“Call for you,” said the switchboard operator, in her usual drone. “Hi, this is Mrs. Berkenstein*,” a shrill voice with a decidedly Germanic accent crackled down the line. “I’m *Nathaniel’s mother. Is this *Sally?” “No, it’s Sam, I said,” rather taken aback at being bleeped before 9 in the morning on my first day as Paediatric Neurology SHO by a patient’s mother. Nathaniel is a 6 month-old boy with infantile spasms. His mother had phoned for a repeat prescription – steroids, ranitidine and pyridoxine. She said Sally (the previous person who was in my job) used to fax the prescription to her local pharmacist.
Before I’d had the chance to sort out her request (and right in the middle of clinic), I had another call from a mother: “*Jacob’s school has sent him home because he was going blue around the mouth and rolling his eyes to one side. We saw Dr. *Ahmed last Tuesday and he increased Jacob’s medicines but he is fitting more now. We don’t want to come into hospital again, what do you advise?” I asked her some further questions, but it was impossible to assess the child without actually seeing him. I explained this to her, but she was adamant; “the team have always given advice over the phone in the past,” she insisted, before admitting that the current situation was a new one. I guess one of the luxuries of being a junior doctor is that when you have your back to the wall, you can always wriggle your way out by saying you’ll speak to your consultant and get back to the patient.
Jacob eventually came into hospital and an EEG confirmed increased seizure activity. A blood gas showed a partially compensated metabolic acidosis – in his case it could be due either to the ketogenic diet or intercurrent infection, so we started him on antibiotics and sodium bicarbonate.
Quite apart from all I was learning about seizure disorders, it was interesting to meet these mothers in person. Both were petite Orthodox Jewish ladies, dressed in the usual garb of loose, dark-coloured long-sleeved blouse and black below-knee skirt, dark tights, chunky black loafers and a hat or headscarf worn at all times. Beneath all that, they looked impossibly young (I’d estimate early twenties, certainly significantly younger than myself) and vulnerable. Speaking face to face with them was absolutely fine – they were both gracious and articulate, and though understandably concerned about their sons, were by no means overly anxious or unreasonable. Perhaps the scary telephone persona was a kind of “take me seriously or else” act.
The road to Lochranza, Isle of Arran (that's rain on the lens!)
