A Woman Scorned

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1965, A small clinic, suburban Dallas

The clinic door buzzer jarred me awake.  I looked at the clock: 1 AM—ample validation of my decision to become a pathologist, one of a tribe who in my rosy imaginings slept soundly and were never disturbed by anything other than the hum of computers and the gentle clack of lab instruments in pristine laboratories.  

But I wasn’t a pathologist, not yet, anyway. It was 1965 and I was a lowly first year resident making $300 per month with four more years of serfdom ahead. I was taking call at a clinic support Marianne and Anne.  It was my first night at a small clinic, and it had gone well: just a few patients, each of whom had a minor problem that was easy to manage.

I shuffled to the clinic door. On the other side of the glass stood a young woman with an infant in arms. I ushered her into an exam room. 

“She’s been crying all day and I just couldn’t wait until morning for a doctor to see her,” she said, nervous as only new mothers can be.  I suppressed an urge to ask, as I often had as a medical student and intern, “Why are you here at 1 AM instead of 8 PM?”  The answers were often interesting.  The most memorable, provided several years earlier in the U. of Mississippi emergency room at 4 AM by another mother with a crying infant: “My husband drives a milk truck and he gave me a ride.”

I asked the usual questions, all the while studying the infant, a four-month-old girl whose pediatrician was one of the clinic physicians.  The chart revealed she had been a healthy newborn, the product of a normal pregnancy, and had the usual immunizations, but for the last few days had been cranky with a mild fever and messy nose.  A low-grade fever appeared earlier in the day. 

“I couldn’t get her to go to sleep, so I decided to bring her in,” the mother said.  I asked about seizures, rashes, and so on—the usual drill I’d learned in pediatrics.  Nothing out of the ordinary surfaced, and I concluded she had an ordinary upper respiratory virus infection and would be fine in a day or two.  But before reaching a conclusion, I needed to examine her.

We laid her out on an exam table, and I inserted a rectal thermometer while mother held her still.  She had a slight fever, but nothing alarming.  She looked perfectly healthy: pink, no rash; with fat little cheeks and thighs; a robust cry, and mucus crusted around her nostrils.  Heart and respiratory rate were rapid, but in the expected range for any feverish infant.  Meningitis was foremost as something to rule out and with good reason, my first born, Anne, had acute meningitis and might have died of it had I not recognized subtle signs and taken her to the hospital quickly. I felt the soft spot in the baby’s skull and was relieved to find it reassuringly soft and flat, not tense and bulging, a sure sign of meningitis.  She wasn’t lethargic, nor was she jumpy, an odd combination that alerted me that there might be more to her fever than the infected ear the pediatrician diagnosed the day before.  I looked in the baby’s ears to see if she had an ear infection: the drums were flat, shiny, and pearly—nothing of the dull, red bulge of infection.  Finally, I put a stethoscope to her chest—a few mucus rattles, but no sign of pneumonia; and her heart sounds were normal: in short, typical history and findings for the usual type of non-threatening viral respiratory infection that occurs in every child.

Then I made a mistake.  I told her there were dozens of viruses that could cause fever, congestion and cough, but I didn’t know which of the many  afflicted her infant, I said, “It’s probably one of the usual viruses. It’s not important to know exactly which one it might be, but I can assure you it’s not anything serious: she doesn’t have an ear infection, meningitis, or pneumonia. She’ll recover quickly. You can give her baby aspirin and sponge baths for the fever.”

This is not what a new mother wants to hear.  “Probably! Probably is not good enough. You don’t know what’s wrong with her, do you!” she said, beginning to sob.

“That’s not correct, I . . .” She cut me off. “You just said you didn’t know.  No, wonder: you haven’t done any lab tests or X-rays.”

I explained that the clinic lab and X-ray were closed; I was the only person at the clinic and didn’t know how to operate the equipment, a statement that made me appear ever more lame.

“My baby is sick and needs penicillin.  Give her a shot of penicillin.  What are you waiting for?  And I want a prescription,” she demanded.

All the while the child was screaming.  Exasperated, I launched into an explanation of what I had done to ensure nothing serious threatened her child.  “Penicillin nor any other antibiotic is going to help your baby, ma’am,” I concluded, “penicillin doesn’t kill viruses, just bacteria, and your baby doesn’t have a bacterial infection.”

“You don’t know that for sure.  Call a doctor!” she demanded.  I wanted to say, “I am a doctor,” but thought better of it.

“I am not going to wake up your doctor at 1 AM about a baby with a mild fever and a runny nose,” I said.  “And besides,” I lectured, “there’s a danger that treating virus infections with penicillin just makes babies resistant to the effect of penicillin. There’s a good chance we’d just be encouraging the growth of super-germs that penicillin can’t kill.  If something truly serious comes along in the future that’s one less antibiotic we could use to save her life. ”  And just to ram the point home, I jabbed her with the professional secret of such matters: “Giving this baby prescription medicines is nothing more than an elaborate form of psychotherapy—for you!”

This is a true saying and worthy to be received by all males: Hell hath no fury like a woman scorned.  As she ranted, all I could think of to say was:  No, I will not call the doctor;  No, I will not not give her a shot of penicillin;  No, I will not write a prescription; Your baby is going to be fine;  Just rely on aspirin and sponge baths.  After more sobbing and shouting she left in a rage, threatening as she walked out the door to have my job, and to sue for malpractice.

I was so tense and upset I couldn’t get back to sleep.  Never had I had such a sour encounter with a patient.  It didn’t take much thought to conclude that I would have been much wiser to administer the psychotherapy required: make up name for the baby’s illness—something like “multiple idiopathic hickyosis” would have done the trick—and I should have written a prescription for some innocuous something.  As I lay there, a great medical truth dawned on me: there are two grand imperatives in the initial interaction with every patient: NAME the condition! and DO something! Anything.  Physical examinations, careful questioning, considered judgment, and reassurance don’t count—injections, lab tests, X-rays, and prescriptions are much better.

Epilogue: Worried that she would make trouble, later in the day I called the pediatrician to alert him.  He didn’t return my call for a few days, but when we talked, he told me that he’d seen the baby and she was fine.  With a chuckle he told me I’d done exactly the right thing medically, but I had some things to learn.