless… The pony tail guy tried other things, a third antibiotic, but the boy kept going into shock. The pony tail guy didn’t bother to inform Dr. Martin or ask him for help….
The next morning, at about 7, before going to his office, Dr. Martin went to see how little Eddy was doing. At some distance from ICU and close to the elevators, in a lounge, he spotted Eddy’s mother and grandmother. They had arrived two hours earlier after having been at home just 4 hours:
“How is Eddy?” he asked them.
“He is dead!” They told him in unison…
“What happened!!!!!!??” himself shocked. “Was he dead when you got here?”
“Yea. They told us that they lost him at 4, when they could not get his blood pressure up and his heart stopped…”
“But nobody called me!…”
Dr. Martin went nearly running to ICU. Eddy’s body had already been taken down to the morgue once he was pronounced.
“Why you guys didn’t call me?” he asked the pony tail chief of ICU.
“And what would you have done!?”
“At least you could have made me part of the team…”
“Yea!… And you could have admitted him one day earlier!” he snickered.
“He was then fine, with just 51 WBCs in the LP. His family were happy taking him home. I even asked the resident for a bed in Irwing. But your resident was not happy about admitting him and was reluctant to give me a bed!…”
“You could have insisted and overruled him!…”
“Yes, I could have… But the boy was then fine…”
Three weeks later Dr. Martin learned -only through the local newspapers!- that Eddy had died not of bacterial meningitis but of ‘triple EEE’ (Eastern Equine Encephalitis, an infection of the meninges and brain by a potent virus which does not make wrong Dr. Martin’s initial diagnosis of ‘Viral Meningitis,’ since they generally start in the meninges before going deeper to the brain). This is in humans often a fatal diagnosis and usually the doctor who cares for the patient -whether he made the correct diagnosis or not- is just a sitting duck for hungry lawyers (and for the family trying to get rich out of a natural misfortune that is nobody’s fault or wrong doing).
Needless to say, Eddy’s ‘nice-and-thankful mother’ (ha!) did sue Dr. Martin (along with the Irwing Hospital ER -specifically Dr. Stein- as co-defendants) within two years, ‘for not having admitted little Eddy on the first day! It is curious -and sadly ironical- that the University Hospital with its residents (who denied Dr. Martin the bed for Eddy when he asked for it the first night) was not named in the suit. And that neither was the pony tail head of ICU, who was ultimately the one who lost Eddy and did no even bother to call -or at least inform- Dr. Martin when things got out-of-control for Eddy in the middle of he night… [But of course this guy was friends with the mother’s lawyer!].
And the fact that Dr. Martin’s diagnosis had been correct did not matter. Or the fact that, had Eddy been admitted that first night ‘to the end of he hall,’ it would probably have entailed the having had that second, crucial, revealing spinal tap later than when Dr. Martin did it first thing the next morning!
It turns out that Dr. Martin did win such law suit in spite of the mother’s lawyer calling him all sorts of insults in the court room, including making him a villain for having asked Eddy’s mother ‘for family history ‘just to clear himself from responsibility!’ the lawyer told the jurors. Dr. Martin did hear later from one of the jurors who had acquitted him that such insults from the mother’s lawyer had actually turned them off completely away from the plaintiff and in favor of Dr. Martin!
[And again, ironically, as of the time of this writing, this writer hears that such S.O.B. losing lawyer, a known ambulance chaser, is now a local state judge! Wow!]
Even Dr. Martin’s own lawyer was ticked off when -upon hearing his ‘not guilty’ verdict- the doc had put his head down, covered his face and cried, instead of jumping up and down thanking his lawyer for the win. The juror told Dr Martin also that they’d voted to clear him even though they thought his lawyer had done a lousy job!…
[Unfortunately, his not having admitted Eddy that contended first night, even if by most accounts Dr. Martin had been correct in his diagnosis and management and he had tried to admit the boy, ended up being costing the doc: He was reported (by the plaintiff’s lawyer-now-judge?) to the State Health Department Office of Professional Medical Conduct (OPC)! Poor Dr. Martin! That complaint and snitch would be one of the many in his long road to perdition…]