| Diary Serial |

On Call: Chapter 5 — I Need a Dentist

“We’ve heard stories,” the father tells me authoritatively. “Doctors miss things. We want to make sure it’s just a stomach bug, and not something worse.”


“I already know why I’m here,” the man in the bright-green hoodie informs me, even before the door is closed.

Stifling a sigh, I paste on a smile and sit across from him. The know-it-alls are some of the toughest patients I deal with on a daily basis. Sometimes they’re saturated with Doctor Google (mis)information, and sometimes they’re just stubborn.

“Hi, I’m Dr. Rubin. Can you please tell me some of your symptoms?”

“Fine.” (Cue the obnoxious eye roll.) “I’ve been coughing for a few days, and I have a scratchy feeling in my throat. My nose is running, and I’m feeling tired and run-down. I need some antibiotics, not a body scan,” he informs me.

“Let me just check you,” I say pleasantly, toes curling with dread inside my comfortable sneakers. He probably has a bad cold — it is winter, after all, and half the city seems to be in the grip of some virus or other — but I don’t think he’s going to take my word for it.

He submits, somewhat impatiently, as I check his ears and throat, and listen to his breathing. He’s running a low-grade temperature, and his throat does look red. The runny nose and watery eyes are classic.

“It looks like you have a cold,” I tell my patient. “Rest and fluids for the next few days should help. You can use—”

“But what about medication? I need azithromycin!” he protests.

“Azithromycin works for bacterial infections. It won’t cure your cold, and it’s not a good idea to take antibiotics for nothing,” I say, keeping my voice level.

“But I need it!” he yells, his face dangerously livid.

“I can’t prescribe it for you,” I say firmly.

“What kind of doctor are you? Who’s in charge here?”

“I’ll let you speak to the attending, sir,” I say.

When the attending physician walks in, he takes in the blustering patient.

“I’m sorry, sir, but Dr. Rubin is correct. We can’t prescribe azithromycin for a viral illness,” he concurs.

Still screaming threats in my general direction, Green Hoodie thankfully decides to leave the premises, and I can finally exhale. It’s always hard when patients ask for things they can’t or shouldn’t have.

In the next room, I meet two highly anxious parents and a six-year-old boy who’s been complaining of abdominal pain for a few days. He’s had a temperature and some nausea, and stomach flu is going around his class. He appears responsive, well-hydrated, and when I touch his abdomen, it’s soft, and he doesn’t flinch. After giving him some medication for nausea, he perks up even more. His behavior is normal, and his pain isn’t acute. It’s not a tough diagnosis, but Mom and Dad aren’t listening.

“I’m not sure,” the mother says, nervously squeezing her boy’s shoulder. “Maybe Liam has appendicitis? Or an ulcer? I have a brother who has ulcers. And I think we should be measuring his white blood count. Do you think there’s something more going on here?”

“We’ve heard stories,” the father tells me authoritatively. “Doctors miss things. We want to make sure it’s just a stomach bug, and not something worse.”

Liam himself doesn’t seem to be too troubled, engrossed as he is in some children’s game on an iPad. But if we start drawing blood and taking scans, that peaceful boy will probably morph into a screaming mess. Yes, there are times when ER doctors miss things, but this case is so clear-cut that I seriously doubt there’s any need for further procedures.

“I’d like a CT scan,” the mother tells me, her voice wobbly. “We want to do what’s best for Liam.”

“I wouldn’t advise it,” I try to explain. “Any scans involve radiation, and unnecessary radiation is not something we advise, especially for children.”

“But I want to make sure,” Liam’s mother insists.

“It’s extremely unlikely that your son has appendicitis, and if he had an ulcer, he would have other symptoms as well.”

I’m banging my head against a brick wall.

“Are you absolutely certain?” challenges the father.

“I can’t promise anything,” I answer, trying to keep the weariness out of my voice. “But medically, I can almost guarantee that Liam has the stomach flu.”

“But you’re not sure,” Liam’s mother repeats. This conversation is going in circles, and I’m up against an annoying common dilemma: overly anxious parents. They come to the ER, scared and vulnerable, but sometimes they ask me to do things I know are wrong. Sending this healthy boy for a CT scan and extensive bloodwork is unnecessary and harmful. Why should Liam be subjected to all these procedures because his parents are neurotic?

What I long to do is stand on a chair (added height is always handy!) and bellow into a megaphone: “Can you just listen to me?!”

Instead, I will probably have to consent to the ridiculous requests because of the specter that hangs over every practicing doctor — lawsuits. What if I send Liam home, and then, in a medical fluke, his condition worsens, and these anxious parents find that he’s seriously ill? There goes my job and reputation — not to mention that I’ll be impoverished by multiple malpractice suits.

I grit my teeth, silently count to ten, and try to reach a compromise: Liam can have some bloodwork done, and if there’s anything alarming, we’ll send him for a CT scan. When they have to deal with a howling six-year-old who dislikes blood being drawn, I suspect they might leave faster. His parents finally agree, and we end the visit on a pleasant note.

Back at the desk in the center of the ER, I allow myself to collapse for a moment. I’ve been clenching my teeth so much today, to keep the sharp words inside, that my jaw is aching.

“I need a dentist,” I mutter, only half joking as I rub a particularly sore spot.

People ask me how Yiddishkeit fits into my life as an ER doctor, and I want to tell them: Being an ER doctor is all about middos. It’s being empathetic and pleasant with everyone, even the nasty patients. It’s smiling when people are asking for ridiculous things they don’t need and can’t have. It’s swallowing the insults and keeping my mouth closed in the face of petty behavior and irrationality.

It’s a level of personal self-control I never dreamed was possible when I learned about the intricacies of the human body. In the ER, I learn to accept the intricacies of the human mind.


The characters in this series are composites; all the stories are true.


(Originally featured in Family First, Issue 892)

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