Over the next few months the bell went off a few times but they were always false positives-the baby was breathing fine. The graphs show some tracings that could be very brief apnea but there are also lots of movement artifacts-the baby thrashing around. I figured maybe she was just restless-those alarms aren't foolproof and put down the first episode to some quirky thing. But I did have the pulmonologists look at her because of her brother's SIDS. Negative. So we decided just to keep a close eye on her during the high-risk period for crib death.'
A year?'
She nodded. 'I played it safe fifteen months. Started with weekly outpatient checkups, tapered off so that by nine months I was willing to let them go till the one-year exam. Two days after the ninemonth checkup they're back at E. R middle-of-the-night respiratory problems-the baby woke up gasping, with a croupy bark. More CPR by mom and they bring her in.'
'Isn't CPR kind of extreme for croup? Did the baby actually pass out?'
'No, she never lost consciousness, just gasped a lot. Mom may have been overreacting, but with her losing the first child, who could blame her? By the time I got to the E.R the baby looked fine, no fever, no distress. No surprise, either. Cool night air can clear up croup. I ran a chest X-ray and bloodwork, all normal. Prescribed decongestants, fluids, and rest and was ready to send them home but the mother asked me to admit her. She was convinced there was something serious going on. I was almost certain there wasn't, but we'd been seeing some scary respiratory things recently, so I admitted her, ordered daily bloodwork. Her counts were normal and after a couple of days of getting stuck, she was going hysterical at the sight of a white coat.
I discharged her, went back to weekly outpatient follow-up, during which the baby would have nothing to do with me.
Minute I walk into the exam room she screams.'
'The fun part of being a doctor,' I said.
She gave a sad smile, glanced over at the food servers. 'They're closing up. Want anything?'
'No thanks.'
'If you don't mind, I haven't had breakfast yet.'
'Sure, go ahead.'
She walked briskly to the metal counters and came back with half a grapefruit on a plate and a cup of coffee. She took a sip of the coffee and grimaced.
'Maybe it needs some steamed milk,' I said.
She wiped her mouth with a napkin. 'Nothing can save this.'
'Least it doesn't cost anything.'
'Says who?'
'What? No more free coffee for the docs?'
'Them days are gone, Alex.'
Another tradition bites the dust,' I said. 'The old budgetary blues?'
'What else? Coffee and tea are forty-nine cents a cup now.
Wonder how many cups it'll take to balance the books.'
She ate some grapefruit. I fiddled with my pen and said, 'I remember how hard you guys fought to get the interns and residents in on the freebie.'
She shook her head. Amazing what seemed important back then.'
'Money problems worse than usual?'
Afraid so.' She frowned, put her spoon down and pushed the grapefruit away. Anyway, back to the case. Where was I?'
'The baby screaming at you.'
