Another extract from my memoir – meeting my first child patient in my Finals

 I’ve distinguished myself through four medical school years by never setting foot inside Barts Children’s Unit. At twenty-six years old, the very notion of sick children sends shivers through me, chilled a few more degrees by Sister Kenton’s reputation for putting to flight any student bold enough to tap upon her ancient office door. But such evasive action proves too good to last. In September, 1966, I show up at London University’s Examination Halls with the first batch of would-be graduates, to discover I’m to conduct my 30-minute baptismal pediatric exam on a 7-year-old–under the direct gaze of my Finals examiner.

My patient is scrunched in a tot-sized wheelchair, face obscured by an outsized mask hooked to an oxygen cylinder. She is too breathless to talk, had I the wit for conversation. Two tiny hands the color of blueberries peek out, dark eyes fixed upon me beneath a straight fringe of hair.

“Would you like to know what’s wrong with Dorothy?”

Mom, my fairy godmother, has just gifted me my first clue: her offspring’s gender. Perhaps she’s going to feed me the answers before I’ve dredged up any questions? Can this be legal?

“Fallot’s Tetralogy, doctor! Whoops, you’re not a doctor yet, though, are you?”

Oh God, one of those arcane diseases I can’t begin to spell.

“Um, well, yes—I mean no! Er, perhaps you could tell me something about your daughter?”

“Been sick ever since I ’ad ’er. Always blue—cyanosis, they call it. ’Er ’eart didn’t grow right inside me, so she couldn’t get her oxygen. Three operations, she’s ’ad.”

Light bulb: keep the lady talking, then maybe skip the physical exam altogether?

“Did they tell you what’s wrong exactly, Mom?”

“Never did get it straight. Just this big hole in ’er ’eart. Blood keeps goin’ all round ’er body, never into ’er lungs the way it’s s’posed to.” She drops her voice. “Dunno how she’s still breathin’, poor pet. An’ she has these spells, goes all black and passes right out. They’re talkin’ another operation, fix things up the way God meant it. We’re awful worried, Dad and me, but we’re goin’ to give it a try. Reckon she’s earned it—not much of a life, otherwise, is it? Well, don’t you want to examine Dorothy?”

My meager store of questions exhausted, I spot my invigilator scribbling notes on his clip board as I wash my hands. Already docking marks for some sin of omission? I peek at my physical exam list, fearful I’ll forget some critical detail… inspection, palpation, percussion, auscultation… But Mom knows the routine as to the manner born, responds to my every request without demur. I fumble for Dorothy’s thready pulse, which promptly slips from my fingers as I’m locating my watch’s second hand. I remember to rub my stethoscope on my pristine white coat to warm it before sounding her heart and lungs. I tune into gushes and murmurs that bear no earthly resemblance to The Cardiac Exam in Cecil & Loeb’s Textbook of Medicine.

Dorothy twists her body back and forth to aid my stumbling efforts, even strives to hold her breath at my request. I clutch at a second clue: at seven, she is three feet high and weighs thirty pounds—statistics even I know are way below par. Then Mom points out her bulging fingers and deeply curved nails.

“Clubbing, that’s called, dear. ’E’ll like it if you notice that.”

I am Sherlock Holmes and Doctor Watson rolled into one, hot on the track of the baffling whodunit that is Dorothy’s heart. I can hardly suppress my glee at reaching a diagnosis, even a sketchy treatment plan. The examiner is beckoning me over. I grin back at Dorothy as I scamper to his side.

“Diagnosis?”

“Fallot’s Tetralogy, sir. Postoperative times three.”

“Prognosis?”

“Guarded, sir. Chronic cardiac strain. A poor candidate for further surgery.”

I’ve nailed this! But his parting words deflate the air from my tires.

“You evinced conspicuous delight at making your diagnosis. A good teaching case, for sure, but a complex congenital condition with a dire prognosis is hardly cause for rejoicing.”

I depart the examination halls thoroughly chastened, knowing he is right. Winded and helpless, this girlie has already faced scarier ordeals than I ever will, and a long healthy life is beyond imagining. I make a vow:  should that cherished certificate ever grace my wall, I’ll never let medicine’s technology blunt my compassion.