My subconscious is wiser than I am, and I’ve learned to pay attention to what awakens me at 3 a.m. Maybe others have had that experience, too ― no patient, no friend, no one ― has ever complained when I call (after sunrise) and start with, “I woke up this morning thinking about you.”
Part of why the subconscious is wise, I think, is because it gets to work in a brain that has slowed down from the too-busyness of the day. In the stillness of the night, it asks, “What about this?”
To tap into that wisdom while the sun still shines, a small voice has starting pausing me at key decision points. It asks, “What could I do now that will keep me from waking up in the wee hours?”
During one such moment, twenty years ago, the answer was, “Get a CT scan of his brain and admit him to the hospital.” So I did. He was nine years old and had been vomiting for two days, and his accompanying headache was worse lying down. “Probably the stomach flu,” I said, but the voice made me examine his eyes, and I thought I saw papilledema ― swelling around the optic nerve where it connects to the retina. I asked a colleague, and she thought she saw it too.
Papilledema usually means swelling in the brain. A brain tumor. An abscess. Something bad.
I told the boy and his mother what worried me, and they left for the hospital to get some IV fluid and await the CT scan.
The CT scan wasn’t completed until 11 p.m., after the radiologist had gone home. I drove to the hospital in a thunderstorm. The CT was normal. The boy felt better after the IV and was eating some jello when I gave him and his mother the news. As a family physician, I spend more time reassuring people, and wondering if I got it right, than in relieving everyone after being alarmist. The latter felt pretty good by comparison.
I walked slowly to my car. As the rain washed over the mud in the gutter, it revealed a ten-dollar bill. When I picked that up, a hundred-dollar bill appeared.
I slept soundly through 3 a.m. that night — with a smile on my face, I’m pretty sure.