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?