Parents bring their child to the emergency department for evaluation of nausea and vomiting. Well, mostly nausea. He vomited once.
When I entered the room, the 7 year old child was underneath the bed trying to squeeze himself into the area where they usually put the patient belongings. He was rocking the bed back and forth. I couldn’t figure out whether he was trying to perform some impromptu Steve Santini routine or whether he had taken an interest in becoming a stretcher mechanic. His parents were just calmly sitting there playing video poker on their matching handheld games. I asked if they could put the child on the bed so that I could examine him.
Once the child was sitting on the bed, he was all over the place. Crawling up and down. Reaching in my pockets. Continuing to rock the bed. Shaking his head back and forth so many times that I was getting dizzy just watching him.
“He has ADHD,” the mom mentioned.
The voice in my head said “Gee, ya THINK?”
“Oh, I see,” I replied.
“He’s been here for nausea several times before. No one can figure out what’s wrong with him.”
“OK. I’ll check his old records as well.”
After examining him, I pulled up his old records. Multiple sets of labs. All negative. He had actually been admitted … once … for his nausea. After reviewing his progress note for the visit, I can see why he had only been admitted once:
After reading this, all I could think of was the following comic that I scanned and saved from a magazine several years ago (which I think is a pretty accurate representation regardless of the era in which it was created). The pediatric unit nurses must have threatened the doctor if he ever admitted the patient again.
On a hunch, I went back in the room and asked the parents …
“Does he tend get out of control a lot?”
“Oh yeah, this is nothing.”
“What do you do when he gets really out of control?”
“We usually give him an extra dose of his ADHD medicine.”
Of course, Ritalin has a slew of side effects … including nausea. Little Joanne Doroshow was prolly just getting overdosed on his medications.
I suggested that they discontinue the extra doses of medication and even consider asking their doctor to wean Little Joanne off his Ritalin. I’m not a big fan of giving kids a lot of these medications, anyway.
Both parents simultaneously asked “But what are we supposed to do when he gets out of control?”
This is a good point. Which was worse, the medication or the disease? Then again, the medications may be what is causing his hyperactivity.
I thought for a moment and then came up with a possible solution.
“Does he like video poker?”
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