The Yale Journal for Humanities in Medicine

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Notes from a Healer

A Leg Up

“It happens whenever he sits still for a short time. He doesn’t complain until he tries to get up. That’s when he cries out in pain. He refuses to stand, and I have to carry him.”

This mother relates how her five-year-old boy began to complain of periodic pain in his knee over the past several days. When I question her further, she reports that he has had no fevers, no sore throat, no other joint pain. He sleeps well at night. No, she didn’t notice any swelling or redness or warmth of the knee joint. I scratch my head, a bit puzzled.

“How long does the pain last?” I ask.

“Maybe thirty minutes,” she says. “Then suddenly, he’s fine again. He runs around as if nothing bothered him at all.”

Intermittent knee pain, severe enough to prevent weight bearing, with no accompanying signs of arthritis and spontaneous improvement after half an hour. What could this be?

“Did he fall down recently, or have an accident of some sort?”

“They said he banged his knee at daycare last week. I noticed a small bruise that day, but it seems to have faded.”

I squat beside the boy on the exam table and inspect his knees. There is no swelling or redness. Gently I palpate both knees in turn without eliciting pain. When I put each knee through its range of motion, the child does not wince. I ask him to lie down on the exam table to check his hip joints. They, too, appear to be normal.

The door to the exam room opens as I finish my exam. A middle-aged man enters and greets me with a smile. He shuffles across the room and extends a hand. “Hi, Doc,” he says, “I’m Justin’s father. How does he look?”

“So far, so good.” Then to the boy I say: “Hop down off the table so we can see you walk.”

Immediately and without hesitation the boy jumps down, landing effortlessly on both feet, nimble as a mountain goat. At my request, he walks back and forth easily from one corner of the room to the other: first normally, then on tiptoes, then on his heels. I detect no abnormality in his gait.

The mother blushes; his father takes a halting step backwards, catches himself and smiles. “Well, how about that? He looks pretty normal, doesn’t he, Doc?”

“Yes,” I agree, “he certainly does. I can’t make a case for any kind of involvement in his knee or his hip for that matter.”

The father beams. “That’s what I wanted to hear,” he says. “You see, when I was a kid about his age, I developed Legg-Perthe disease. Despite years of treatment, I still walk with a limp.”

Slowly I nod my head. Now it all becomes clear. Like father, perhaps like son.

“I see. At this point, Justin looks fine. Why don’t we have you continue to observe his activity at home. Try not to make a big deal of these complaints. My hunch is that they may just fade away over the next couple of days.”

“And if they don’t?”

“Then call me, and we’ll proceed with some x-rays and lab studies. But I suspect that he’ll do fine.”

The parents seem relieved. They thank me for my time and file out of the room with the boy leading the way, high-stepping down the hall.

Later that week, I telephone the parents. To their delight, the boy’s symptoms have not returned.

About the Author

Brian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades. As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine. Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care. His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of fifty-seven patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice.

Published: June 24, 2007