Shortly after 3:00 I was listening to Chloe’s precise clinical description: her daughter, Mysti, had been fine and “in her usual state of rambunctious health” despite a runny nose and a low grade temperature of 99.8 to 100.6 that mom had not felt warranted treatment because she was eating and drinking and playing normally, and sleeping despite a very mild cough when she lay down.
That morning she had noticed a change. Mysti stopped playing, became fussy, and wanted to be held. Her cough was now “chesty and junky” and increasingly disruptive. She had barely touched her lunch. Her temperature had climbed to 102.8 and came down only to 102 with ibuprofen. Her respiratory rate was about 24 but without retractions or grunting. At that point she had called our office and been worked into the schedule.
I listened to this description of an ill child while I watched her daughter playing happily on the floor of the exam room.
“When did she get her last ibuprofen?” I asked, thinking about the fact that the nurse had recorded a temperature of 98.4, a pulse of 82, and a respiratory rate of 14.
“A little more than 2 hours ago,” was the answer.
“Hmm. You know, she looks pretty good right now. And I haven’t heard her cough since I came in.”
Chloe paused. She looked down at her daughter. She leaned forward and her eyes narrowed. I could see a small tremor pass through her. Then, softly and more to herself than to me:
“Damn. I brought the wrong one.”
She looked over at me, an expression of true panic on her face. “I do know my kids. Really. I don’t understand how I brought the wrong one.”
That was pretty easy to answer. “You’re a mother of four including twins, and you work full time as a nurse. When was the last time anything was easy? Call home and have your husband bring Mysti right in.”
It got more complicated then. Her husband was upset because the “well” twin was now suddenly ill. He had been about to call to request two prescriptions for whatever Mysti needed. It took several more calls, but she and my nurse worked it out that Mom would bring well Amber back home, pick up sick Mysti and grandma, and return to the office. Karl would bring well Amber and the older two kids to grandpa at the grandparents house on his way to work. Chloe would stay here for the visit, and grandma would take sick Mysti back home after the visit, while Chloe went to work.
An hour later I was seeing the real Mysti, who had a temp of 103, a respiratory rate of 22, an oxygen saturation of 99%, a right otitis, and crackles consistent with pneumonia in her lower left lung, which we treated with azithromycin and ibuprofen. Everyone did fine.
Peter Elias is a family physician who blogs at his self-titled site, PeterEliasMD.
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