This is a transcript of a brief talk Dr. Colin Knight gave at the end of his fellowship in 2007. All graduating chiefs and fellows were to speak about their “most memorable case.” Some gave academic presentations, Dr. Knight’s was more personal. Here is part three of the talk. Parts one and two were posted earlier this month.
While working as a flight surgeon in the 28th Bomb squadron — the B-1 schoolhouse for the Air Force — I met a young B-1 navigator student named Ed. I continued to take care of him as he finished his training and moved across base to the 9th Bomb Squadron, the operational squadron. One day, he came to me to say that he had just found out that his mother at hepatitis B. Unfortunately, when I tested him, he proved to be a chronic carrier of the disease. This would be tragic and scary for anyone diagnosed with it but for someone in military aviation it can be career-ending. By this point in my Air Force career, I was very familiar with the waiver process and with a few phone calls and the right paperwork I was able to get Ed returned to flying status. In consultation with a hepatologist, we put Ed on a screening program to watch him for liver cancer.
Several months later, a bottle of wine and a framed photograph showed up in my office. Ed called me to explain. “All my life, Colin, I’ve wanted to see the White Cliffs of Dover. Thanks to the work you did to give me a waiver and return me to flying status, I deployed with my squadron to England this summer. The picture on your desk is a picture I took of those cliffs from the window of the B-1. Without your help, I would have never been able to take it. Thank you.”
That December Ed’s AFP took a jump and a liver ultrasound showed a mass that had not been there before. Amazingly he had developed hepatocellular carcinoma less than a year we had found out he was a carrier of hepatitis B. Despite a clean resection, Ed developed a recurrence after I left active duty and died soon after. I still have the photo on my desk.
My first weekend of call as a fellow was going well until the phone rang early Sunday morning. The NICU charge nurse apologized for waking me. “We have a kid here,” she said, “who we are really worried about. She’s had increasing abdominal distension. She’s vomiting and she’s becoming more tachycardic and tachypneic. We’ve been calling the senior resident all night long and he won’t come to see her.” I thanked her for calling me and asked her to give the patient a fluid bolus, start antibiotics, and obtain X-rays. I was scared as I drove to the hospital. Taking care of neonates was foreign to me and as a new fellow I really did not want to screw up. After examining the patient and the X-rays, I called the attending. We soon took her to the operating room and found that she had a single adhesive band the across the SMA; her entire small bowel was dead. After the resection, she was sick in the ICU for months. We were finally able to send her home on TPN. I watched her grow into a cute toddler. Over the time I’ve known her mother, a Mexican immigrant, she has gone from knowing no English to be conversant in it.
These long relationships with patients are one of the most rewarding aspects of pediatric surgery.
As we focus today on what is memorable I think it’s important to note that for most of our patients, while what to us may be minor, is to them memorable. In fact, it may be the most important event of their lives.