The Attributes of an Outstanding Physician II

There were others who were instrumental in changing Olivia’s life for the better. We were told repeatedly, that she would experience catch-up growth by the age of two, but as I changed her diapers, I had a nagging feeling something was wrong. On hearing my concerns one day, my older daughter's pediatrician asked if she could take a look?

I undressed Olivia and she turned to me and said if it were her child, she would take her to a pediatric orthopedic surgeon. Later admitting she was unsure if she was seeing a rare form of dwarfism, she was certain something was very wrong. She arranged for the appointment within a month, just shy of her sixth month birthday. She took the time to listen. Olivia’s life would be forever better because of it.

The ortho ordered an x-ray of her femur. It showed a fine white line along the outside edge of her bone. He repeated the x-rays on a few more bones. All showed the same fine white line. There were also hairline fractures. He sent us immediately to the hospital for a full skeletal set of x-rays. Every x-ray showed the same pattern.

At the end of the day, he turned to us and admitted he did not know what was wrong with Olivia, but asked for time to think about it and to make a few phone calls. I knew we had another excellent physician, greatly appreciating his honesty and candor.

A few days later he called, asking us to take Olivia in for blood work.

“What are you thinking?” I asked.

“I think she has rickets.”

“Rickets!!” I exclaimed.

I remembered rickets from my freshman Biology class as the disease that results from a vitamin D deficiency. I was shocked!

When her blood work returned, her alkaline phosphatase levels were sky high. Dr. Forness’s hunch had been correct. She had a severe case of rickets. We were to discourage any standing and begin vitamin D supplementation immediately. She began weekly bloodwork to monitor her condition.

So, how did an infant in 2003 develop a disease hardly reported in the United States for decades?

As one specialist colorfully put it, “We had a train wreck in the making.”

What conditions led to our train wreck? Olivia, because of the severe intrauterine growth retardation caused by the insufficient placenta, ran a 70% risk of developing a metabolic bone disorder. I had been on bed rest through the summer, depleting my own vitamin D supply. Olivia’s skin is a bit darker because of her father’s Filipino heritage, increasing her risk even more. She had spent little time outside and when we did venture out, her car seat was covered with a blanket so we would not accidentally lose the contact lens. Finally, I was breast-feeding and our pediatrician had not seen the need for vitamin supplementation.

It turns out that breast milk is almost the perfect food. It has everything a baby needs with the exception of vitamin D. Olivia’s pediatrician sincerely apologized for the oversight, another important quality, and we began treating the deficiency with supplementation. Olivia’s alkaline phosphatase levels slowly came back into the normal range. An endocrinologist oversaw her treatment.

Her pediatrician sincerely apologized.

“I should have caught that. I won’t make the mistake in another child,” she promised.

Her sincerity was so very much appreciated, for isn’t that what most of us hope for? That we learn from our mistakes and in the life of a physician, that another child is spared the same mistake? I consider the courage to admit a mistake and correct it whenever possible, the gold standard in medicine. Ironically, if it happened more, I suspect there would be fewer lawsuits and healthier patients. Truly, what patients want more than anything is to get better.

To say her endocrinologist had a significant effect on Olivia’s life would be an understatement of immense proportions. He is an amazing man and an amazing caregiver. In his personal life, he battled diabetes and Parkinson disease with courage and grace and was an inspiration to his young patients and their parents. Though no longer actively seeing patients, I am sure his colleagues continue to value his wisdom for he is highly intelligent, a fantastic problem solver and leaves no stone unturned. He loved Olivia and the feeling was mutual.

He once told me, “We may never understand all of Olivia’s mysteries, but we should never stop trying.”

This final quality would ultimately save our lives.