Thursday, July 5, 2007

Short White Coat: Lessons from a little one

Short White Coat is a blog written by fourth-year Harvard medical student Jennifer Srygley. Her posts appear here as part of White Coat Notes. E-mail Jennifer at jen.shortwhitecoat@gmail.com.

When is a wave not a wave? One of the first patients I saw on the pediatric neurology service at Children's Hospital Boston was a 12-month-old baby who had recently started raising her right arm when she became agitated. Her arm seemed to take on a life of its own, so sudden and repetitive were its movements.

While she had been developing normally -- she could pull herself up and was already saying a few words -- there was concern that her arm-raising might be the sign of something more sinister: partial seizures. When we examined her, she seemed perfectly normal. But a baby's brain can be hard to examine. A more conclusive test would be to monitor the electrical activity of her brain while she was waving her arm.

While the baby didn't seem to enjoy the sticky electrodes placed on her scalp, the electroencephalogram was much more physically taxing on the parents. They stayed up all night to monitor when she was having episodes of arm raising, so that the brain-wave recording could be correlated with the episodes. Even if her parents didn't have to remain wakeful and vigilant all night, I doubt they would have been able to sleep. The hours waiting for a test result to come back can stretch as long as the corridors of the hospital.

For my patient, the results were good. This baby did not have seizures -- just a quirky arm-raising habit when she got upset, perhaps the earliest signs of her personality emerging.

Though her neurologic work-up wasn't complicated, my experience with this patient and her parents reminded me that too often on the wards, we forget that every patient fits into a network of family and friends who worry and wait for every test result.

Posted by Jennifer Srygley at 05:20 PM

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