Tuesday, March 30, 2010

Jennifer Frank, MD: An "oops" of epic proportions

An acquaintance recently reminded me of a painful episode in my parenting history. “I was telling someone about you yesterday,” she started. “My friend was giving me grief for not bringing our daughter to the doctor right away when she had a wrist fracture. I told them that you missed your son’s clavicular fracture and you’re a doctor.” Ouch.

Two summers ago, our oldest son was playing with a friend while we were attending a minor league baseball game. His friend swung him around and let go. Our son landed on his outstretched arm and started crying.

My husband brought him back to where I was sitting with our daughters. He seemed like he was in a lot of pain, but it was hard to tell if he had fractured something. I palpated along his humerus, rotated his hand back and forth, looked for swelling. He could move his arm but said his shoulder hurt. It wasn’t dislocated and I couldn’t find anything specifically wrong. So, we comforted him with cotton candy, stayed for another 30 minutes to watch the end-of-game fireworks and headed home.
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Our son alternately appeared totally fine and then would start crying and complaining about his arm hurting. On the drive home, my husband and I debated the necessity of a trip to the ER. I did a more careful exam in our kitchen once we arrived home. He was guarding his arm a bit but told us that it felt better. It was late and we were all tired. I imagined how we would be triaged on a busy Saturday night in the ER and pictured waiting with a sleepy, cranky kid for hours. We gave him some ibuprofen and put him to bed, planning to take him in the next morning if it was still hurting him.

By the next morning, he seemed better. He was playing happily in his room. Every once in awhile he would complain of his arm hurting, but as he tends to be overly dramatic at times, we weren’t sure how much he was actually bothered by his arm. I would spy on him as he played Legos to see if he was using that arm or not. He seemed to hold it close to his side but would use it if needed. I still wasn’t sure. We decided to keep observing him.

By Tuesday morning when he was still complaining of arm pain, we took him to his family doctor. Unfortunately, he had suffered a clavicular fracture. Fortunately, he had self treated it by holding it flexed and close to his body. He was fitted with a cool-looking arm sling that offered a little bit more protection until the bone healed itself.

Of course, my husband and I both felt terrible, and still do, that we – two physicians – missed this in our own child. However, it helps me to comfort my patients’ parents when they too miss something and serves as a good reminder why I don’t doctor my own kids.

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