TSK: I have the utmost respect for your idiocy.
Ok, parents of the 3-month-old girl with a high fever and diarrhea – let me get this straight:
- You all just returned from 3 weeks visiting family in Mexico.
- While in Mexico, little Ayeli had “a cough and runny nose, no fever” and you took her to a doctor who gave her a shot of penicillin (yay, modern Mexican medicine!) plus 3 days of oral penicillin. She “got all better in 3 days” (wow, big surprise, a cold getting better in less than a week!).
- Now she’s had “black watery diarrhea” for 3 days, and a fever since last night (although, of course, you have no idea what temperature it was because you don’t own a thermometer). Here in my clinic, her temp is 101.5 degrees.
- Her flu and strep tests are negative here, her chest x-ray looks fine to me, her ears are fine, her lungs sound fine, her throat looks fine, there’s no rash.
Ok, all that being said: you absolutely refuse to let me get a catheterized urine specimen to check for a bladder infection. “Is that really necessary?” you ask. “The doctor in Mexico didn’t do that!” you exclaim. “We don’t want to cause her any pain!” you wail. “Would you do that to your own child?” you challenge. (To which I answered, “Yes, in this situation at this age, yes, I would.”)
Oops, you’re absolutely right! I was just gonna have my nurse stick a tube up your child’s urethra for the pure giggles of it!! You caught me – I’m a sadist! And obviously that doctor in Mexico is the world’s expert on diagnosing Fever of Unknown Origin, since he pre-emptively put her on antibiotics before a fever even BEGAN! I’m certain that the injected penicillin hurt much less than a 30-second catheterization, too! I quiver in the presence of your genius! Here, take this prescription pad and go get her something nice at the pharmacy!!!! It would also be really nice if you’d condescend to doing these stool tests I’m ordering to see if she’s bleeding internally from some yummy enteric pathogen – but if that’s too gross for you or something, don’t fret about it – seriously, who dies from diarrhea nowadays?! Oh and when her fever doesn’t go away by tomorrow, don’t come back to my clinic, because the first thing I’ll do it stick a catheter in your child’s urethra while praying that she doesn’t have a bladder infection headed for her kidneys and All Points West!
I walked out of that exam room and told my nurse: “My new motto is: You can lead a horse to water, but you can’t make it think.” I’m pretty proud of being able to come up with that from within my cloud of blinding rage at that moment.