Textbook Cases and Caring for Family Members

You know why they call it a textbook case?  Because it follows the textbook exactly.  It’s a classic, perfect example.  There is no deviation.  It’s a no brainer.  If you can read the textbook, you can diagnose the problem and suggest treatment as well as a doctor. 

And how often do those textbook cases occur?  Not often, I’d venture.  It’s also why society refers to physicians as those who practice medicine.  There are so many variables that come into play and affect the ability to diagnose a problem.  The most common and serious is that too many doctors wish to pigeonhole their patients into a neat little disease diagnosis.  They expect them to align with the textbook. 

It just doesn’t work that way in the real world.  Not in my world, anyway.

Cases in point.

About 28 years ago, I experienced a miscarriage.  Bleeding had stopped a few weeks earlier, but then it started again.  Heavily.  Bright red.  And I was passing large clots.  My doctor was out of town.  The on-call guy refused to see me because I couldn’t possibly be passing clots; otherwise, I “never would have stopped bleeding.”  (Do they really think we make this stuff up just to annoy them?)  After another day or so I finally got another doctor to take pity on me.  He got me into the hospital for an emergency D&C that evening.  Some women do retain tissue after a miscarriage.  Untreated, it can cause fatal hemorrhage or infection.

When Queen of the Picky Eaters was seven years old, she came down with what we thought was a cold.  Then she developed a cough that sounded like a seal-like bark.  It seemed like croup to me, but according to my memory, it was something that affected infants and toddlers.  Still, she didn’t seem to be doing very well and said she was starting to have a hard time breathing.  Aaron took her in to the urgent care.  It was indeed croup.  However, nothing about this case was normal.  Croup normally occurs in late fall and winter.  This was the middle of summer.  Croup normally afflicts children six months to three years in age.  QOTPE was nearly eight years old.  And it’s more common in boys, which QOTPE obviously wasn’t.  The cough itself was the key.  We can’t get hung up on what is normal.  We have to focus on what is actually happening.

A couple of months ago, my daughter-in-law Buttercup had been playing on the floor with eight-month-old Sweet Pea and gently pulling her to a stand.  Then Buttercup heard a loud “pop” and Sweet Pea started wailing.  It had been about 15 minutes and Sweet Pea was refusing to use her arm.  Buttercup was starting to freak out.  I told her that we could pop it back into place (even though I was pretty sure she’d want to go to urgent care).    I also told her what the doctor would do and that Sweet Pea would cry briefly, but then all would be well.  The doctor there “wasn’t quite sure” it was nursemaid’s elbow, because Sweet Pea wasn’t holding her arm in the typical way.  Because she didn’t exhibit a common sign and didn’t fit the traditional cohort (much younger than average), the doctor wasn’t sure.  The X-ray didn’t reveal any fracture, so he finally decided to treat it as nursemaid’s elbow, and it was.

Several years ago we were visiting with a friend whose then 13-year-old son with Down’s syndrome was not feeling well. She wasn’t sure what was wrong, but she mentioned extreme thirst, frequent bathroom trips, and weight loss.  I commented that it sounded a lot like what happened to my husband, just before he was diagnosed with type-1 diabetes.  And I added that before it all started, he had experienced a bout of influenza.  Horror displayed on her face, she said her son had had the flu a couple of weeks earlier.  The next day she got her son into the doctor, who pretty much dismissed the symptoms as lingering effects of the flu.  Only when she mentioned our conversation did the doctor have his blood checked.  Blood sugars were through the roof.  The boy was diabetic. She credits us for saving her son's life.

A good friend of ours in pretty good physical condition suddenly started experiencing pretty uncomfortable back pain.  He couldn’t relieve it no matter how he moved.  He called his son over to massage his back, but nothing worked.  After several hours, he finally went into urgent care, where he was diagnosed as having a heart attack and got a quick trip in the ambulance to the hospital.  He did not exhibit any other symptoms besides the back pain. 

None of the above were textbook cases.  The point is, a lot of what we will see may not be textbook cases.  Not everything will line up.  We are going to have to research and make best guess.  It’s what licensed physicians do as well.  If we have studied and stored up some knowledge, it may help us puzzle out more difficult cases a little more quickly.  We can’t get hung up on the symptoms not fitting perfectly.  The patient could have something else going on at the same time.  Sometimes we just have to make our best guesses.  Doctors do it all the time.

 

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