The phone rang at 3:02 a.m. "Dr. Michel? Hi, it's Julie Zilm*. I am so sorry to call you at this hour, but we're at our wits' end. Tyler's been crying nonstop for an hour, and we don't know what to do! We first thought it was a nightmare, but he's awake now and has been crying since 2 a.m."
Was this call a nightmare? I pinched myself. No such luck. I sat up in bed, also definitely awake. Tyler, 2 years old, had gone to sleep as usual that night, Julie told me. When she tucked him in after his bath, she noticed he was a little warm but didn't think much of it. He'd been sniffling slightly the past few days but seemed fine otherwise. Before calling me, Julie had pressed on his stomach to test for belly pain, felt around his ears to see if they ached, and inspected his mouth to check whether a new molar was coming in. Negative on all counts. Since it didn't sound as though Tyler was acutely ill, I advised Julie to relieve his pain with 1 1/2 teaspoons of Children's Tylenol, the proper dosage for a 25-pound child, and to give me a call in the morning.
The next day, Julie brought Tyler into our offices. They both had gone back to sleep once the pain medication took effect, but Tyler woke up in the morning with a fever approaching 102°.
"Sorry about last night, Dr. Michel."
"Oh, that's all right. Part of the job," I assured her, waving a tongue depressor before Tyler like an airplane. "Tyler, say 'Aaah.' Good, now turn your head for me. Aha -- there's our culprit."
I turned off the otoscope and let Tyler's hair flop back over a bright red ear. "No wonder he was unhappy last night. He has a whopping ear infection."
"I knew it was something serious!" Julie said. "So I guess he'll have to take antibiotics, right?"