Case Report-Worthy

Outside the closed examination room door, I paused to shoot a quick glance at my preceptor who gave me a nod and smile, as if to say “Go ahead. She won’t bite.” I took a deep breath as I always did prior to meeting a patient for the first time and knocked. From within, I heard a muted “Yes? Come in.” We filed into the room. A wisp of a woman in her early 50s with short curly brown hair and pale legs that dangled limply from underneath her paper gown sat perched at the end of the examining table. I stood deferentially to the side, allowing Dr. Judd to greet his patient. “…and this is Dr. Chretien, a resident working with me today.” Ms. Martin (or Cheryl, as she insisted) looked over at me and gave me a hesitant but kind smile. Her big blue anxious eyes made her seem child-like. In comparison, I felt clunky, solid. Giant-like. I would later discover we were the same height. I guess I didn’t know exactly what to expect. When Dr. Judd had excitedly told me about her case, mine was the wide-eyed expression: such a rare diagnosis—one seen only on board exams, not in real life, unless you’re lucky. Her story was case report-worthy. “Yours to write,” he had said. Dr. Judd laid out plans for her upcoming surgery: what tests had been ordered, where and when. Her eyes darted back and forth from him to me; she was overwhelmed and seemingly apologetic. As he wrapped up, I sensed her unanswered questions and lingered behind. As soon as the door closed behind Dr. Judd, Cheryl’s confessions spilled out in small waves around my ankles. She was scared. She didn’t understand. She liked my smile. Would I meet her at her next appointment? I had my own confession to make: I wanted to write her case report. Would she let me? I hung those words on a line between her and me, embarrassed to have my underthings aired, flapping in the wind. But she quickly put me at ease: Yes, she nodded. Yes. On the inside, I sighed in relief. Even without the report, I would want to help you. In the weeks to follow, I repeated this to myself over and over. On the day I borrowed the department’s digital camera to take pictures of parts of her body that made her blush. The times I met her in the outpatient laboratory, ultrasound or pre-op clinic. The time her mother embraced me at the end of one of Cheryl’s follow-up clinic visits, whispering in my ear, “Thank you for taking such good care of my daughter.” “Bed seven,” the clerk said in the pre-operating suite. “Are you family?” “No, I am one of her doctors.” I approached the drawn curtain and briefly hesitated as I heard many voices accompanying hers. Her mother, I recognized. Her sister. But, there were other voices now. Male voices I did not recognize. Self-consciousness descended upon me like a surprise rain shower in August. What did they know about me? Did they know I was writing a case report? I pulled open the smallest amount of curtain to allow my body to slip through. The familiar inner monologue started: Was I genuinely concerned? Was I trying to cover up my real interest in a research report? But, I cared about this woman. I did. “Hi.” Cheryl smiled and grabbed my hand. I felt all eyes on me. “Are you doing okay?” I asked. “I’m a little scared, “she said quietly. “It’s going to go just fine.” “Have you met my husband and son?” she asked. “This is Dr. Katherine. I can’t pronounce her last name!” They didn’t smile back at me. I fought the urge to leave immediately. In a few minutes, the anesthesiologist came to bring her back into the O.R. I wished her good luck one last time and slipped away, feeling hopeful and anxious for her surgery on the backdrop of my ever-present guilt. The next day, when I came by to find Cheryl, she was thankfully alone, sitting up on the side of the bed, legs dangling as they had the first day we met. “Hi,” I started, “I heard it went great.” She smiled back, about to speak, when her eyes settled on the door behind me. “Oh, you remember my son?” I tensed as if an intruder, caught red-handed. We exchanged pleasantries though I secretly hoped to disappear into the faux wood floors. A few minutes later, he excused himself to get something to eat from the cafeteria. Finally, I could revel in the joy of Cheryl’s recovery. She looked so good. “My son can’t stop asking me about you.” Panic. Quickly, she added, “He really admires you.” Admires? Or suspects? *** It is nine years later. As I sort through the stack of the day’s mail, I find a lemon yellow envelope addressed in large rounded cursive. My heart leaps a little. I flip the envelope over to find a Mickey Mouse sticker festively decorating the seal. Cheryl. I wonder what might be inside this time. Photographs from her most recent Disney cruise? Last time, she had written an entire letter to me on the back of small pieces of scrap paper she found while waiting in line at the post-office, stapled together in order. I carefully open the envelope and pull out a card. Out fall a few photographs and a folded up piece of lined notebook paper, complete with ragged edges torn from a spiral binding. The photographs are of paintings: a cat, a bowl of fruit, a panda bear nuzzling its child. The letter starts like always: “Dear Dr. Katherine.” I learn that Cheryl has taken up painting and takes classes every Wednesday night. The panda painting, she writes, won first prize in a student contest. Her instructor was puzzled by the title she gave to the painting, “Katherine and Jolie,” so she explained that she named it after me and my daughter. I look at the photograph of the panda bears again before closing my eyes, now wet. “So what test would you order now?” I ask my students and residents. “Knowing what you know so far?” They are close: they have almost cracked Cheryl’s case. “Biopsy the rash,” offers an astute intern. Moments later, we are discussing her diagnosis, and I recognize their wide-eyed expressions of piqued intellectual curiosity. “Isn’t that rare?” they say. “Great case!” they murmur. I tell them about the case report. But, I also tell them about Cheryl—the gentle spirit who had made an amazing recovery after that fateful surgery nine years ago and who continues to do well. The person whom I’ve kept in touch with all of these years. And most importantly, the way some patients find their way into your heart, despite your best original intentions.