The call came after I had drifted off to sleep, late on a Thursday night. "Hi, Mark, it's Pete Parsons in the ER. I have an eight-month-old here I'd like you to take a look at. He has a fever and the mom tells me that he's been real fussy all day. What puzzles me is that he has a funny kind of strabismus, and the mom is worried. She says his eyes didn't look like that before."
Suddenly I was wide awake. A seasoned emergency room physician who handles heart attacks and major trauma with calm competence can get very nervous when faced with a sick infant. I expect that reaction. But sometimes there are red flags that tell me I need to rush to the hospital immediately. This was a red flag: The baby had strabismus, or crossed eyes. Normally, that's not an emergency, but the mother said the boy's eyes hadn't been crossed before. And she said he had fever and fussiness. That combination of symptoms could mean trouble.
When I arrived at the emergency room, the nurse directed me to the curtained-off enclosure where little Jesse Rivera lay on a gurney. He was awake, but he wasn't moving much. And he wasn't looking at his mother, who was leaning anxiously over him, stroking his small hand. "Uh-oh, this could be a sick kid," I thought. To a pediatrician, "sick" means "I'd better do something, or this baby might die."
