Читать книгу Who's Killing the Doctors? - Alex Swift - Страница 9

But Dr. Phillips was not just a regular neurologist. Yes, she saw some adult patients, some grownups in their 20s and 30s who had been with her since they were kids. She also did occasional IMEs though reluctantly. Her work with IME’s was more medical-detective style than true ‘medicine,’ healing or helping, and she liked to ‘investigate.’ But she considered herself primarily a child neurologist as her official credentials clearly stated. She had had the long training, degrees, certificates and boards to call herself both a neurologist and a child neurologist, but she much preferred the latter. If she could afford it, to see only children, discharging from her practice young adults as they turned 18 or 20, she would have done so long ago as did her colleagues in academia with her same qualifications at the University Hospital.

In private, solo practice, she was not busy enough to see just kids with neurological disorders, so she kept most patients in her practice as they grew older. She had child neurology colleagues in the West Coast who told her they also had a 30 to 40% of their patients above age 20, but like her they were too in solo practice, not in academia. So with reluctance, she still did some IME’s; and often, by necessity, she saw older relatives of her patients-kids when they ask her to take them too as a patient -please, please, please!- and she occasionally took adults with epilepsy or migraines -or MS, Parkinson’s, Wilson’s and Huntington’s- who might have been dissatisfied with some of the other ‘adult neurologists’ present in the area. She stayed away from Stroke and Alzheimer’s.

The good child neurologist Dr. Phillips, as in her daring frankness for IMEs, was also frank in her report on kids, always sending her written note not only to the referring physician but also to the parents. In those she prepared on difficult kids she was perhaps too honest and realistic–especially on sociopaths, autistics, ADHD, slow and underachievers in school: She’d give blunt and pessimistic prognoses without covering everything with honey and outright lies meant only to please parents and educators. But such honesty also got her in trouble with some parents AND educators.

Just before that long conversation with her colleague Barbara, when they talked about the IME on that woman in the trivial accident, Dr. Phillips had seen in her office a 3 year old autistic boy, super hyper and non verbal who was attending a special ‘E.I.’ (Early Intervention) in an elementary school. His mother had told Dr. Phillips of her frustrations in caring for him and of her doubts in the worthiness of what the school was doing for him. She was seeing no signs of improvement in her child’s behavior or any progress in his eye contact or towards language and communication after having attended the program daily for a good year. She thought the program was just ‘baby sitting’ and frequent confinement with a bear hug by his one-to-one aide or in a small safe space, a cubicle, all by himself without interacting with other toddlers.

Autism had been diagnosed in that child by someone else a year earlier, at age 2, though Dr. Phillips would tell her friend Barbara and other colleagues that she normally picked it up much earlier, generally, often with limited eye contact and no laughter, before 12 months. “His pediatrician had just told the mother to have patience. He had not done much for him either; there is not that much that the best hands can do for autistics either but referred him for ‘E.I.,’ Early Intervention. The public sees often on TV the now famous line ’autism speaks,’ that I see as not just misleading, but often as a sad joke in the moderate-to-severe cases” Nora said.

“Most of these,” she went on, “end up in a group home of some sort. In this case, his mom brought the boy to the doctors’ on a leash. After many visits in which she expressed her frustration -while one of the nurses in the office constantly confined the toddler- the pediatrician finally, when the boy had turned two, had told mom that he thought her boy was autistic. At least mom had now a diagnosis. The doctor just referred him then to the local school for E.I. Mom was initially happy and she appreciated the special, small bus-with-an-attendant and the free baby sitting.

“Every so often mom would show up in school to watch her child in the E.I. room, often spending a good couple of hours standing there without interfering. But she saw no ‘teaching’ or warm interaction with the boy by anybody, or anything that she was not doing at home. She voiced that she was thinking of pulling him out of the program. I did not see anything wrong with that and even mentioned it in my report.

“But when the primary care doc (the pediatrician who had referred the kid to me) read my report, he was annoyed, really ticked off and called me on the phone to tell me his disagreement about pulling him out of the early intervention program. We argued on the phone back and forth, myself defending my pessimistic opinion and told him about my long negative experience with similar, very delayed kids. The primary doc told me that THAT was dangerous, got very rude with me, and swore that ‘he would report me’ (to OPC, of course) and even hung up on me! I eventually found out that he indeed did… and so did the Director of the ‘E.I.’ program in the school that the boy was attending when she got from the pediatrician a copy of my report. Just another complaint against me that the disciplinarians at OPC won’t dismiss, especially when the complaint is coming from another doctor, a doc snitching on a colleague…”

In the meantime mom apparently had hooked up with some sort of agency, institute or clinic for special intervention in autistics, far away from Buffering by several hours of driving, but they had done much advertising and claimed very promising results. They had received her and son with the royal carpet treatment -for a high price not covered by their insurance- and mom was started on a massive program of exercises, ‘stimulations’ and sounds, very demanding. The father in the meantime could not take it and left his family, mom, son and a daughter alone, Dr. Phillips heard. Mom then enrolled a long list of neighboring to help her with the ‘stimulation.’

The doctor did not think much of such program, which she had seen fail in others, but the case having already generated against her a complaint with the State Health Department, she did not discourage the mother. Yet much later, she heard, after a couple of years, mom would give up that program too as ‘useless,’ Nora said.

A difficult 3rd or 4th grader she saw gave Dr. Phillips BIG headaches. She had seen in the kid behaviors described by mom as present in some relatives on her side of the family and on the girl’s father’s side… The doctor emphasized the genetic side of such and told mom that she was concerned about the girl’s future as a stable adult and did not think that the school would succeed in the girl catching up to her peers as she was way behind in her learning… The doctor’s report went only to mom but it met with disbelief from the mother who then reported her to the Health Department and so did the GP who had sent her to Dr. Phillips.

That complaint against the poor doctor was the one that had generated for Nora Phillips a ‘First Case of Misconduct’ with the state’s OPC…

And yes, over time other complaints against the child neurologist kept coming, piling up in the dossier the Health Department was holding on her in the waiting, ‘building up her case’ so they could sack her without escape. Not all resulted yet in a major, ’Second Count of Misconduct’ but were a reflection of her tough field, a difficult medical specialty – even if she was not a surgeon or easily sued. Yet she continued to walk a very fine line, confronting frequently difficult assessments.

One of those such cases, about which her friend Dr. Good had even read in the local papers was that of a 5 year old boy with hard to control, constant, brief quivering seizures. No medications had worked to eliminate them and he had already been seen by other specialists. Dr. Phillips saw in him a really normal boy in his alertness and playfulness, even if every so often he had ‘body quivers’ that would last a few seconds but affected his balance, enough to make him stumble a few times a day. He would be ’back to normal’ and giggling within seconds and never got hurt in the quiver or fall.

“Give him time,” Dr. Phillips had reassured his parents. “No meds have helped,“ but he will outgrow this in the next few years, even if it all looks awful and unbearable right now. Plus there are three or four new medications in the pipeline about to appear in the market in the next two years, like Felbatol, Topamax, Lamictal and Gabitril.”

But his parents could not take it even if Dr. Phillips insisted that in spite of so many ‘spells’ their son was in between totally normal. The boy often even apologized after a quiver and he would resume with Dr. Phillips the gentle ball game she had with him right in her office. Indeed he was actually good at tossing and catching the ball with a wonderful, sociable personality. She felt that those spells were not affecting his growth or neurological and mental development appreciably in any negative way.

But his parents did not appreciate being told that their son was ‘just about very normal’ and that all they could do was to ‘wait and see.’ So they took him to a famous child neurologist, out of state hours away… This guy, known nationwide had recommended to take his right side of the brain out immediately. He had diagnosed him -without a biopsy- with a horrible disorder caused by a form of encephalitis, ‘Rasmussen Encephalitis,’ affecting only one side of the brain, “that eventually may extend to the other side,” Nora explained to her friend Barbara.

The only way to eradicate it and stop his constant spells, he told his parents apparently, is to take out that whole right side of his brain. This may seem too radical of a measure, like giving him a bad stroke, but a child’s brain has a lot of ‘plasticity’ and is capable of compensating better than the brain of an adult. The initial troubles he may have with the left side of his body will improve and eventually will be very mild, plus his seizures will be gone. Radical and very aggressive, they would have to think about his proposal and then take a big swallow… and he encouraged them to go for it!

They, besides surprised by such assertiveness and the unexpected, proposed surgical approach, were pretty soon in favor of such, but liking also Dr. Nora Phillips’ personal warmth and reassurances, went back to her and see what she had to say about that famous guy’s recommendation. They did see her… but held their breath in surprise when she disagreed with the more famous neurologist from far away, in spite of the constant electrical seizure discharges displayed in his Electroencephalogram (EEG), but only on the right side of his brain, test very similar in both labs.

“I disagree with his diagnosis, and I have also seen both EEGs. I don’t think this is Rasmussen’s Encephalitis. I also feel that his proposed surgery is outrageous and that it will sort of kill your boy’s wonderful and playful character, his amazing vitality. I believe after the surgery he won’t be walking or talking and that he will not recover enough for anybody to say that ‘he has recovered.’ Remember that his right brain still works -in between spells- as well as his left side, but after the surgery he will no longer have that whole right half.”

As soon as they got home, another county in the state, they contacted their pediatrician, many neighbors, the local church and the local press, all encouraging them to go ahead with the drastic surgery. And the ensuing article in the press trashed Dr. Phillips – as not supportive. Her was the only voice of dissent. The local pediatrician also crucified her… She was outnumbered! It turns out that the pediatrician, yet another, also reported her to OPC “for being incompetent and dangerous”…

And yes, the boy did have the surgery that everybody anticipated as his savior…

And his surgery went well…

Or did it?…

…Never mind that when his parents brought him for one more visit to see Dr. Phillips a year later, that he was not falling with frequent quivers, but was in a wheel chair, and… well… not walking or talking or smiling and giggling -as she had predicted- or playing ball with her any more. She felt a knot in her throat and in her heart…

“Those butchers at that Children’s Health have really killed him,” she shared with her friend Barbara. “On top of that, I’ve become the fall guy, literally trashed, and I keep quiet without saying a word in my defense, and I have one more complaint against me with the state wolves”…

Barbara moved the conversation then to suggest, as per her husband the judge, that Nora leaves the state ASAP to avoid OPC inspecting her office and sacking her.