“He’s had a headache for three days, and it isn’t going away with Tylenol or Motrin,” began the father. He had brought his thirteen-year-old son in to see me because he trusted me. I had been his doctor for years.
“He plays football at school but hasn’t had any bad collisions in practice, and the regular season hasn’t started yet. He hasn’t had any other symptoms like vomiting or vision changes, but he goes to sleep with a headache and wakes up with one, and I did not let him go to practice yesterday. Thank you so much for accepting him as a new patient.”
“I’m honored, sir. Is he on any medications or taking any performance supplements?” I began.
I did a thorough history and physical exam checking everything I could think of. This was not a typical presentation for a boy his age, but I found nothing at all abnormal.
“Let’s get some lab work to check for infection, inflammation, bleeding, thyroid, or other weird and unusual issues,” I began in frustration. “I agree with you that something’s not exactly feeling right here, and I want to see him back in two weeks. I’ll call you tomorrow with the lab results, but I want to see him right away if the headaches get worse or any new symptoms develop. Thank you for bringing him in to me, Jim,” I finished as we all walked down the hall to the lab.
“OK, Doc, thanks.”
The following week my nurse grabbed me when I came in and told me that the young boy we had seen the week before had died. I was stunned. She did not have any other details, so I looked in his hospital records. I knew I would have to call the father soon, but I would wait a day due to the confusion likely going on at his home.
“Doctor Adams, the father of the boy that died yesterday, is on the phone for you,” said our front desk staff who peeked her head into my clinic room. I was with a patient, but this had priority, so I excused myself.
“Doc, this is Jim. I guess you heard about my son?” he began.
“Yes, sir. I am so sorry. I looked at his hospital record yesterday and was shocked. I have never ever heard of a brain aneurysm in a child his age.”
“I know. That is why I’m calling. I know you’re probably beating yourself up over this, and I need you to know that the neurosurgeon told me that he had never seen this in someone so young, either. Please don’t blame yourself.”
I was bewildered for a moment. “Jim, I don’t know what to say. You’re calling me to see if I am OK? I was planning to call you this afternoon to see how you were doing. I just don’t believe this happened when all the tests were so normal,” I muttered with pain in my voice.
We spoke as friends-in-mourning for a bit more, but Jim never came back to see me as a patient. It would be too hard to revisit his loss and grief.
I worried more in the years that followed about headaches, and I ordered more CT scans than were probably medically indicated.
“I have never had a vasectomy fail yet,” I began when counseling my patient. “But one out of 500 vasectomies do fail for various reasons, so your odds are good. I should note, however, that you are my 500th vasectomy.” I used this joke routinely when counseling patients prior to the procedure.
An email much later, from the wife of this same patient, had an address that began with ‘[email protected]’ She was asking me to schedule another vasectomy for her husband. I had done his vasectomy the previous year when they had only five children. It had obviously failed as she had just delivered child number six. The other possibility could be another man in her life, which I did not want to discover, so I pulled his records to see if the six-week sperm count was negative.
“Congratulations on your new daughter. This is a surprise for both of us,” I began over the telephone.
“Yes, it is, but we’re both quite happy. I do think we should look into another vasectomy, however. That is much easier than having my tubes tied.”
“Absolutely. Did your husband ever come in for the sperm count last year after his procedure? I don’t see one in his records.”
“No, he did not. I know that because I asked him to do it about a hundred times.”
“OK. I’ll get him to give me a sample soon, and obviously, that will show active sperm.” I paused for a response. “There are not any other men in your life are there?”
“Doc, seriously? I had five children and a husband to take care of. No time in my life for another man,” she laughed.
“Sorry. It’s just a doctor-question I needed to ask before I get him back on the surgery table,” I finish apologetically. “You know he is my first ever vasectomy failure.”
I have made lots of mistakes over the years. I have given an elderly patient an antibiotic that caused kidney failure, and another patient took my prescribed medicines that resulted in heart failure. I have missed lots of correct diagnoses that should not have been missed. I try to remember the long list of diagnostic guesses that have been proven incorrect because I learn much more from my patients than I do from medical books.
And I try very hard not to make the same mistake twice.
This was Chapter 69 of my new book Swords and Saints A Doctor’s Journey – Enjoy.
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