11.26.2013

Otis and the EarAche

Otis is a typical 9 year old boy. I realize that is awfully judgy of me, having just known about him for minutes... but I've become pretty good at recognizing key features of patients. For example, I say he's typical because he has two hands and two ears and he wears pants.

He came with his mother to our clinic because one of those darn ears just wouldn't stop hurting. And for good reason. Looking in the ear, my colleague, Vanilla, saw a nasty looking otitis media, an infection of the middle ear. His eardrum looked like a mini cherry tomato.

Open and shut case.

Vanilla prescribed some antibiotics and analgesics and the boy with two ears left.

Three weeks later, Otis came back again, still wearing pants. And still complaining of right ear pain. This time, a peek through the otoscope showed something completely different.

And more worrisome.

His external canal, the hollow tube running from the outside of the ear to the ear drum, was filled with pus. The cherry tomato had popped, spilling pent-up infection into the narrow tunnel. The mother explained that she had not picked up the antibiotic prescription. This didn't surprise Vanilla. It has become a tune we hear all too often these days. So Vanilla cultured the drainage, encouraged the mother to get the medicine (which she agreed to) and the boy with two ears left.

72 hours later, Otis and his mother returned for follow-up. Otis was feeling more miserable, feverish, growing Pseudomonas (learned from the culture result) and still had not taken any antibiotics. Why?

The mother, embarrassed and concerned, confided that she simply couldn't afford the medicine.  Not then. Not now.

Vanilla then came into my office with a dilemma. Here is a minor, hurting, at the mercy of his mother's poverty and lack of resources. We both expressed concern about not only the child's acute suffering, but potential complications of an untreated infection, including hearing loss. This 9 year old typical boy could be on the cusp of turning atypical: with two hands and one ear.

"I want to pay for the boy's antibiotics," she told me. "Should I?"

There are compelling reasons to do it.

And not to do it.

What would YOU do?

7 comments:

NPs Save Lives said...

I have worked in a rural health care setting for the last 6 years. I also have the same types of patients with limited incomes. Unfortunately, If you pay for his prescription, you will be opening a potential can of worms. Word will spread and then others will expect you to do the same for them. Refer them to a local charity or church with a letter explaining that she needs the money for the script but make sure that the charity actually picks it up themselves.

LoriPhdinme said...

How can mom afford 3 separate provider visits but not a prescription? Although this does tug at the heartstrings because it is a child, this is potential series of "no good deed going unpunished". It will as NPs mentioned the expectation crowd will shortly line up and pound their cups upon the antibiotic bar
If mom is truly in need, a charity program is the most correct course. Is the antibiotic on the reduced cost list for Walmart i.e. $4 list?

Ms. Fish said...

Lori,
The patient is able to be seen in our clinic for free. But medications are not free. As sad and seemingly unreal as it is, an extra $4 is more than some people have.

LGH said...

Well, of course I would buy it. I know what others have said about opening a can of worms; I know that. I served a mission at the LDS Employment Center and I sometimes would give money on the sly to people. One time the guy came back lurking around for more. I know that some people take advantage and come back for more. I saw that often. BUT, I could not see a child suffer. I just couldn't do it! I'd buy the medicine, ask the mother NOT to tell anyone. Maybe others would come, and I certainly wouldn't help them all. Discernment would be key, but to me, the child deserves that small bit of help. And, I do agree with one of the others who responded that surely a local charity could help, but I'd also buy the medicine....

Lauralee said...

I definitely would buy the medication for the child and hope that the mother administered it properly. The thing that matters most to me is the child's immediate welfare. If others expected my handout in the future, I would evaluate the need individually, person by person. We have been so blessed to have more than the average and I feel an obligation to always share where possible.

When I was in Russia in 1996, my brother and I filled our pockets with rubles. EVERY begger (and there were plenty) that came our way was given a little money. It was not our place to evaluate whether or not it was warranted, but it was our obligation to help as we could afford. It is not what "they" do, it is what "we" do that matters most.

Vera Hirschi said...

Maybe you could set up an account in the office and ask for anyone to help donate money to it for cases like this one. Patients that may have an extra dollar or two could contribute when possible and any employee. If there is money to help, you help, if not you can not this time. But the child needs help and if the patients know from the start that it comes from a special account they may not have a line to bug you each time. It is not the child's fault that he is so bad so what a dilemma is correct. Good luck. Just a thougt.

Ms. Fish said...

Great insights. Thank you for your responses everyone.

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