A Good Case


I awaken startled, an unrelenting mechanical shrieking
My mind struggling, I move in slow motion grabbing the pager
A familiar voice, “There’s a patient down here for you to see”
2:00 a.m….”Be rigth there.”  Oh, goody for me.
Jasmin B. 5 yr. old African American female brought in by mom
Presents with lethargy and decreased appetite over the past week.
My mind now races, differential diagnoses, wait, ask more questions
Paint chips.  “I always get mad at her when I catch her eating them, doc.”
“Wow!  Look at the lead level!  Never seen one so high.”
“Cool, look at the lead lines in her bones.  See them there and there?”
Peering through a lens, “Look, that’s basophilic stippling.  Pretty cool, huh?”
“Not too bad for your first student case, pal.”  Yes, actually.  Goody for me.
My mind fully functional, moving, flying now.  Must read Nelson’s, the Bible
Lead poisoning.  Jasmin is crying now.  Stark white walls surround her.
Uniformed strangers under the dim lights lock the bars in place around her bed.
Pages fly back and forth, I must read for tomorrow’s rounds
Next morning, a herd of white clad strangers peer through Jasmin’s window
I regurgitate Jasmin’s history, wading through the attending’s questions
We enter the room single file…look at her bluish gums, a classic finding
The mass of white then retreats after more questions are asked
BAL, EDTA intra-muscular injection, every four hours; Jasmin is five.
Like clockwork, the nurse invades the room, gripping the hypodermic needle
On cue Jasmin cries, anticipation can be such cruel torture
“Good case, Calvin.  Should show up on the exam, especially her treatment.”
Four days have gone by, crawled by in her eyes, treatment unchanged
I find myself spending more time with her, talking about her toys, playing games
We manage to laugh, even giggle in that sterile looking and smelling environment
The ‘good case’ has given way to her childish countenance and wonderful smile
She smiles at least until the hour is at hand, the dreaded time for pain
Both thighs and buttock have grown patches of deep purple and black hues
Tears flow, sniffles and cries of helplessness resound, panic engulfs the room
Then it’s over, the anticipation almost worse than the event, waiting begins anew
A familiar routine: her crying, my silly magic trick, her eventual smile and then playfulness
In time Jasmin is eventually discharged, freed from our treatment to home and family.
Good case?  Perhaps.  Wonderful child?  Most definitely.  Lesson learned?  Yes.
Goody for me.

Calvin Javier, Class of 2000