Dr. Daniel Guzman wonders aloud why he eats and eats and doesn’t gain weight. Could it be that he typically walks five miles during a 10-hour shift in the Emergency Department at Cook Children’s Medical Center, never breaking for meals, and that in the last five hours he’s sat down exactly once for 90 seconds to explain something to a reporter?
“We have a little bit of an attention deficit – doing 10–12 different things at one time,” Guzman says of physicians like him in pediatric emergency medicine. “I do my best when I have to do multiple things at the same time.”
And this he does, often swinging an HP laptop in one hand (the battery runs out, because he never has time to re-charge) and followed by a scribe, who takes notes on Guzman’s patient encounters. On this school-day afternoon, he sees an ornery boy with a fauxhawk and a BB in his ear (Guzman has extracted a kernel of corn and various bugs from kids’ ears, including a live cockroach); a 17-year-old boy with a nasty boil on the back of his neck; several kids with breathing conditions and a teenage girl with carpal tunnel syndrome who complains of extreme pain but has a normal heart rate, a strong clue that it’s psychosomatic.
“Our minds are powerful, powerful things,” Guzman comments afterward, choosing his words carefully. “I’m gonna believe anyone who says they’re in pain.”
And he also sees poop – lots of poop. In x-ray images. Think about it the next time you’re tempted to go to the ER complaining of awful abdominal pain: Could it simply be poop? Guzman handled every such case soberly, ruling out serious conditions such as appendicitis. But on a remarkable number of occasions he would examine x-ray images of his ailing patients and discover that their problem was, in fact, poop – as in gas, constipation.
Guzman loves his job, and it shows. He’s at ease with any patient, any parent. Part of it comes from growing up in a big family. His father was a candy distributor, dispensing Hot Tamales and Pixy Stix to every mom-and-pop store in the Rio Grande Valley. Guzman learned to listen, to be tolerant of different personalities, to go with the flow.
A visit to an eye doctor at the age of 4 triggered his interest in medicine – “a passion that started early in life that just never went away,” as Guzman puts it. Though no one in his family had worked in a medical field, Guzman’s parents fully supported his desire to be a doctor. At first he wanted to be an opthalmologist, but while studying at Boston University School of Medicine he found himself attracted to pediatrics – and the adrenaline rush of emergency medicine. The reasons, as he explains it, are simple.
“I’m kind of a kid at heart,” Guzman says. “I like to have fun. Everything else seemed way too serious. It fit my personality more.”
With emergency medicine, “Every time I walk into a room there’s something different. But I can still have fun. I can still play with kids.”
On a recent Tuesday afternoon in Cook Children’s Emergency Department, which sees some 110,000 patient visits a year from children as far away as West Texas, the tempo quickened after school let out. The ED, in fact, has its own daily, weekly and yearly rhythms, with visits picking up when the school year starts – concussions and bone breaks from school sports; kids on foot and on bikes struck by cars – then increasing exponentially in flu season, with kids “sharing cooties.” Trauma cases tend to come in on the weekends, with families traveling by car to less familiar places.
The evening brought its share of oddities – such as 8-year-old Pike Mathews, who had a sharply defined, luridly purple imprint of a Lego on his right temple. One could forgive his parents if they thought he was telling a tall tale: The boy evidently fell hard from bed, with the exact point of impact being a Lego block. He shows signs of concussion – a severe headache and nausea – and is soundly asleep when Guzman first visits him. Later, the kid with spiked hair and a crooked smile wakes up and offers these words of wisdom before going home with instructions to stay off his bike and out of sports for two weeks: “Getting hit in the head was better than getting hit in the balls with a ball.”
Then there is the gross. Guzman is called upon to lance a pus-filled boil on the back of a teenager’s neck. First, he advises a visitor exactly where to stand, because, the doctor says, “I’m great at squeezing pus from an abscess and shooting someone.” This particular boil explodes without collateral damage, however, and Guzman moves briskly to the next case.
This one is a puzzler. Sydney Hendricks won’t wake up. When Guzman applies sharp stimuli to the 19-month-old’s foot, she doesn’t flinch. As her young mother shifts the girl in her arms, Sydney’s head flops limply from side to side.
The girl was playing on the floor that morning, her mom narrates, and then she went to sleep and wouldn’t wake up. Grandpa drove her to the hospital. “It was freaking me out,” he says. “I started calling her name, and she didn’t even look at me.”
Stepping out of the room, Guzman says quietly, “It’s bizarre.” He dictates notes to his scribe: “Listless on exam. Minimally responsive to deep stimuli.” Guzman suspects that the girl accidentally ingested some medicine – “This happens all the time,” he says – but he isn’t sure. The toddler is otherwise healthy and well cared for; the doctor orders tests. He refrains from quick assumptions. “If you don’t have a healthy dose of fear every time you treat a patient,” he says, “you lose that edge as far as treating that child.”
Later in the evening, Sydney snaps back to normal and goes home.
She begins a trend of cases drifting toward the serious. A tiny figure lies on a big bed in one of the trauma rooms. Lilee Jenkins, 22 days old, is flushed and fussy; she was transferred to Cook Children’s from another North Texas hospital. “Babies are scary,” Guzman says. “So many things that present can be really deadly fast.”
Lilee has pyloric stenosis, a condition that is more often found in boys. Guzman sketches her insides on a piece of scrap paper, explaining how muscles constrict the opening of her stomach into the small intestine. Each time Lilee is fed, she vomits it up in projectile bursts that are the telltale sign of her disease.
Jenkins’ young, first-time mom is frightened. Her baby hasn’t been able to keep anything down for several days now. “She would wake up gagging,” the mom says. “It’s the scariest thing I’ve ever experienced in my life – her eyes would be bugging.”
Right now, Guzman explains, the baby’s fluids need to be stabilized so she is strong enough to undergo surgery. Later in the night, a surgeon will cut the muscle blocking the way to her bowels. Without this emergency procedure, the baby would continue to dehydrate and possibly die. In the 1920s, in fact, pyloric stenosis resulted in death more than 50 percent of the time. Now, virtually no patient in the United States dies of this disease.
Guzman takes a moment to reassure the mom, suggesting she might want to step out while a nurse inserts an IV into the baby’s minuscule vein. “I feel like a bad mom if I leave her,” the mother says. But Guzman knows it will be even tougher to watch.
The mom leaves, and Guzman pauses. His work, he says, has made him “extremely happy.” A husband and father himself, with a 3-year-old in school and 1-year-old at home, the doctor never forgets the importance of “being able to understand families and where folks are coming from, what scares them, and helping them get through that process.”
While many of his cases are simple, such as prescribing breathing treatments for a wheezing 5-year-old or dealing with a backlog of poop, moms and dads view it differently.
“For that family,” Guzman says, “it’s not routine.”
