poured out before bed
“My ee-yor hoits!”
The statement is more of an accusation than a part of the history of the present illness. The four year old sits across the exam room from me, his legs dangling from the adult-sized chair, both hands over his right ear, regarding me with such animosity I begin to dislike myself. I mean, who am I to be bothering him so?
His mother continues to fiddle with her iPhone, texting, reading, completely disinterested in the whole affair. She has barely looked up during the interview, didn’t even make eye contact when I entered and shook her hand. I had to repeat my questions about fever, the presence of URI symptoms, about her son’s meds and past medical history multiple times so engaged was she in her internet and connection machinations. A simple history that should have taken less than 5 minutes to gather has taken nearly 20 thanks to her complete indifference.
“OK, so this is what I’m hearing. Jonny started with cough and a runny nose four days ago, at which time his temperature was 100.1F. Tylenol resolved the fever, and his upper respiratory symptoms decreased, but yesterday he began to complain of right ear pain and of a feeling of ‘plugging.’ He has had one ear infection in the past for which he was treated with amoxacillin, and this ear pain feels similar to that episode. Does that sound correct?”
Silence, but for the clicking of fake nails on the iPhone screen.
“Does that sound right, ma’am?”
“Mmm? Oh, yeah sure. Can we have the antibiotic now?”
“I’ll take a good look at Jonny and have a talk with my boss; then we’ll decide on the best treatment.”
“But I’m sure it’s an ear infection.” For the first time she meets my gaze for more than an annoyed second. “And he hates being examined. You shouldn’t have to look at him. We’ve done this before, he just needs the medicine.”
“I understand you’ve seen these symptoms before, but we still have to examine Jonny, just to make sure there isn’t anything else going on.”
“I don’t see why you have to – it’s a waste of time. But go ahead and try. He’ll hate you for it.”
She resumes her web surfing. Jonny refuses to sit on the exam table, so I nab the portable oto/ophthalmoscopes and sit across from him. He stays in his chair, but moans loudly, tries to push me away as I check for cervical lymphadenopathy (none), listen to his heart, lungs, and belly (all normal). He whines and calls me “a big fat meanie”, but opens his eyes and mouth for me to examine (moist, pink membranes, no conjunctival injection, no pharyngeal erythema, 1+tonsils without exudate), tips his head back to let me look into his nose (clear discharge without bogginess or polyps). He is hesitant when I go for the unaffected ear, which is clear, but sits still. When I ask to see the ear that hurts he slaps my hand. Hard.
“It’s the last one, I promise, sweetie. I just need to tickle your ear a little, I promise it won’t hurt.”
“NO.” He throws himself against the wall and covers his head.
“We need to see it to make it better, Jonny. Please, let me look?”
“NO-OOO!” his response echoes in the small exam room.
“Told you he hates it. I don’t see why you have to put him through this. It’s cruel,” comes his ever so accommodating mother’s reply.
“I’m very sorry, but I have to look. It shouldn’t hurt at all. Jonny, can you sit on mom’s lap while I look in that ear?”
“You mean you want me to hold him down like some monster. I won’t do that. It’s not right. I want to see the real doctor now.”
I find Dr. Jones and explain the situation with an apology and a sigh. The blood rushes to his face as he shakes his head and follows me to the room.
“Hello ma’am, I’m Dr. Jones. What seems to be the trouble?”
Mom looks up from her iPhone. “Jonny has an ear infection and this girl wants to torture him.”
“How is she torturing him?”
“By looking in his bad ear. We know it’s an infection, he shouldn’t have to go through that. You should listen to your patients – they’ll tell you what’s wrong!”
“I know it’s unpleasant, but we actually do have to examine him. We don’t know what type of infection he may have, or even if it is an infection. We need to know to give him the right treatment.”
“Yeah, but he’s had this before.”
“I understand that, but we do have to look.”
“This is stupid.”
“We want to help, but we need to look in his ear to give the correct help. Can we look in his ear, please?”
“Fine, but I won’t be a party to it.”
Jonny immediately starts screaming and runs to the door. Dr. Jones picks him up, wraps his arms about him, Jonny’s head held firmly against his chest, sore ear out, and sits on the exam table. I move in quickly and peer into Jonny’s ear, my own ear drums sore from the caterwauling Jonny has taken to make.
The canal is…blue.
Jonny manages to move his head and I pull back until Dr. Jones has control, then look again.
Yep, it’s blue, alright. I change the otoscope focus to get a better look.
“What do you see?” Dr. Jones asks. “Did you get a good look?”
“Foreign body,” I murmur, catching his eye, then step back.
“Ma’am.” I address his now codfish-faced mother. “Your son does not have an ear infection. He has a Barbie shoe in his ear. A blue Barbie shoe.”
Of course, she refuses to believe it until we extract and hand her said blue shoe. We prescribe prophylactic antibiotic drops and prepare to politely send her on her disinterested, disbelieving way.
She sniffs disdainfully as she bustles junior from the exam room, declaring with all the snideness to which she is not entitled, “I just HATE it when no one pays attention to me….It’s bad business not to listen to people.”
I can do naught but agree.