He was blueberry blue, about 10 inches tall, and he looked like he had been through a lot of adventures on the playground. Up until that point, I had never done a physical exam on a teddy bear, but there's a first for everything...
My actual patient was a five year old boy who came in with his mom, a chief complaint of night terrors. And the plush toy at hand, who I later learned was named Buddy, was my patient's safety device. As I talked with his mom, the story unraveled as weeks of sleepless nights, screaming and waking up in a cold sweat, and residual fear during the daytime. We spoke at length about his social history, his childhood development, and new events that had transpired in his everyday routine. I tried to ask my patient questions - how school was going, was there something in the dark that made him scared - but surprise, surprise he wasn't very talkative with a person he had just met a few minutes ago. After I had exhausted every question I could come up with, I proceeded with the PE. I let him know in advance what I would be doing. I watched his grip tighten on Buddy as I listened to his heart and lungs. And that's when the lightbulb went off. How would I want to be treated if I was his age?
"Is it ok if I listen to Buddy's heart and lungs?" He looked at me with wide eyes and nodded yes. I placed my stethoscope on the bear's chest and put on my best pensive face as if I was trying to discern a murmur amidst the polyester filling. As I reached for the otoscope I told my patient that I was going to try to see his brain with the fancy flashlight. An ear exam on a child without wincing and moving around, and actually being able to visualize the landmarks, is a success in my book. We moved onto the nasal passages and I asked him, "How many boogers do you think are in your nose?" This made him smile, hooray! And when I let him know that I had stumbled upon a giant booger with the flashlight, he giggled just a bit. Lesson learned - young kids usually laugh at boogers.
I asked my patient to lay on his back so that I could listen to his belly, and I tried to guess what he had for lunch as I placed my steth in the four quadrants. Who knew a PB&J sandwich could be so loud? Buddy was included on the abdominal exam; turns out he had hypoactive bowel sounds.
I stepped out to present to my attending, summarizing the H&P and coming up with a plan. We both returned to the examining room to talk to the mom, and I stood by the table where my patient sat who was still clutching the bear. I felt a tug on my white coat sleeve, and when I looked down I saw my patient offering me Buddy. This was his safety object, the thing that brought him comfort in those moments of terror. And I was a person he had just met in a mere fifteen minutes. But there he was, all quiet and shy, gently reminding me of the human connection in medicine. It was, simply put, moving.
I mentioned in a previous post that I'm hesitant about pediatric patients because they can't always answer my questions. I've got my adult interviews down to a pattern, but put me in front of a toddler and watch me crumble. But, I'm learning to adapt my approach and trying to remember the questions that are asked during the pediatric and newborn exam - Do you wear a helmet when you ride a bike? When did the mom receive pre-natal care? It's those highly detailed inquiries that can make all the difference in a patient's healthcare, and slowly but surely I'm collecting them and adding them to my interviews. And when you have a patient like Buddy, it makes you work harder at being better for the peds patients.