The Yale Journal for Humanities in Medicine

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Notes from a Healer

As You Like It

Although she’s seventeen, she’s here with her father. Actually, it was his idea that she come in for an evaluation, even though she’s feeling a bit better today. She had a harrowing week, beginning last Saturday evening. It all started with the onset of her menses.

She complained of a dizzy spell, accompanied by a mild headache. She asked her father for an aspirin. He checked the glove box in his truck parked outside the restaurant and found some Excedrin. She took two tablets. That night, for the first time in months, she couldn’t fall asleep. And she noticed something else: her heart was racing. She took her own pulse—120 beats per minute.

Throughout the week she continued to experience spells of rapid heart beat. These sometimes lasted several hours. She couldn’t calm herself down. At times she became tearful and upset, anxious to the point of near panic. She also described cramping abdominal pains along with her period. And she continued to sleep poorly at night. Curiously, her appetite remained unaffected. Her father nodded in agreement: “She still eats like a horse!”

There are no other signs of illness—no fevers, no sore throat, no cough or congestion. When I question her, she admits that she’s been under the gun lately. Mid-term examinations are coming up. She’s a straight A student, taking several advanced placement courses this year: physics, calculus and English literature.

“I’m intrigued,” I say. “What are you reading in your AP lit class?”

“Shakespeare,” she says.

She’s also just received word that she’s been accepted to college in an accelerated program—if all goes well, in two more years she will enter medical school. “The pressure’s on; I’ve got to keep my grades up,” she tells me.

I proceed to the examination. Today her heart sounds regular in rate and rhythm—no clicks, no murmurs, no gallops. Pulses are equal and symmetrical; blood pressure is fine. There is no goiter or thyroid nodule; the neurological examination is normal as well.

“You look well today,” I assure her.

“What do you think set this off?” her father asks.

“Well, it could be one of several things. Sometimes young ladies can become emotional at period time”—the girl nods her head—“and we know that she’s been under duress lately between school and concerns about starting college. The initial insomnia may have come from the caffeine in the Excedrin tablets—”

“She’s extremely sensitive to caffeine,” her father says.

“Just drinking a can of cola sets me off,” she concurs. “How much caffeine is in a can of cola?”

Here I must plead ignorance. “I don’t know off the top of my head; but obviously, you’re sensitive to it.”

“So you think she’s O.K. at this point, Doc?” her father says.

“By her own admission she’s feeling like her old self today. I doubt there’s a problem with her heart. A lot of these symptoms can be attributed to her current stress and menses. I’m sure she’ll do fine. Call the office if these symptoms recur.”

“Will do, Doc. Thanks for your time.” The father stands to shake my hand.

“I suppose this will all turn out to be ‘Much Ado About Nothing,’” the girl says with a grin.

“Well,” I smile back, “‘All’s Well That Ends Well.’”

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: February 4, 2008