"Only those who do nothing..."

Medical Advice and Family

“Only those who do nothing make no mistakes.”
-Joseph Conrad

They were a very nice couple. Two very young kids who genuinely loved and cared for each other. Unfortunately life’s reality had overmatched them. He had been drafted into the Navy at age 18. She was his sweetheart; age 16. It made perfect sense for them that they should get married. He would be away for at least two years. They could not bear the thought of being apart from each other for that long. The meager salary offered by the military was more than either one of them saw in six months, let alone one. Medical care would be free. Marriage was a great idea.
As was the subsequent pregnancy. Obstetric care was part of the military’s commitment to them. The Navy would give them one free baby. They were doing OK with his salary; formula was cheaper at the Commissary, and they would not have to worry about paying for immunizations. Having a baby was the thing to do.
Until he got deployed. To the Far East, for a minimum of six months. She was two thousand miles away from home and had no idea of the demands a child placed on a single mom. She tried to move closer to her mom, but to be truthful her parents were busy with jobs of their own and did not have much time to help or any sympathy for her plight. The child, a beautiful little girl who was smarter than both of her parents put together, grew up in a very permissive and unstructured environment, although it was a loving home and she was never neglected.
This is when I met them. He had reenlisted, mostly because he had no better options in his home state. They had been transferred to the Navy base that I served in. I took care of an ear infection first, then a case of diarrhea that mom developed. We found out that we were neighbors. I complained about something wrong with my car; he had a mechanical bent. Soon he was doing all sorts of odd jobs around our apartment, and when we had our first child she was a built-in babysitter.
One day she showed up at the dispensary with the little girl. No appointment: this was an emergency. Of course I agreed to see her right away.
“She won’t let us sleep. She goes to bed whenever she wants. She won’t stay in her room. We haven’t had any intimacy in months.”
I’m wondering who’s the adult in this home. But I say nothing. I nod.
“We’re at our wit’s end.”
I took a look at the child. She’s healthy. Very smart; excellent vocabulary for her age. Very self-confident. She’s obviously in charge.
Buy a lock for her bedroom. Make sure that there’s nothing in there that she can hurt herself with. Lock her inside. Tell her that you trust her to take care of herself in her room. No matter how loud she screams do not unlock the door. After a day or two she’ll give up her screams.
They followed my advice. Two weeks later they came in together.
“The situation is no better.”
Did you buy the lock?
To my regret, they had followed my advice. The child screamed for a half hour, after which she entertained herself by jumping up and down on her bed. She fell and broke her clavicle, after which she screamed for two hours. They ignored her. Exhausted, the little girl fell asleep. The next morning her parents noticed that she could not move her left arm. A visit to the ER ensued. I was lucky that the ER did not turn them, or me, in. But here they were, coming back to me, for more advice. This is how much they thought of me as family.
Then there were the calls from my daughters. When their mother and I separated they often manifested their anxiety by calling me to complain of assorted ailments. Pains in the arms, or chest, or knees.
Put ice on it. Ten minutes. Off five, then ten more minutes.
I knew that they were incapable of maintaining an attention span longer than five minutes. They tired of the ice pack quickly, and of course they would not call me back knowing that they had not followed directions. Their pains faded quickly.
One day I received a call from the youngest.
“I have a sore throat. It hurts to swallow. Should I use ice?”
There was no indication that she needed any urgent attention. I asked my daughter to place ice on the outside of her throat. She developed a fever the next day.
“The ice didn’t work.”
My standing as the infallible doctor took a blow.
Then there was my son’s forearm. He played goalie in the school soccer team (he has never enjoyed running). I forgot what the initial injury was; it doesn’t matter. He complained of pain.
I had tickets to take him to see a tennis match that evening. I felt that maybe he was backing out of his commitment.
We’ll give you some ibuprofen. We’ll stop at Walgreens and get you a splint for the forearm. No need for you to not go to the tennis match.
Which we did. He complained of pain the next day, but I could not see or feel anything wrong. I told him that he could play goalie again.
At school the next day he used his forearm to lift himself up from a sitting position. He heard a crack. His pain intensified.
The school called me. My wife picked him up. When I got home I saw a clearly deformed forearm. An obvious fracture.
It’s broken.
“You told me that there was nothing wrong.”
There is now. You need an X-Ray.
“You sent me out on a broken arm to play goalie?”
You probably had a microfracture yesterday. This is different.
“No it’s not. It’s in the same place. It was broken yesterday. Why should I trust you?”
I had no good answer for him.
Family. There’s a reason that they tell you never to treat your loved ones. Despite this very sensible warning, I see this happen all the time. I have taken care of dozens of doctors, nurses, and their loved ones over the years. In very few instances have the medical professionals butted out completely from the case at hand. As soon as I see a doctor’s mother walk in my office I have learned to get on the phone and find out what this woman’s son or daughter is thinking. Then I have to make my diagnosis work around and with the doctor’s hypothesis. It has worked well over the years.
My children still ask for advice once in a while. I do not offer ice or splints anymore. I try very hard to allow their doctors to prescribe without me butting in.
We’re all pretty healthy.