An Innocent Looking Rash

Ted Hall was in for a blood pressure check and flu shot today. He is a secure, big-boned man with a hint of a southern drawl. A retired military man with a son who is a decorated war hero, he has seen a lot, and seems to take everything in stride.

Wrapping up his visit, I looked at his “Problem list”, the cover sheet on the left hand side of the chart that lists his allergies, chronic medical problems, social and family history. A couple of words under “Family History” caught my eye and rekindled my memory. I asked:

“How is Brittany doing?”

He beamed. Brittany was his youngest daughter. I had seen her only once, but I have carried the memory of that June afternoon in my heart for the last 23 years.

It was a stifling hot Thursday afternoon. I was relatively new in town and Brittany Hall was a High School senior, who usually saw a colleague of mine who was off that day. She had a rash on her legs, graduation was the next day, and I agreed to see her as a “double book”.

Entering Room 11, the same room where I saw her father today, I met a pretty, blonde girl with a flowery summer dress. She didn’t look like most girls from around here, and she carried herself differently. She seemed older and more mature than most eighteen year olds.

Brittany felt fine, and was just concerned about an unsightly bright red rash on both legs. It had been there for a couple of days. She wanted it gone, or at least less noticeable by graduation the next day.

The rash that covered both calves of her fair-skinned legs was petechial and didn’t fade when compressed. The rest of her exam was normal.

“These are broken blood vessels,” I explained to her. “We need to run some blood tests.”

Fifteen minutes later I knew for certain what I had already feared. Her white blood cell count was 28,000, all the same kind of cells – she had acute leukemia, and within twenty more minutes I had arranged for her to meet with the oncologist on call at the hospital twenty miles up the road.

As she left the office with Ted, who came to pick up his daughter, she said:

“And I thought I would just get a cream to put on my legs.” 

I never saw her again, but the reports from the Cancer Clinic kept trickling in. She went through chemotherapy, delayed long enough so she could attend her graduation, and then she left for college. Ted was my colleague’s patient, and I would see him occasionally. Dr. Walls left the area, and Ted became my patient a couple of years ago.

I know I had asked him once before about Brittany, and he had told me she was well, but that time we had not pursued the subject more. Today we lingered more with the story we shared.

“She’s 42 now, you know, a beautiful woman” he said, “and she is married and has two gorgeous, healthy children. The cancer doctors had warned her she might never had children, but she had no problems.”

“I’ll never forget that day she came in with the rash on her legs,” I said.

“Me neither,” he choked.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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