Читать книгу Who's Killing the Doctors? II - Alex Swift - Страница 11

Dr. Martin was not very popular with the pediatric staff at the University Hospital. It was the days of Dr. Frank O. This guy was known nation-wide for a controversial ‘how-to’ book on ‘what to and not to feed kids.’ His fame soon got him a celebrated high position in the D.C area (only his life to be cut short by a deadly illness; ha!). The young, upstart Dr. Martin had been in private practice for just a couple of years. He was an easy target for scrutiny -and critic- by his fellow colleagues in academia, across the street, especially by the tough Peds boss Frank O. Dr. ‘O’ had a slew of med students, interns and residents, and had underneath a fairly large group of general pediatricians and specialists. He was to many of them a god-like authority.

Dr. Martin had been called to the Irving Hospital ER to see a young brittle diabetic boy who presented from another, 30 miles away hospital ER with ‘a probable stroke,’ unable to move his right side or to talk. He had been fine till he went to bed the night before. By the time Dr. Martin got there the boy, Jack Durham, already had had a CT scan of his brain -which was normal- and had been seen by the upstairs peds resident. The nurses were about to wheel him to the ward when Dr. Martin got to see him. He confirmed the neurological findings and saw no need to add anything to their assessment as the boy’s diabetes did not seem in acidosis -or hypoglycemia-, he was alert, though not talking yet and was beginning to move his right hand. The pediatricians, as the ER attending, blamed the diabetes as the cause of his stroke, which fortunately was rapidly improving.

By late morning little Jack was perfectly well. Dr. Martin was able to snick out of his office during his scheduled lunch break, came to see him and suggested an early discharge since he was fully recovered neurologically, up walking and talking, and his blood sugar was fine. So it was done. The boy went home after 6 hours in-patient.

In the next three months Dr. Martin got to see Jack Durham three more times, each with an identical story. In those times the blood sugar was NOT an issue though the pediatricians still considered his diabetes the culprit. The boy’s case was so unusual that it was formally presented in their departmental weekly Grand Rounds. The possibility that ’the boy may be having unwitnessed seizures in the middle of the night -facilitated by his brittle diabetes- and his stroke-like picture be just a post-ictal phenomenon,’ was ventured by Dr. O., the big guru. Yet ‘his Electroencephalogram (his EEG) has been normal ‘times 3,’ had argued Dr. Martin. But he was willing, as per Dr. O., to give little Jack a try with phenobarbital daily as a preventive of seizures… [medical malpractice Lawyers in a parallel case at later time, would argue against him that he should never have given the patient ‘anticonvulsants’ if he did not think the patient was having real seizures! What an irony!].

But the phenobarbital did not work as little Jack had one more identical episode while on that drug. And so it happened again when he was next tried instead, on Dilantin, and later on Tegretol against Dr. Martin’s own judgment. It was all happening within the span of 10 months. From the beginning, and after his first normal EEG, Dr. Martin was beginning to think that ’this was not due ‘to unwitnessed nocturnal seizures’ but to recurrent ‘hemiplegic migraines,’ a few cases of which he had seen during his fellowship down in the big City. One such hemiplegia, he recalled, quite prominent, he had seen in a young man in his late teens when after a just won race in Central Park, his happy coach had poured a bucket of ice water on his head; he remembered how the young man had immediately ‘stroked out’ – and then Dr. Martin saw him in the nearby ER. He remembers having suggested the diagnosis of benign, hemiplegic migraine ‘that will resolve by itself in about six hours.’ He had been right. His chief neurologist there was impressed with the young Dr. Martin, but was still incredulous about his diagnosis.

By the time Dr. Martin tried Jack on that last drug, Tegretol, he was already planning to try the young boy next on a fairly new drug then Inderal (=propanolol, a beta blocker) that was beginning to be used by neurologists as a preventive for migraines (and not of seizures). So after his last, 8th or 9th episode, when he discharged little Jack from the hospital, fully recovered again and with then-again stable diabetes, he placed him on Inderal (against the opinion of the floor pediatricians0.

His decision to discharge the boy on Inderal shared with the residents in the ward soon reached the Department Chief, the guru Dr. Frank O. What!!!! he had said. Doesn’t that stupid Martin know that Inderal can make his diabetes worse? It is well known that Inderal ‘masks’ the effects of hypoglycemia in diabetes, and thus it is considered dangerous for them!… Dr. O. did bump into Dr. Martin not long after that -casually, by the hospital elevators- and crudely crucified him in front of his entourage for such. Dr. Martin defended himself and told him about the effectiveness of Inderal as a migraine preventive, fact about which Dr. O. was till then ignorant… ‘I am not aware of that,’ he confessed as he left him and disappeared with his group inside the elevator.

And unfortunately for Dr. Martin, ‘his dangerous medicine,’ his daring -wrong-use of Inderal in diabetics, had already been reported by Dr. O’s Staff to the State Health Department, to OPC!, The Wolves…

Several months went by and our young Jack Durham, kept on Inderal by Dr. Martin in spite of the warning by the big pediatric boss Dr. O., had no more ‘episodes’ of stroke-like hemiplegia. He did not have to be admitted again to the hospital for that, or even for his brittle diabetes!… Dr. Martin did share that with the peds residents when he met with them on account of other patients’ admissions. They were impressed… and apparently notified their chairman, Dr. O., of the fact…

Time after that, and again in front of the elevators of the pediatric floor, Dr. O. bumped again into Dr. Martin… this time apologizing to him for his prior criticism of his having made the ‘unusual diagnosis of hemiplegic migraine’ and for having dared to use Inderal in a brittle diabetic! Dr. Martin thanked him as Dr. O. got into his elevator. Yet neither Dr. O nor anyone in his department ever called the Health Department to put now a good word for him, to cancel the previous complaint against him!…

And he, not Full Time Faculty of the Department of Peds in the University Hospital, would always feel from that point on, that somehow he was not a welcome member of the local peds community, especially those in academia, both attendings and residents. A pediatric colleague in private practice like him, told him that.

For many years Dr. Martin would follow that patient Jack Durham all the way into his mid 20s. Several times his own local primary care doctors would try to take him off the Inderal as ‘bad for your diabetes.’ The first time, a year after his last bout of hemiplegic migraine, he did go off the drug for a month but he soon suffered another stroke-like episode one day upon awakening, just like at the beginning. His mother then put him right back on it and after that, she blocked any and all subsequent suggestions of discontinuing the drug in her son. And to Dr. Martin’s knowledge, Jack never had any more problems with hypoglycemia or with recurrent hemiplegia!