Notes from a Healer

Would It Weren't So

Brian T. Maurer
btmaurer1@comcast.net

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“This mother wants her son’s Epi-pen prescription renewed for this school year.”  The medical assistant gently slides the chart onto the corner of my desk.

Although the boy has been a patient in the practice for over a year, I’ve only seen him a couple of times, mostly for viral-induced asthma.  “What’s he allergic to?” I ask.

“The sticker on the chart lists peanuts, tree nuts, and peas,” the medical assistant points out.

I pick up the phone, punch in the local pharmacy number and dictate a new prescription to voice mail.

Days later the boy’s name appears on my schedule for an annual physical exam and asthma check.  His mother asks if he should be tested for allergies again.  I ask her when he was tested last.  “When he was a baby,” she tells me.

“What did those tests show he was allergic to?”

“Everything,” she says.

Involuntarily, I raise my eyebrows.  Everything sounds suspicious, especially for an infant.  “What sort of physical reaction did he have to peanuts or tree nuts?” I ask.

“Oh, he never had any sort of reaction.  We just kept him away from those foods.  His allergist at the time prescribed an Epi-pen, just in case.”

Inwardly, I groan.  Over the years I’ve seen similar scenarios.  A child with questionable allergies is tested, only to find he’s “allergic” to substances that many times he’s tolerated well.  A decade ago RAST testing was not as sensitive as the modern ImmunoCAP tests.  I wonder if this boy is truly allergic to everything.

“I think it might be a good idea to retest him,” I tell the mother.  “That would lay the issue to rest.  There’s no sense restricting his diet if he isn’t really allergic to certain foods.  How’s he been doing with his asthma?”

“He hasn’t had a problem all summer, but winter time is usually the worst.  He gets a cold and boom!—his asthma flares up.”

I review the boy’s medication regimen and treatment plan, then proceed with the examination.  Afterwards, I write an order for two panels of allergy tests: a respiratory panel and a food allergen panel.  “You can take him to the lab at your convenience,” I say, handing the slip to the mother.  “I’ll call you with the results when they come in.”

“I’ll be away for the next two weeks,” she tells me.

“In that case, I’ll mail you a paper copy and we can follow up when you get back from your trip.”

Later that week the lab results come across my desk.  The boy exhibits a high sensitivity to peanut, cashew, pecan and macadamia nuts.  Perhaps the Epi-pen prescription was warranted after all.  He also demonstrates sensitivity to dust mite and the pollen of several trees—oak, birch, maple, box elder among them.  I circle the higher values, slip a copy of the tests into an envelope and instruct my staff to send it to the boy’s mother.

Several weeks later I encounter the mother in the office.  This time she’s brought her other son in for a sore throat.  “By the way, did you receive the results of the allergy tests?” I ask her.  She nods her head.  “It’s good we had him tested.  He certainly has an allergic profile.”

“Yes.  I gave a copy to the school, just so they would know.”

A month passes.  The mother calls to request a letter to exempt her son from his six-week industrial arts course.  I skim the message and return her call.  “I got your request,” I tell her, “but I’m a bit confused.  What’s the problem with him taking shop?”

“Well, he’s allergic to all of those trees,” she tells me.  “I talked with the instructor, and they use all sorts of wood in their projects: oak, maple, birch, pine.  I didn’t want him to have a major reaction in class.”

A faint smile forms on my lips.  “I don’t think we have to worry about that,” I explain.  “Your son is allergic to the pollen of those trees, not the tree itself.  You can rest assured that he won’t have an allergic reaction from exposure to the wood.”

“Not even the sawdust?”

“Not even the sawdust.”

“Well, that’s good to know.  So he can take the class without a problem?”

“Call me if any issues arise,” I say.  “He should be fine.”

Should - like would and could - is merely a remnant of the subjunctive tense in our modern tongue.  As is the case with other archaic words in the lexicon, confusion sometimes arises with their use.

Wood that it weren’t so, I muse, as I gently return the receiver to its cradle on my desk.

 

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: November 5, 2012