It was my day to see ‘acutes’ - patients who call with issues that need to be seen that day. A day to be prepared for anything. Acute days are an unpredictable mix of straightforward minor illnesses, more complex flares of chronic illnesses, unusual presentations of common problems, and challenging undifferentiated complaints. Our triage process is pretty good and our triage staff excellent, but acutes are hard to assign a slot, and the acute provider is seeing many patients usually seen and better known to her partners, so the acute provider is always stressed. And relieved when the day ends.
The day had been busier than usual from the moment I arrived at 6:45 am, and I was doubting I would get done in time (or have enough energy) to go for a planned after dinner solstice kayak with my wife and some friends. Then magic happened: a single late afternoon appointment recharged me and made my day.
She presented with a rash that blistered and itched. After taking her history and doing a focused exam, we discussed her symptoms, the probable diagnosis, and the treatment options. She was mildly distressed by the diagnosis of a curable but slowly resolving problem, but seemed reassured by the plan. As I finished printing her prescription and a summary of the plan, I asked one of my standard closing questions: “Is there anything else we should talk about?” With no hesitation, she said she had something to ask me. My heart sank, fearing a complex issue too important to defer that would make me late for my planned evening.
She asked if I used to coach youth soccer. Nonplussed, I confessed that my wife and I had coached together for a number of years, but not for almost 20 years. She asked if I remembered a 9 year old with a badly broken leg. I remembered it immediately and quite vividly. Our team had just arrived at the high school field and was warming up on the sideline awaiting the conclusion of the game preceding ours. My wife and I were busy in an open space behind one goal with our pre-game ritual: making sure our crew of sixteen 9 year olds were all there, had the correct jerseys on, had shin guards and tied shoelaces, and were warming up.
As I supervised our kids and watched the last minutes of the game out of the corner of my eye, a young player was tackled vigorously in mid shin and went down hard near the top of the penalty area. By the time I got there, several adults including his coach were trying to coax him into trying to stand up. He was ashen pale and crying quietly, and there was a 20 degree bend in his mid shin with bone obviously distending the skin. I sent the coach off to call an ambulance, sent the other adults off to find his parents, and waved to my wife to bring our kit with its ice packs. I asked who he was and introduced myself, and told him I was a doctor, that I knew his leg hurt, but that all he had to do was relax, that we would take care of him, and that everything was going to be ok. He asked what was wrong with his leg and I told him it was broken, and that they would take a neat x-ray picture of the bones at the hospital and he could probably get a copy if he wanted. He asked if he would still be able to play soccer and I told him he would probably have to wait until next season. Shortly, a grandparent arrived (his parents weren’t at the game) and the ambulance arrived, he was splinted and went off to the ED. She told me that Barton was her son, that his leg had healed fine, that he had never forgotten how calm I was or how I made everything seem ok, and that he had pursued a medical career (pharmacy) because of what had happened that day.
Knowing that his leg injury had healed well was nice, but knowing that I had made a difference was special. Thinking about it while kayaking that night, I was struck by the fact that what I saw as pretty mundane, some standard first aid in the field, he saw as a memorable and inspiring intervention that had a lasting impact.