'Right. Okay, again things start to look good, so again I taper off and terminate, set up an appointment in two months. Three days later, back in the E.R two A.M. Another croup thing. Only this time the mother says the kid did pass out-actually turned blue.
More CPR.'
'Three days after you terminated,' I said, making a note. 'I'ast time it was two.'
'Interesting, huh? Okay, I do an E.R. checkup. The baby's blood pressure is up a bit and she's breathing rapidly. But getting plenty of oxygen in. No wheeze, but I was thinking either acute asthma or some sort of anxiety' 'Panic at being back in the hospital again?'
'That, or just the mother's distress rubbing off on her.'
'Was the mother showing a lot of overt distress?'
'Not really, but you know how it is with mothers and kids-the vibes.
On the other hand, I wasn't ready to rule out something physical. A baby passing out is something to take seriously.'
'Sure,' I said, 'but it could also have been a tantrum gone too far.
Some kids learn young how to hold their breath and pass out.
'I know, but this happened in the middle of the night, Alex, not after some power struggle. So I admit her again, order allergy tests, complete pulmonary functions-no asthma. I also start thinking of rarer stuff: membrane problems, an idiopathic brain thing, an enzyme disorder. They're up on Five for a week, real merry-go-round, consults by every specialty in the house, lots of poking and probing.
Poor little thing's freaking out as soon as the door to her room opens, no one's coming up with a diagnosis, and the whole time she's in, there are no breathing difficulties. Reinforcing my anxiety theory. I discharge them and the next time I see them in the office, I do nothing but try to play with her. But she still won't have anything to do with me. So I gently raise the anxiety issue with mom but she's not buying.'
'How'd she take that?' I said.
'No anger-that's not this lady's style. She just said she couldn't see it, the baby being so young. I told her phobias could occur at any age, but I clearly wasn't getting through. So I backed off, sent them home, gave her some time to think about it. Hoping that as the baby approached one year and the SIDS risk dropped, mom's fears would diminish and the baby would start to relax too.
Four days later they were back in the E. R croup, gasping, mom's in tears, begging for an admit. I put the baby in but ordered no tests.
Nothing even remotely invasive, just observation. And the baby looked perfect-not even a sniffle. At that point I took the mom aside and leaned more heavily on the psychological angle. Still no sale.'
'Did you ever bring up the first child's death?'
She shook her head. 'No. I'thought of it but at the time it just didn't seem right, Alex. Overloading the lady. I figured I had a good feel for her-I was the attending doc when they brought the first child in dead. Handled the whole post-mortem... I carried him to the morgue, Alex.'
She closed her eyes, opened them but focused away from me.
'What hell,' I said.
'Yeah-and it was a chance thing. They were Rita's private patients, but she was out of town and I was on call. I didn't know them from Adam but I got stuck doing the death conference, too. I tried to do some basic counseling, gave them referrals to grief groups, but they weren't interested. When they came back a year and a half later, wanting me to take care of the baby, I was really surprised.'
'Why?'
'I would have predicted they'd associate me with the tragedy, a kill-the-messenger kind of thing. When they didn't, I figured I'd handled them well.'
'I'm sure you did.'
She shrugged.
I said, 'How'd Rita react to your taking over?'
