What Davon Taught Me

By Melissa Sparrow

If I could do residency over again I would be more forgiving of myself for my mistakes. Because it is largely from my mistakes that I have learned to be a good doctor.

One of my most poignant memories is of a little boy I saw in neurology clinic just prior to leaving Baltimore for Christmas vacation. Sixteen-month-old Davon had stopped walking about two months earlier, a problem that had brought him in and out of the emergency department, where all of his labs and X-rays had been normal. When I saw Davon, I knew something was terribly wrong. He was irritable; he had heightened reflexes; and he just wouldn't bear weight. Because he had been a premature baby, though, it was difficult to discern which of his symptoms were new and which were part of his baseline neurological exam.

I talked the case over with the attending neurologist, and we decided Davon needed a brain and spinal cord MRI. The problem was that at the hospital where I was doing this rotation, pediatric anesthesia was hard to come by, and since it was just before the holiday, it wouldn't be available for several days. It was also respiratory-virus season, and the wards were filled with coughing, sneezing, infected babies, nurses and residents. We worried that if we hospitalized Davon for the wait, he would catch a virus. Whatever was going on with him was not acute,we believed, and probably wouldn't change drastically over the next couple of days. So, after consulting with the clinical team, pediatric anesthesia and Davon's grandmother, we decided to obtain a brain and spinal cord MRI in three or four days—right after Christmas. I gathered my things, said goodbye to everyone in the clinic and left for vacation.

Three weeks later, and back at Hopkins, I ran into the nurse from the neurology clinic.

"Did you hear about Davon?" she asked me quietly.

"No."

"He has a huge brain tumor. It's wrapped around his carotids and his optic nerves."

"No!"

"Yes!"

"Is he here now?"

"He's in the OR. They have an eight-hour surgery planned. I'm going to go see the family now."

Together, we made our way to the OR waiting room. I felt like I was backpedaling through a sea of thorns and mud. He had a brain tumor and I didn't know it. . .I didn't send him straight to the emergency room to get a CT scan-and he could have herniated. . .he could have died, and it would have been my fault. . .because it's the resident who must see these things through and I didn't. . .I went on vacation and when I came back I didn't call.

I saw Davon's grandmother sitting on the plastic blue couch in the waiting room. She was dressed as if for church, her rayon dress pinned with a brooch. I lurched toward her. "Hello Ms. Smith, I'm Dr. Sparrow. I saw Davon back before Christmas," I waited, bare of words. I felt like if she threw me across the room, I would deserve it. Instead, she stood up and reached out her arms. She had tears in her eyes. "I'm just so happy you doctors figured out what's wrong with Davon. I knew there was something. I'm just so relieved we're going to get that thing out."

I talked with the nurse at some length afterward about what had transpired with Davon after I left for Christmas break. It turns out the neurology office had contacted the primary-care office, and together they had called the boy's insurance company nine times to try to arrange this imaging study. Nine times the insurance company had denied coverage. Amid all this negotiation, the grandmother had taken Davon to his developmental follow-up that was routine for ex-premature babies at that hospital. There, the attending and another of our residents noticed that he had an abnormal sensitivity to light, a medical condition called photophobia, and wasn't using his arms correctly. When they also discovered that his head circumference had sky-rocketed, the resident marched Davon and his grandmother straight to the ED, put an IV line in him herself and arranged ambulance transport to Hopkins. There, he had the CT scan that showed the living snake in his head.

One day, not long thereafter, I decided to tell my cohorts about what had happened. We were in morning report, a wonderful ritual where senior residents meet with attendings and our residency chairman, among others, and talk about our patient-care concerns. It's a secure place, a kind of family gathering. On Fridays there are juice and bagels with cream cheese and jam. I decided, because the whole thing was just tearing me up inside, to put my sense of failure on the table. It felt like a safe table after all these years, and these people were my friends.

"It wasn't your fault, Melissa," one attending said.

"This was a systems problem," another added.

I remember feeling like a great weight had come off my chest. We talked about presenting Davon's case at a noon conference so everyone could learn from the errors, including mine, with the clear vision of retrospect.

What the whole experience taught me is that I will always get a CT Scan on a child who has stopped walking with no explanation. Certain moments of fear, remorse and forgiveness, I've discovered, can shape one's world forever after.