Thursday, November 4, 2010

Miller Emotions at it again...

I need to start off by saying the Miller emotion gene is hyperactive. If you have ever been around my family you will know that it is not uncommon for us to blubber through a hallmark hall of fame TV special, or cheer during the Olympics trying to not let the person sitting next to you notice the tears in the corners of your eyes, or become verklempt listening to Christmas music. I've done so much better and have gained much better control of my emotions than in years past. I rarely cry anymore, and I thought I had suppressed this Millerism. The other day it got the better of me and caused quite a scene.

I was on call and had been at work for 16 hours and had 14 hours still to survive. I was already tired and when I'm tired my emotions are harder to control. I was called to evaluate a 7-year-old who had just been sent to the hospital by her family doctor to be evaluted by a Heme/Onc doctor. I was to go obtain the child's story, do a physical exam and begin the admission orders for the doctor to come review. I walked into the room to find the cutest little family sitting together on the bed. They all had matching blue eyes and blond hair. The oldest daughter sat on her Mom's lap and looked ghastly pale. The apprehension in the room was palpable and I tried my hardest to establish good rapport and to build their confidence in me. I asked the patient about school, her favorite things to do and her friends. I talked to her and her little sister about their Halloween costumes. Then I started asking about her symptoms and how she ended up in the Heme/Onc ward late at night. The symptoms had been present for several months and were all very non-specific: persistent cough not relieved with albuterol and singulair, increasingly tired, strange skin discoloration on the chest and neck, cervical lymphadenopathy. In short the Mom told me she "just wasn't the same".

I was thinking of possible reasons this girl could be here and why her family doctor would want an Oncologist to evaluate her. I thought of ALL (acute lymphoblastic leukemia) which is the most common childhood cancer. I started thinking of some of the complaints associated with this disorder (all of which she had already described). I asked about fever and bruising and other things. I then asked about bone pain and Mom's hand flew to her mouth and she said, "Oh my gosh!! Yes! I had totally forgotten about that. She was complaining about hip pain and leg pain". The Mom started tearing up and she started to lose the composure she had maintained up to this point. And guess who else started tearing up and developing a shaky voice and had to pause in order to continue?!? ME!! My emotions swept over me and I nearly started crying along with this mom who was trying so hard to hold it all together. When I started the exam she had to get up and go into the bathroom to compose herself. When I finished, the attending was outside waiting for me and we talked a great deal about ALL and how this very well could be cancer. We ordered a number of different labs and had to wait until morning to find out what was going on.

I left this family thinking for sure their daughter was going to die. Can you even imagine your Doctor crying when you explain the symptoms you have been having. Hello Kent?!? Can you even imagine how scared and how little hope this family had after I left the room. I tried my best to help them not imagine the worst and to explain some of the other possibilities. The attending talked to them about some of the other possibilities. I'm sure it was the stupid med student crying that stuck in their minds that night - not anything we tried to comfort them with later. So did she end up with ALL and a chemotherapy protocol put into place? No! She had Iron deficiency anemia. She was started on iron and had a nutrition consult. simple. easy. case closed. I was pulled in so many different directions the next morning I didn't get a chance to see her before her doctor discharged her. I'm sure they still think I think she has cancer. Grrr... Miller emotions are not going to be the best thing to have as a doctor.


  1. The Miller emotions are not fair. I started to cry reading the first paragraph. LAME! I but they didn't think anything of it. I bet you thought it was worse then what it was. :)

    Just today we have someone in our deptment leaving, as I was saying bye I started to cry- Hello it's not like we were best friends- just the whole thing was sad. I am for sure going to be like grandma taylor and have tissued shoved up my sleeve. Just for things like that.

  2. Ya know - Dr. Barry (the resident doctor we loved that saved Marissa) - teared up on one occasion. AND I WILL NEVER FORGET THAT MOMENT! He bonded with us right then - in a way that helped me feel like -- even when the diagnosis can be at it's worst -- people don't just give up. He cared. It showed. Mostly through his expertise and actions ... but, that one moment spoke volumes to me too.

    You are amazing, Kent. I'm so glad that the little will be okay. And I'm sure the family will remember a doctor that CARED ... Dr. Kent!

  3. You are spot on Michelle. It is an amazing thing to see a professional who genuinely cares. That is what these people will remember. Thank goodness it wasn't worst case senerio, but if it had been, they would have been grateful for that moment.

  4. I remember one night, probably sitting in the room next to the one you were in, talking about horses and dogs with a little girl with ALL who had come in with fever and I also felt those emotions trying to gush out. I often find myself swallowing that big lump and trying to hide the welling water in the corners of my eyes...

    I'm sure it's the same for you, but that's one of the main reasons I chose peds, because I care enough about these kids that I get choked up about it. I've decided that as long as I'm not sobbing and incoherent, it's probably okay to let the emotions show.