Karam Article

 Al (Karam), MD on duty
The Dallas Morning News
February 12, 2003
By Karen M. Thomas

Dr. Al is working the room, and, this is a tough crowd. Five-year-old Blake doesn't want his ears checked. His twin brother, Ben, is watching, his eyes growing big. It's his turn next.

"Come on, buddy, it's not going to hurt," says Dr. Al Karam, a Dallas pediatrician. He's speaking softly but firmly, his kind eyes focused on the fearful boy's face.

"I don't want you to look in my ears," Blake says, and he begins to cry.

"Blake, come on. Why is he doing this?" asks his frustrated mother, Cathy Adams of Rockwall.

Dr. Al doesn't know. He does know that sometimes little boys get scared at the doctor's office. Sometimes they cry. So he does what he can to allay that fear.

He often teases. He says he's Peter Pan. He allows his young patients to hold the blood pressure cuff or makes jokes about seeing monkeys in their ears. He opens his mouth to demonstrate "Say ahhhhh." And then he moves swiftly to complete his exam, simultaneously holding on to a resisting child, doling out medical advice and reassuring an anxious parent, all within the span of several minutes.

Winter, for a pediatrician, is the high season. Viruses swirl through schools, child-care centers and households, wreaking havoc on youngsters. Babies cry all night, active toddlers sit still with fever, and first-graders are sent home from school when the lunch they've just eaten refuses to stay put. Worried parents flock to the pediatrician's office with their children in tow.

Dr. Karam, who has been in practice for 17 years, is ready. Like most pediatricians, he has learned to listen, entertain, diagnose, soothe and treat, all in the interest of keeping children healthy. And he has worked out a system to see a steady stream of young patients.

That system is mainly his head nurse, Marilyn Wiggins. She sits at the glass-walled nurse's station with the telephone receiver held to her ear. She's performing triage, listening carefully to parents as they call in and describe what isn't quite right with their children. To some parents, she offers encouragement: "That's perfectly normal with a newborn. You're doing fine."

For others, she clicks with the computer mouse and makes an appointment. The symptoms sound like an ear infection or maybe strep throat. Those children need to see Dr. Karam. While on the telephone, she happily waves hello to patients being placed in nearby examining rooms.

"You got to have a good nurse," says Dr. Karam, 47. "Not only does she need a good knowledge of medicine and how to determine over the phone who is sick and needs to be seen and who does not, but you also need a nurse who can talk to parents and give advice, especially first-time parents, bless their hearts, who have feeding issues and sleeping issues."

"I tease that whenever Marilyn retires, I'll retire, too."

But right now neither Dr. Karam or Ms. Wiggins has time to consider retirement. At 9:30 a.m., Dr. Karam's schedule looks feasible. With a little luck he'll be done by 5 p.m., home in time to help his wife, who is a lawyer, fix dinner for their six children. Afterward, he promised two of his children, he would help with homework and school projects.

But he knows not to count on leaving on time. The telephone is ringing and Ms. Wiggins is listening, questioning and steadily scheduling. By early afternoon, Dr. Karam's appointments have spilled past 5 p.m. He has 45 families scheduled for appointments. Only six involve regular checkups. Everyone else is sick. Now he knows that he will be lucky if he finishes by 6 p.m.

All in a day's work

Pediatricians know that they face long, unpredictable days. They aren't the highest-paid in the medical profession. Most have families and find the juggle between home and work difficult at best. Dr. Karam has only one other pediatrician in his practice. That means every other night, Dr. Karam is on call, available to treat children too sick to wait until the morning. And he is also on call every other weekend.

Each day, in addition to seeing patients, Dr. Karam has a stack of medical journals on his desk he needs to read. He has e-mails to answer, telephone calls to return and paperwork to address. Sometimes he grabs a quick lunch with friends at the Physicians' Dining Room at Medical City Dallas Hospital across the street when his office closes for an hour and a half for lunch. He spends the rest of the time in his office trying to clear his desk. Other days, he skips lunch entirely.

On a recent cold, crisp day, he has already made a trip to Presbyterian Hospital at 8 a.m. to examine three newborns before going to his office. At the end of the day, before he can go home, he plans to examine a baby girl born in the afternoon at Medical City.

But Dr. Karam didn't become a pediatrician to have convenient hours. He treats children because he loves the work and the families.

"This isn't a job to me. It's fun," he says.

A loyal following

Parents appreciate his passion. And they will do practically anything to keep him. Some drive long distances. Others plan family relocations around his office.

Leah Arrington, the mother of five children, lives in Dallas. She's come to Dr. Al's office with her three youngest - a 4-year-old son, her 2-year-old daughter and 4-month-old Isabel.

Isabel is sick. Her nose is crusty. Her usual sunny disposition has crumpled. She's fussing and squirming in her mother's arms. The Arringtons have recently placed their home for sale. But Mrs. Arrington says she won't be moving far.

"Where his practice is dictates where we move," she says.

There are times when patients have to leave Dr. Karam. Babies grow and eventually become adults. But some families put that off for as long as possible. Others find a way to return. Former patients can think of no better doctor for their own children. They come back to Dr. Karam, which he finds an honor.

In an examining room with Peter Rabbit wallpaper, 17-year-old Brennen Cage, dressed in his school uniform of shirt and tie, sits on the edge of the examining table.

At 6-feet-4, he cannot lie down. He and his dad, William Cage, have come because Brennen knows he is getting sick. He's scheduled to play in an out-of-town basketball game the next day.

"Do you mind still coming here?" Dr. Karam asks.

"No," says Brennen quickly. He has come to Dr. Al since he was 9 months old.

Dr. Al tells Brennen he is probably getting sick, although there isn't much to diagnose yet. He can go on his trip, but he probably won't feel that great. He tells him to drink lots of fluid and to rest. He wishes him luck. Then the young man and his doctor share a firm handshake.

Outside the examination room, a staff member moves a small magnet from door to door so Dr. Karam knows which room to enter next. He takes the patient folder down from the rack near the door, flips through the chart and then opens the door.

In some rooms, there are families with youngsters sprawled out while playing with action figures. Dr. Al greets the parents, steps over the children and begins. He listens patiently as one small child describes a tummy ache, an earache, a headache. A flicker of a smile dashes across his face when a mother describes her sick child's voice not as hoarse, exactly, but rather whiny.

At the end of one exam, a mother hesitantly tells Dr. Al that her toddler has begun to throw herself on the floor and bang her head.

"That's perfectly normal," Dr. Karam says. The mother looks surprised. He tells her that if it hurt, the child wouldn't do it. He explains that it is a tantrum. The mother should ignore it and be consistent with discipline and not give in to the child's demands.

Winding down

It's late now and the rhythm is changing. The phones aren't ringing as much. Instead, Ms. Wiggins is returning telephone calls. She will stay until she has called back every parent who called before 5 p.m.

At nearly 6 p.m., Dr. Karam tells Ms. Wiggins good night. He has seen his last patient in the office and is ready to examine the newborn. As he walks across the street to the hospital, he calls home. His wife and one of his daughters are leaving soon for a school program. He tells another daughter he'll fix dinner. When he hangs up, he mentally plots the rest: He'll put the youngest to bed so he can help his son and another daughter with school projects.

"Oooh, why is Dr. Al doing that to me?" he says in a high singsong voice to the 3-hour-old baby as he lifts her from her cradle in the hospital nursery. She gives a croaky little cry of protest as he removes her swaddling clothes. He asks the nursery nurses a few questions and gives a few directions. Then he finds the baby's parents in the mother's hospital room. The room is packed with relatives.

"She looks great, " he says. He'll have a more detailed conversation with the parents later. He tells them to make an appointment to see him in two weeks. And with that, the day ends.

Dr. Karam leaves the room, tugs his fedora in place and heads home.