My first job as a physician assistant was with a pediatric practice in Maine. I began working in June, so I was well-acclimated by the time winter arrived. I’d gotten to know many of the young patients as well as their caring mothers and fathers by the time snow started flying.
Many of the mothers were experiencing motherhood for the first time, and they were as uncertain about all the pitfalls of raising a child as the child was about being manhandled by a stranger, albeit gently and kindly. My job as a PA had me treating the parent as much as the child, as it turned out. I always allowed time to answer questions asked by the parents in an effort to avoid having them go away confused and uncertain about their child’s situation and their treatment plan.
Since part of my responsibility was to be on call after regular office hours, my cell phone number was made available to all our patients. I could answer the phone in the comfort of my home and often solve the problem right then and there. If I determined that the child needed to be seen, I’d arrange to meet the mother or parent and child in the hospital emergency room, which was a twenty minute drive for me.
The winter in Maine is the time for colds, coughs, ear infections, strep throat and the dreaded croup.Croup affects young children far worse than it affects big children and adults, for the simple reason that small children have smaller, narrower airways than their older siblings and parents. Croup is usually a side effect of a cold. It is inflammation that settles in the throat, and in the case of young children it causes swelling and narrowing of the child’s airway. When it’s bad, the results are noticeable. The child struggles to draw in a breath and expel it,and it’s often accompanied by a crowing sound with each breath. You can imagine the effect it has on a young child’s parents, especially if it’s their firstchild. Panic often sets in.
When my cell phone rang and I answered it to hear a frantic parent, voice raised well above the normal decibel level, begging me to do something to save their child, my first words were, “Take a deep breath and tell me what’s going on.” That, together with my own calm voice, usually brought the panic level down a notch, maybe more. The conversation usually went something like this:
“My little Andy can’t breathe! He’s gasping and making horrible sounds with each breath!”
It sounds bad to the parent, but to me it meant Little Andy was holding his own, though he wasn’t having any fun at the time.
“It sounds like he has a touch of the croup, Mrs. Andy,” I’d begin.
“A touch of the croup! It sounds like he’s dying!”
“He’s going to be all right, Mrs. Andy. Here’s what I want you to do, okay? Go in the bathroom and turn on the shower, and when the water’s warm, have Andy stand under the shower stream and take long, slow breaths. Have him do it for a good ten minutes, and let’s see how he’s doing after that. Call me back when you’re done, and tell me how he is, okay?”
“Okay! Come on, Andy. Doctor Charlie wants you to take a shower!” Then she hung up.
I would stand by the phone and keep track of the time. If Mrs. Andy didn’t call back in ten minutes, I could be pretty sure that the simple treatment had worked. Past ten minutes, I usually got a call back from a much calmer Mrs. Andy saying that Andy was much better, thank you very much. The simple treatment of cool, moist air being breathed in almost always reversed the crowing sound and strained breathing.
Unfortunately for me, it didn’t always work out. One of the main reasons was because Mrs. Andy didn’t give Andy enough time in the shower, her own panic causing her to shorten Little Andy’s shower time and call me back with the news that it hadn’t worked and he wasn’t any better.
At times like those, action always spoke louder than words, although I could predict with 99 percent accuracy that Little Andy was going to be fine. As I said earlier, it’s important to treat the parents as well as the real patients.
“I’ll meet you and Little Andy at the Emergency Room of the hospital, Mrs. Andy. Bundle him up and head on over. It takes me twenty minutes to get there, so if you beat me there, I’ll be right along, okay?”
“Okay, Doctor Charlie. Thank you!”
I’d throw on my coat and hatand pull on my gloves, and drive to the hospital. The car was icy cold, so I’dturn on the heater to take off the chill. I’d drive into the hospital parking lot and park, then walk to the Emergency Room. If Mrs. and Little Andy were there already, I’d eyeball Andy while greeting Mrs. Andy. “How are you feeling, Champ?” I’d ask him.
“I’m feeling good, Doctor Charlie. I think the shower worked,” he’d tell me, no sign of difficulty breathing as hespoke. He was alert and his skin color was normal.
Reassured, I’d turn to checkout Mrs. Andy. She, too, was calm and under control once more, a smile sealing the deal.
I would go through the motions of examining Little Andy to make sure there wasn’t something else going on. I’d look in his ears, look in his mouth and have him say ‘aaah!’, and feel his neck for enlarged lymph nodes. Then I’d listen with my stethoscope to his breathing and his heart. In most cases, it would be a nasty cold that triggered the croup.
When I’d finished, I’dtell Mrs. Andy that he was going to be fine, and maybe prescribe some simple anti-inflammatory medication for him to take.
Then it was Mrs. Andy’s turn.“I don’t understand how he made such a dramatic recovery. He seemed so, so seriously sick to me.”
“You did everything right, Mrs. Andy. His time in the shower may have been a little short, but when youtook him outside into this freezing cold night, the icy air did the rest. It cooled down his irritated throat and helped open his airway.”
“Just like that?”
“Just like that.”
“Thank you so much, Doctor Charlie. You’ve taught me so much tonight.”
“That’s what I’m here for, Mrs. Andy. I hope you and Little Andy have a good night.”
Working with young children taught me the importance of the combination of treatment and education. They go hand in hand.
Charles M. Dupoy has traveled the world, seen Africa as a Peace Corp volunteer, been a saleman and a farmer, and a magazine writer and editor, and an EMT. later he studied for and became a physician assistant which took him from pediatrics to geriatrics, and from Maine to the Santa Fe, New Mexico penitentiary where he worked in the maximum security unit. Retired now, he draws on his lifetime experiences while writing suspense novels. His first published novel, EASY KILL, is the first in the series, featuring his kick ass heroine, E.Z.Kelly. The second in the series is due for release in the Spring.