When I think of scars, my mind drifts back to my rotation in the Burn Unit as an intern in Mumbai, India. We were conducting trials on the use of a plant-based calendula gel on burn dressings. As an intern, I would attend to each patient throughout my entire twelve-hour shift. My patients were young women, some even younger than myself at the time, usually between the ages of eighteen and twenty-five, all victims of burns.
Susanna came into the U.S. fighting the mosquito-borne viral disease chikungunya. Her thin body, wracked with fever, shivered and fought off the infection; her family back in her home country called around for a PCP who would see her. They found me and scheduled an appointment. I knew the signs and symptoms of chikungunya, and I knew the hard mass I felt in her belly was something else.
She was diagnosed with cancer two days later and started chemotherapy as soon as she recovered from her infection.
My patient complains of chest pain a few days ago while mowing the lawn. He has no chest pain today, but his story is so good I decide to order an EKG, bloodwork, and some other tests. I start running the differential diagnosis algorithm in my mind; sometimes, a patient history is all I need to make a diagnosis.
Joanna has always been more dramatic than my other patients, but this time she seemed so much more distressed and fidgety than before. I had to ask, “How are things at home?” That was her cue to ask me to bring in my medical assistant, who has now become her friend, to help with translation. She did not want me to misinterpret anything she told me, in her broken English. And so we switched to Spanish.
Mrs. Beazley comes in a few days before Thanksgiving. Her chief complaint: “My nails look awful.” As she sits on the exam table, I notice that she can’t reach her feet to take off her shoes and socks. I review her labs and note her blood sugar level. My mind starts to outline the lecture I’m about to deliver; I start off by saying, “So, tell me what you ate for breakfast today.”
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