Wednesday, May 6, 2009

The Results Are In

So throughout Adventures in Cardiology, the Matron has hung her diagnostic hat on the following words that fell from the (shockingly young, beautiful and, of course, fashionable) pediatric cardiologist:   "Two to three percent of everyone's heartbeats are irregular.  We only call this irregularity a disorder, disease or problem if the irregularity is as high as 10%.   If Merrick's irregularities are less than 10% of his total beats, we'll just monitor him annually and not worry one bit.  If the number is 10%, we'll have a conversation and discuss how to proceed."

Let's be clear.   Creative License and Reality frequently collide in the Matron's world (offline too) and License wins, every time.  Unreliable narrator!   Get thee to a nunnery!  But really and truly, the whole Cardiological Discourse hung on that 10%.  So the Matron has spent the past 48 hours fixated on that number:  "Please let the beats be less than 10%.   Less than 10%.  Less than 10%."

First thing in the morning, the Matron calls the clinic and points out that she got an initial (unheard, thanks honey) message around 1 on Monday but didn't get a call at all Tuesday --and she is a mama who is WAITING.  She was polite about this, but made note, hoping to impress upon the secretaries that she wanted the Word.

Within two minutes, the cardiologist called her.

First there was a long period of explaining how incredibly busy she had been the day before -- bombarded with the decaying, malfunctioning, pathetic hearts of children---urchins frail enough to require hospitalization.  Unlike your son, who is Just Fine which is why I didn't take time away from the limpid and pale to return your call.  The cardiologist very carefully explained to the Matron that when doctors don't call or leave multiple messages, you get to rest easy.   

Truly.   The Matron is an educated woman with lots of degrees.  Many of her friends are doctors.  A simple "I genuinely didn't have a minute and I'm sorry" would've sufficed, without that fine, fine line of shame.  Indeed, the Screenplay the Matron wrote yesterday when the doctor didn't call reflected that sentiment:  he's fine!  She liked that narrative.  

Duly chastened, the Matron thanked the doctor (because that's what you do) and inquired: "I'm so relieved he's all right!  But what was the exact percentage of irregular heartbeats out of all total?"

Here's where there was a good long pause.  And a breath.  

"I believe the number was 9.9%."

Matron, absorbing how completely arbitrary that .1% feels, in either direction.

Doctor:  "So good news!   His irregularities did subsist when his heart rate went up.    He looks terrific.  Kids outgrow this, sometimes.  So let's see him next year for another monitor.  Ta-ta!"

She couldn't get off the phone quickly enough.  

The Matron went along with the whole deal, pondering second opinion,  until the mail arrived.  The report must have been sent yesterday, along with the missed phone call.

And the official, documented results:   "Holter over 24 hours showed HR range from 61-194/min.  Average HR of 109 min.  10% Unifocal monomorphic PCV's."

That doctor did not want to have an honest, genuine heart to heart with the Matron.  She did not want to say:  "Look, he's at 10%.  But given all the rest--he's not symptomatic, his skin color is good, he's not complaining -- and that children generally outgrow this, let's monitor and not worry.  Should we talk about what to do when you're on the fence and it's a matter of judgment?"

No.  She didn't want to enter that color Gray into the conversatioin - where it belonged.  And that makes the Matron?  


You should put your ear to Merrick's bony chest.    Imagine you're his mama, hearing the beats that go bump  in the night, in a million weird ways, the new musical backdrop to your own heart.  
Don't you think that woman deserves a genuine conversation?


Becky said...

Well, it's a relief. But I sure understand why you're feeling angry and confused. Like, is 10% important or not? Definitely that deserves a conversation.

As it happens, I just finished reading that book How Doctors Think. Definitely a good read, especially for people with kids. It helps you be your own advocate, and your child's advocate, in preventing cognitive shortcuts and misdiagnoses, stuff like that. Lots of interesting case studies.

I am glad that Merrick has been pronounced okay!

thefirecat said...

It's also entirely possible that the report rounded up.

Here's the bottom line: do you trust the peds cardio? Because he's asking you to trust him when he says that your baby's ok.

I used to have a heart murmur when I was little. Now I run marathons. (my cousin also was thought to have one. Turns out it was just that he was so damn skinny that it was an ECHO. An ECHO, of his heart, thumping away in his ribcage. He's so healthy he's a freakin' naval captain. With his own ship. They don't give those away to sick people.)

Bottom line, it sounds like Merrick's fine. And you need to either trust that doctor, or ask to redo the test, or get a second opinion from another doctor.

Michele R said...

I can understand how you feel after these couple of weeks. I am taking this to mean that you should do some research and then tell the doc you are ready for a conversation now that you've had the initial conversation. Not sure if you have an HMO which would tie up your flexibility, but when it comes to docs I never forget that I am their client and that I can fire and I can hire. I also like to make comments on and read this site:
I am glad to hear that it does not look like it is serious.

Suburban Correspondent said...

It can't hurt to get a second opinion. Just for peace of mind...

Heather said...

If this were my child? I'd, at the very least, want him monitored again. He's probably fine, but I'd want a more definitive YES HE'S FINE. But that's me. Hope there was at least a little relief with the news.

Jenn @ Juggling Life said...

I'm with you--pissed.

And you know what, it's BS that you had to wait 2 days to hear the little white lie you did. The message could have been, "Please call us when you have a minute. The results look good and I'll fill you in on the details when we speak."

There's no excuse.

sexy said...
This comment has been removed by a blog administrator.
Inside the Philosophy Factory said...

If you can arrange a second opinion, I'd probably do so.. if only because you'll need to deal with a cardiologist for a while, and this one hasn't exactly earned your trust.

Tammy said...

As someone who's had a loved one (husband) go through heart issues, I think you are completely entitled to a Conversation.

If Merrick wasn't seen at the Mlps Heart Institute, give them a call. We went there for a 2nd opinion and were VERY pleased with the amount of time the cardiologist took with us to understand our situation.

They will probably tell you the same thing--that since Merrick is otherwise non-symptomatic, it's a watch & see if he out grows it thing. But, at least you will have the benefit of a concurring opinion.

~annie said...

Oh, I'd be angry, too. You DO deserve that conversation. With it so borderline line, I'd want a second opinion, too.

Becky Brown said...

Oh, honey. I'd be pissed, too. I am pissed on your behalf.

Good for the saintly doctor for serving those frail kids with the broken hearts. Good for her. But she completely failed you and your kid and about gave you a heart attack in the process. Not acceptable.

Lynda said...


Anonymous said...

Well, it is not the doctor's call whether or not to take that 10% seriously or not - it is YOUR kid. Ask for a second test, or a second opinion.


Amy said...

I hate dealing with medical issues. Sometimes they don't get it-being a parent causes you to worry SO MUCH. My youngest has had many problems requiring many specialists and they so often downplay it. Of course I over-react but that doesn't change anything.

I'm glad he was at 9.9%? My little one had a murmur but he was one of those that grew out of it. At least nobody makes a big deal about it anymore. Did ya know that the more they can hear it the better it is? Crazy thing. Better have a stiff drink, you deserve it.

Karen Jensen said...

I'm furious for you and sweet Merrick. And I am holding you in the light.

another mary said...

Hum, I'd be mad and I'd want to talk more about this. You are his mom and you have a connection that not one other person with whatever expertise on this earth has and it's there for a reason. I think that doctor was mean spirited and unprofessional to try to shame you for needing answers. Yes, Mpls Heart Institue, St. Paul Heart Clinic -I'd call.

Anonymous said...

I'm sorry Matron, I've suffered my fair share of dodgy doctors, it's tough. Hope Merrick is okay.
Den has heart issues, and she was devastated to be told this week, that she couldn't become an astronaut because of them. She's over it now, apparently she'll be an olympic gymnyst instead ;)