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  8. The Abdominal Exam

The Abdominal Exam

“Your fingers are your eyes to see beneath the skin,” my stepfather says to me. “When you examine your patients, close your eyes and imagine what is beneath the surface.”

He and I–an experienced physician and a nascent medical student, respectively–are sitting on our living-room couch next to a twenty-year-old neighbor who’s asked for advice, after explaining that he’s had a sore throat, fever, and fatigue for the past two weeks.

I place my hands on our neighbor’s abdomen, palms and fingers, skin to skin. I feel nothing. I close my eyes and try to imagine what I should be feeling. Every inch of his belly is soft. The more I push, the more I realize that I can’t feel anything. No masses, no tenderness. I dig my fingers deep into his left side, thinking he might have infectious mononucleosis, seeking evidence of what I’ve learned to call splenomegaly, but I feel no signs of an enlarged spleen.

“I can’t feel anything,” I say to my stepfather. I move aside and let him examine our friend.

He places his hands on his stomach and palpates for a minute or two.

“I feel healthy, non-distended bowels,” he says to both of us. “There is no presence of splenomegaly. The liver edge is smooth and not enlarged. There are no masses and no tenderness. I don’t feel a pulsating mass. This is a normal, healthy abdomen.”

Then he turns to me. “Make sure you feel every abdomen you encounter, and with time your fingers will know what to look for. But remember, it is as important to be able to recognize what is normal as it is to recognize what is not.”

D. Micah Milgraum
Philadelphia, Pennsylvania


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