A case that illustrates the way medicine is meant to be

As most everyone knows, medicine is not an exact science. Every patient and every family must be treated individually. We all recognize that many things have the possibility of not going perfectly, especially when an ill child presents to the hospital. I am lucky enough to be a part of many families’ experiences at the hospital that go so well that you want to tell people about them.

Goodness knows, there are enough television ads and billboards pointing out when things do not go perfectly well. I recently had the privilege of being part of a great story that went just as we hope every single case would go. I suppose this example illustrates the way medicine was meant to be.

A one-month-old baby was brought to the emergency room with a fever and a swollen thigh. The emergency room physician and staff very quickly recognized how potentially sick this child was, and immediately performed a series of tests we call a “septic” work-up. This includes blood work, urine tests and a spinal tap. The child also had an ultrasound of the swollen area.  Attempts were made to drain and culture the leg for a possible bacterial infection.  The child was rapidly given antibiotics and was admitted to the hospital. Despite the rapid introduction of antibiotics, it was clear that the baby was not getting better and in fact the child was heading into something called septic shock. This was quickly recognized, and the child then received intravenous fluids and more antibiotics. Then an emergent MRI was done on the leg and consultations from multiple pediatric subspecialists were obtained. These specialists included an infectious disease doctor, pediatric surgery, pediatric orthopedics, pediatric anesthesia and critical care.

Despite our best efforts up until this point, it became clear the child was going to require surgery along with more pediatric medicine heroics. The child was moved to the pediatric intensive care unit (PICU), had the leg operated on and was placed on very serious life support measures. Happily, the child did extremely well and was sent home after spending about a week in the hospital.

This experience has impacted me in a couple of ways. The story of a child with septic shock does not always end well, despite everyone’s best efforts. I believe this child did so well because of the amazing group of dedicated physicians and nurses. This little one required care in the emergency room, the pediatric ward, the radiology suite, PICU, surgery suite, back to the PICU, back to the pediatric ward and finally home. It took an incredible amount of communication, coordination and cooperation among all of these areas within the hospital. It also required a unique capability to recognize very quickly the potentially life-threatening situation this child was facing.

The level of expertise and skill sets of literally dozens of people saved this boy’s life. If this child would have been in a more rural setting or at a hospital that does not care for very sick children, I do not believe he would be alive. I am so personally proud of all my colleagues and our nursing staff who collectively and with outstanding care and passion did exactly what we are meant and expected to do. God bless that sweet little boy.

Ira M. Pinnelas is a pediatric hospitalist, Arnold Palmer Hospital for Children, Orlando, FL. He blogs at Illuminate.

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