A Pink Eye That Changed My Life
There were more cases of Pink Eye in my office this week than the entire winter season altogether. The most difficult job as a pediatrician is to comb through the finer details in a sea of “pink eyes”, to ensure a more serious illness is not lurking beneath.
Below is one such exceptional experience.
It was a cold winter afternoon many years ago when an experienced mother of three called in because her son had pink eye. She asked me to call in antibiotic medication because it was snowing and they had to drive 20 minutes to get to my clinic. I felt guilty saying no, like I was putting this family in danger asking they come in to the clinic for such a ‘simple’ problem; yet I insisted that seeing her son was necessary.
Upon entering the exam room, her son looked paler since I had last seen him. He had been sick on and off a few weeks with fevers and a reduced appetite. His eyes were definitely pink. I listened to his heart and lungs, laid him back, completed a full examination, and then asked him to sit up. He was holding his neck stiff and would not turn it without moving his torso at the same time. His throat was slightly red, and a few swollen lymph nodes were present (common in children with illness), but there was nothing else abnormal on exam to aid my diagnosis.
A neck x-ray was ordered to make sure make sure his throat (trachea) was normal. The radiologist called to report his trachea looked hazy and recommended a CT scan. I agreed. She called a bit later worried and concerned. There was a large abscess in his neck and his airway was the size of a pinhole. She did not want to release him back to my clinic without an ambulance. I called the family and she called for ambulance for transport to the hospital.
I relayed the information to mom, who was amazingly calm, cool, and collected. I explained she should not leave the radiology building; an ambulance was on the way to get her and her son. He was very ill and required transfer to the nearest children’s hospital 45 minutes away. She followed my instructions and arrived at the tertiary care facility an hour later. He had surgery that night for a neck abscess that was 4 x 5 cm in size. Use a ruler as a guide and think about the diameter of a child’s throat; there is little room for error with the small airway of a child.
Afterward, the surgeon informed mom it is unusual to see an abscess of this size as children often do not survive an infection pushing on the windpipe to this degree. The odd shape kept it hidden making diagnosis extremely difficult. He wondered how she determined there was an infection in his neck. She said she thought it was a case of ‘pink eye’, but her doctor refused to call in an antibiotic without examining him first. He commented that decision had saved her son’s life.
This sweet boy is now a tall and lanky teenager; every time I see him I am thankful for the decisions we made that night. To refuse calling in an antibiotic without laying eyes on a child is the “right call” for me as a pediatrician and mother. Some families leave my practice because they feel this rule is an inconvenience. There is NO substitute to evaluating my patients with my OWN eyes and there never will be.
Recently, a dad stopped me at a birthday party my children attended to ask why I would not call in an antibiotic for pink eye without seeing and evaluating his child for this illness. He was offered an appointment and declined. Now you understand why I feel my reasons are valid and can actually save lives.