A career in medicine wears down the hearts and souls of many physicians. My pediatric journey has been filled with countless rewarding moments, but also haunting ones as well. By the third and final year of residency arrived, I was unclear as to whether medicine had been the right choice for me at all. After 11 years of hard work, dedication, and the burden of heavy debt, the destination looked different than I had imagined. While filled with doubt, one of the most important lessons of my career reeled me back for more: the necessity of trusting a mother’s intuition.
When I entered room number 10 in the emergency room, a 6 year old girl was sitting on the bed and her mother was sitting next to the bedside. When I inquired as to her chief complaint, she answered “something is not right about my daughter and I would like you to do a blood test.” It was the final day of 10 12-hour shifts in a row and I could not seem to muster even one more ounce of compassion. “Ok” I replied without giving it much thought. I sighed, completed a cursory history and physical, and though many years have passed since this night, nothing seemed clinically worrisome at the time. In all fairness, my closed minded perspective likely got in the way.
While checking the computer for prior visits, I saw her daughter had a blood count done the previous day. Yesterday, the result had been normal. I was incredulous. The pediatric emergency room was very busy that night. Relaying the story to my attending, he told me to “do another CBC and release her once the result came back normal.” Returning to the room, I let her know a complete blood count (CBC) had been ordered. Relief washed over her face.
Reflecting back years later, I would characterize myself as being abrupt, condescending, and dismissive of this mother and her concerns. I felt justified thinking she could not possibly “know” what I knew as a physician and she was being overprotective. Let me be very clear, this story is absolutely about a night this physician-in-training learned a hard lesson, one which changed the course of my practice of medicine for the better.
Approximately one hour later, the lab called up to the emergency room with results. “It’s leukemia”, said the lab technician. My jaw, and my heart, hit the floor. “Excuse me, will you say that again please?” I asked, still unable to believe this healthy child was sick. “Leukemia”, she repeated. “There must be some mistake. The result of the smear was normal yesterday.” She replied, “No, we missed it yesterday.” Apparently, the laboratory director pulled the smear evaluated the previous day, reviewed it, and found immature cells which are characteristic of early leukemia.
I slowly walked to the exam room wracked with guilt while tears welled up in my eyes and sat down to tell this mother that her beautiful little girl indeed had leukemia. The oncology team planned to admit her that evening and begin the oncologic evaluation and treatment process according to protocol. I felt terrible; not only for the diagnosis, but also for my glib demeanor while interacting with this mother and her child. She sighed and said she was relieved to finally know what was wrong with her daughter. “I am so sorry,” I said. I was sorry for many more things than I could say.
This is one moment I wish could be erased from my memory and done again, though differently. Ideally, I would greet the mother and child with a warm smile, take an extensive history, perform a thorough physical exam, discuss a list of possible diagnoses with mom, and send blood tests accordingly. I would reassure this mother we would properly evaluate her concerns.
The wisdom imparted to me by this mother has been absolutely priceless. She taught me the most vital thing physicians do is to take time and listen to the patient or the person who knows their child best. This unforgettable lesson has stayed with me for the past 18 years. This “little” girl would be 24 years old today and may already have children of her own; she owes a debt of gratitude to her mother for having the tenacity to push a doubting physician to do her job.