Besides keeping my practice youthful, the children I cared for kept me young as well. I hope you will enjoy a few stories about these “Little Ones” (Part 4) that are excerpted from my book, The Best Medicine: Tales of Humor and Hope from a Small-Town Doctor.
Myra was a young child with a chronic cough. During the process of trying to figure out what was going on, and after several failed treatments, the mother became increasingly impatient — often threatening to take the child to a specialist.
“I’d be more than happy to arrange a consult,” I said, “any time you want. But they are going to want to run some basic tests. Let’s do those here. It will be faster and cheaper. And if we find out what this is, we’re good.”
To my relief, we discovered the cause: cough-variant asthma — a type of asthma in which the child’s main symptom is a dry, nonproductive cough. When the child’s tiny bronchioles constrict, instead of causing wheezing, which is usually the case with asthma, they lead to a cough. I suggested starting the child on a bronchodilator that was delivered through a small handheld container.
The mother was skeptical but agreed to give it a try before heading out to see another doctor. I offered to have Judy, our nurse, give the mother instructions on how to use it with a spacing device. The inhaler is pumped once, releasing the vaporized medication into the spacer. Then the child can slowly inhale the mist deep into the lungs.
However, the mother’s retort was something like, “Do I look like I was born yesterday? Of course, I know how to use the sprayer!”
I handed her the prescription and recommended a follow-up visit to retest the child’s lungs in a couple of weeks.
At the follow- up, the mother appeared irritated. “We need to see a specialist!”
“Give me an update. What’s going on?”
“You said you’d fix my child’s cough, but you didn’t. She’s no better. The medication made no difference at all.”
“Well, sometimes we have to try one or two inhalers to find just the right one. But first, how often did you use the inhaler?”
“Every four hours while she is awake. Just as the instructions on the spray container said. We went through the first one in a week and got it refilled.”
I never had anyone call an inhaler a spray container, I thought. And with at least sixty sprays per canister, she must have been using eight to nine squirts per day. “Could you be using it incorrectly?” I asked, almost immediately wishing I had not phrased it that way. The mother sat up straight and became visibly upset.
“Do you think I’m an imbecile?” she exclaimed.
“No! Not at all,” was all I could say. “Maybe it’s the inhaler. Can you show me how you give it to her?
The mother looked irritated, jerked around, pulled her purse off the floor, grabbed the inhaler out of it, glared at me as she gave it several shakes, yanked off the cover, and turned to her daughter. “Let’s show the doctor we’re not idiots, sweetheart,” she growled. “Lift your chin.”
The daughter dutifully looked up at the ceiling and unbuttoned her blouse, as the mother sprayed one spray on each side of her neck, and another on each side of her chest, as one might do with a perfume atomizer. I tried not to laugh and kept a serious face. The little girl coughed, and the mother glowered. “See, it actually makes her worse.”
“Maybe we could try a little different approach. Could I show you something?”
The mother looked suspicious but nodded.
I stepped out of the room for two reasons. The first was to have a good chuckle. Big Mrs-know-it-all really didn’t! After composing myself, I retrieved a sample spacing device. Back in the room, I took the inhaler, attached it to the device, and actuated the spray into it, which created a little cloud of aerosolized medication.
“Now,” I told the girl, “after you breathe out, put your lips on the mouthpiece here, and slowly breathe in the spray.”
The mother’s eyes widened as she gasped, “Oh, no! You mean the medicine is supposed to go in the lungs and not on the skin!”
She began to laugh hysterically. Between snorts, she blurted out, “No wonder it didn’t work! I feel like an idiot!! Carpe duh!!!”
Used correctly, the medication worked perfectly!
THESE STORIES ARE EXCERPTED, with the permission of Baker Publishing Group from/Revell, from my book, The Best Gift: Tales of a Small-Town Doctor Learning Life’s Greatest Lessons. You can learn more about the book or order a copy here.
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