This baby had gone home 4 days before, after being treated with phototherapy for jaundice caused by a B-O blood group incompatability. (Mother's antibodies get into the baby's system and break down blood cells, leading to an increased level of bilirubin, which causes jaundice. Too much bilirubin causes brain damage.) At discharge, mother had promised to bring the baby back in two days for a jaundice level (bilirubin level), so we could make sure the jaundice wasn't worsening again, but now it was four days past discharge and we hadn't seen her. The previous day the nurse had called her and left a message. Earlier this day she had called again and paged her, to no avail. Finally, a couple of hours after I called her, the mother called back. She promised me that she would bring the baby in that day for a bilirubin level.
Chances are the level will be okay. Usually the jaundice doesn't worsen too much after stopping phototherapy. But occasionally it does, and it only takes one baby with brain damage from jaundice to ruin your day - and potentially lead to a large malpractice suit against you.
If there is one thing that drives doctors crazy, it's when patients don't do what they are supposed to do, especially when they have promised to do it. Before I discharged her baby, I asked the mother if she was sure she had a way back to the hospital for the jaundice level and made sure she understood its importance. She was young but seemed reliable. I knew there was a chance she wouldn't bring the baby back, but, except in the worst social circumstances, we simply can't keep babies in for days until we're sure the jaundice level is okay.
When I talked to her on the phone, she told me that she was really sick two days before, when she was supposed to bring the baby in. Maybe so, but that didn't explain why she didn't return our calls or have someone else bring the baby in. I know that many of my patients don't have cars or a lot of friends with cars, but if they can't bring the kid back, they should just say so and we'll figure something else out. Work with us, folks. We really do want what is best for the child.
I'm waiting for her to show up as I write this. I hope the baby's okay. She probably is, but I'll have just a little less acid in my stomach when she shows up and we can make sure of it.