Notes from a Healer

Small Potatoes

Brian T. Maurer

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“The pain is in my leg—here.”  The boy leans forward and grasps his left calf.  “And just today my back started hurting too.”

“How long has your leg been bothering you?” I ask.

He shrugs his shoulders.  “Five days,” he says.

“Can you sleep at night?”

He nods his head.

“So you’ve had the pain in your calf for five days, but your back just started hurting today.  What’s the pain in your leg like?”

“I dunno.  Sort of like an ache, I guess.”

“Is it like a cramp, or something like an electric shock?”

“No, not really.  It’s just there.”

“He was bitten by a tick about a month ago,” the boy’s mother says.  She’s been sitting quietly in the chair listening to her son’s attempts to explain his pain.

“How long was the tick in place?”

“I pulled it off as soon as I felt it,” the boy says.

“I didn’t see it,” the mother says.  “I had just come home from the hospital at the time.”

“I see.  Well, let’s have a look at that leg, and your back too.”

The boy readily hops down from the exam table when I ask him to.  I check his spine; ask him to bend forward, backward and to each side.  He does so with ease.  I instruct him to lie down on the exam table so I can check his leg.  There is full range of motion at the hip, knee and ankle.  I note no swelling of the calf, no redness.  There is minimal tenderness to palpation when I squeeze the calf muscle.  Straight leg raising does not accentuate the pain.

“It’s difficult to say what’s causing the discomfort in his leg,” I say.  “Have you given him any medicine for pain?”

“No,” the mother says.  “For some reason I usually don’t think to give my kids pain medicine—not unless they’re really hurting.  At this point I’m just worried about the tick bite.”

I nod my head.  “Usually Lyme disease doesn’t show up like this, but I can certainly order a blood test to check.  Meantime, you could give him something for pain if it gets bad.”

I reach into the overhead cabinet for a lab slip and proceed to fill it out.  “There are two drawing stations in town,” I explain, telling her the locations.

“Yes, I remember.  I took my daughter there a couple of months ago.”

“Good.  I’ll call you as soon as the results come back.”

I open the exam room door for the boy and his mother.  “By the way, you mentioned that you had just come home from the hospital.  Were you ill?”

“Not me—my daughter.”

“Your daughter....”  I search my memory for the name.

“She was just diagnosed with leukemia,” the mother says.  “She’s in remission now, but she’s got two and a half years of chemotherapy ahead of her, and she’s only five.”

Of course; now I remember.  I had seen the little girl for a clinical pneumonia.  She improved on a course of antibiotics, but relapsed a month later.  The second time my colleague had ordered a routine CBC along with a chest x-ray.  The WBC came back 53,000 with 93% immature forms.

“If I recall correctly, the final diagnosis was ALL, is that right?”

“Yes.  They say that if you have to have leukemia as a kid, that’s the one to have.”

“It carries the best prognosis—the best chance for cure.”

“That’s what we’re hoping for,” the mother smiles.  “After what we’ve been through, I can deal with some back and muscle pain—even if it turns out to be Lyme disease.  At least you can cure Lyme with antibiotics.”

“Most of the kids I’ve seen with Lyme disease respond quickly to treatment.  Invariably, they do well.”

The mother nods her head.  “At this point anything short of cancer is small potatoes now,” she says.

Oddly, in this moment, I find myself in total agreement with her.

When it comes to the relative weight of medical diagnoses, perspective is everything.


About the Author

  • Photo of Brian T. MaurerBrian 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 patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice. Interested readers can read more of the author's writings at his website and blog.

  • Published: August 8, 2011