with her since they were kids. She also did occasional IMEs though reluctantly. Her work with IME’s was more medical-detective style than true ‘medicine,’ healing or helping, and she liked to ‘investigate.’ But she considered herself primarily a child neurologist as her official credentials clearly stated. She had had the long training, degrees, certificates and boards to call herself both a neurologist and a child neurologist, but she much preferred the latter. If she could afford it, to see only children, discharging from her practice young adults as they turned 18 or 20, she would have done so long ago as did her colleagues in academia with her same qualifications at the University Hospital.
In private, solo practice, she was not busy enough to see just kids with neurological disorders, so she kept most patients in her practice as they grew older. She had child neurology colleagues in the West Coast who told her they also had a 30 to 40% of their patients above age 20, but like her they were too in solo practice, not in academia. So with reluctance, she still did some IME’s; and often, by necessity, she saw older relatives of her patients-kids when they ask her to take them too as a patient -please, please, please!- and she occasionally took adults with epilepsy or migraines -or MS, Parkinson’s, Wilson’s and Huntington’s- who might have been dissatisfied with some of the other ‘adult neurologists’ present in the area. She stayed away from Stroke and Alzheimer’s.
The good child neurologist Dr. Phillips, as in her daring frankness for IMEs, was also frank in her report on kids, always sending her written note not only to the referring physician but also to the parents. In those she prepared on difficult kids she was perhaps too honest and realistic–especially on sociopaths, autistics, ADHD, slow and underachievers in school: She’d give blunt and pessimistic prognoses without covering everything with honey and outright lies meant only to please parents and educators. But such honesty also got her in trouble with some parents AND educators.
Just before that long conversation with her colleague Barbara, when they talked about the IME on that woman in the trivial accident, Dr. Phillips had seen in her office a 3 year old autistic boy, super hyper and non verbal who was attending a special ‘E.I.’ (Early Intervention) in an elementary school. His mother had told Dr. Phillips of her frustrations in caring for him and of her doubts in the worthiness of what the school was doing for him. She was seeing no signs of improvement in her child’s behavior or any progress in his eye contact or towards language and communication after having attended the program daily for a good year. She thought the program was just ‘baby sitting’ and frequent confinement with a bear hug by his one-to-one aide or in a small safe space, a cubicle, all by himself without interacting with other toddlers.
Autism had been diagnosed in that child by someone else a year earlier, at age 2, though Dr. Phillips would tell her friend Barbara and other colleagues that she normally picked it up much earlier, generally, often with limited eye contact and no laughter, before 12 months. “His pediatrician had just told the mother to have patience. He had not done much for him either; there is not that much that the best hands can do for autistics either but referred him for ‘E.I.,’ Early Intervention. The public sees often on TV the now famous line ’autism speaks,’ that I see as not just misleading, but often as a sad joke in the moderate-to-severe cases” Nora said.
“Most of these,” she went on, “end up in a group home of some sort. In this case, his mom brought the boy to the doctors’ on a leash. After many visits in which she expressed her frustration -while one of the nurses in the office constantly confined the toddler- the pediatrician finally, when the boy had turned two, had told mom that he thought her boy was autistic. At least mom had now a diagnosis. The doctor just referred him then to the local school for E.I. Mom was initially happy and she appreciated the special, small bus-with-an-attendant and the free baby sitting.
“Every so often mom would show up in school to watch her child in the E.I. room, often spending a good couple of hours standing there without interfering. But she saw no ‘teaching’ or warm interaction with the boy by anybody, or anything that she was not doing at home. She voiced that she was thinking of pulling him out of the program. I did not see anything wrong with that and even mentioned it in my report.
“But when the primary care doc (the pediatrician who had referred the kid to me) read my report, he was annoyed, really ticked off and called me on the phone to tell me his disagreement about pulling him out of the early intervention program. We argued on the phone back and forth, myself defending my pessimistic opinion and told him about my long negative experience with similar, very delayed kids. The primary doc told me that THAT was dangerous, got very rude with me, and swore that ‘he would report me’ (to OPC, of course) and even hung up on me! I eventually found out that he indeed did… and so did the Director of the ‘E.I.’ program in the school that the boy was attending when she got from the pediatrician a copy of my report. Just another complaint against me that the disciplinarians at OPC won’t dismiss, especially when the complaint is coming from another doctor, a doc snitching on a colleague…”
In the meantime mom apparently had hooked up with some sort of agency, institute or clinic for special intervention in autistics, far away from Buffering by several hours of driving, but they had done much advertising and claimed very promising results. They had received her and son with the royal carpet treatment -for a high price not covered by their insurance- and mom was started on a massive program of exercises, ‘stimulations’ and sounds, very demanding. The father in the meantime could not take it and left his family, mom, son and a daughter alone, Dr. Phillips heard. Mom then enrolled a long list of neighboring to help her with the ‘stimulation.’
The doctor did not think much of such program, which she had seen fail in others, but the case having already generated against her a complaint with the State Health Department, she did not discourage the mother. Yet much later, she heard, after a couple of years, mom would give up that program too as ‘useless,’ Nora said.
A difficult 3rd or 4th grader she saw gave Dr. Phillips BIG headaches. She had seen in the kid behaviors described by mom as present in some relatives on her side of the family and on the girl’s father’s side… The doctor emphasized the genetic side of such and told mom that she was concerned about the girl’s future as a stable adult and did not think that the school would succeed in the girl catching up to her peers as she was way behind in her learning… The doctor’s report went only to mom but it met with disbelief from the mother who then reported her to the Health Department and so did the GP who had sent her to Dr. Phillips.
That complaint against the poor doctor was the one that had generated for Nora Phillips a ‘First Case of Misconduct’ with the state’s OPC…
And yes, over time other complaints against the child neurologist kept coming, piling up in the dossier the Health Department was holding on her in the waiting, ‘building up her case’ so they could sack her without escape. Not all resulted yet in a major, ’Second Count of Misconduct’ but were a reflection of her tough field, a difficult medical specialty – even if she was not a surgeon or easily sued. Yet she continued to walk a very fine line, confronting frequently difficult assessments.
One of those such cases, about which her friend Dr. Good had even read in the local papers was that of a 5 year old boy with hard to control, constant, brief quivering seizures. No medications had worked to eliminate them and he had already been seen by other specialists. Dr. Phillips saw in him a really normal boy in his alertness and playfulness, even if every so often he had ‘body quivers’ that would last a few seconds but affected his balance, enough to make him stumble a few times a day. He would be ’back to normal’ and giggling within seconds and never got hurt in the quiver or fall.
“Give him time,” Dr. Phillips had reassured his parents. “No meds have helped,“ but he will outgrow this in the next few years, even if it all looks awful and unbearable right now. Plus there are three or four new medications in the pipeline about to appear in the market in the next two years, like Felbatol, Topamax, Lamictal and Gabitril.”
But
