Now That You Mention It
Page 54
“Do an X-ray or something,” Teeny said. “Maybe she needs to go to the mainland. I’d be more comfortable if she was in Portland.”
“Mom, please,” Sullivan said.
“Does Grandma need to be here?” Audrey whispered.
“Nope,” I said. “Teeny, would you mind waiting out front, please?”
“I’m staying.” She folded her arms.
“Go, Mom,” Sully said. “There’s no need for you to be here.”
She didn’t move. “Tim, would you escort Mrs. Fletcher to the waiting room?” I said, not looking away from Audrey. Her face was a little flushed.
There was a hiss behind me, Timmy’s low voice. Good.
“Is it her appendix?” Sullivan asked.
“Let’s find out. Okay if I feel your belly?” I asked Audrey, pulling on exam gloves.
“Sure.” She rolled onto her back, grimacing.
“Any vomiting or diarrhea?” She shook her head. “When did you first start feeling this?”
“Um...this afternoon. And then it got really bad after Mom dropped me off at Dad’s.”
“Did you eat anything unusual?” I pressed on McBurney’s point. No flinch, so it wasn’t her appendix.
“No. Not really.”
“Have you ever had pain like this before?” I asked.
She glanced at her father. “Um...maybe? Once or twice.”
“Any blood in your stool?”
“Stool?”
“Poop.”
“Oh.” She blushed. “No. I don’t think so.”
“Have you lost any weight recently?”
“I wish.” Her face got even more red.
She winced as I felt her left lower quadrant. “When was the last time you pooped?”
“Dad, can you go or something? This is so embarrassing.”
“Yeah, and I changed your diapers. I’m not leaving.”
I looked at him and smiled. “I don’t think it’s appendicitis, Sully. But maybe Audrey would be more comfortable talking without you here.”
“I definitely would be,” she said.
“I’ll stay.”
“I need to be Audrey’s doctor right now,” I told him. “She’s still a minor, so you can stay if you really want to, but you’re making her uncomfortable.”
“Indeed you are, Dad.” Snark. Always a good sign.
He frowned, twin lines appearing between his eyebrows. “Okay,” he grumbled. “I’ll be right outside, angel.” He kissed her forehead, sucker punching me in the heart.
“I’ll take good care of her,” I said.
He nodded and walked out, wiping his eyes with the heels of his hands, and for that, I fell in love with him a little bit.
“Nothing like an overprotective father,” I said.
“I don’t really like talking about my bodily functions with him here, that’s all.”
“Understandable. Okay, some of these questions are a little embarrassing, but I can’t treat you for the right thing if I don’t have honest answers. Okay?”
She nodded.
“Last time you pooped?”
“This morning.”
“And it was normal?”
“Yes.”
“Good. Next question—are you sexually active?”
“No! God, no. I probably won’t be for another thirty years. Or I’ll die a virgin.”
I squeezed her hand. “How would you describe the pain?”
“It’s like there’s a knot in my stomach. Down lower, actually.”
I felt where she pointed. She was significantly overweight, so it was a little tough to get a read on her organs. “Turn on your side, honey.”
She did, and I saw that she had two purple stripes on her skin. “Have you always had these?” I said. They looked like stretch marks and could’ve been—lots of kids got them during sudden growth spurts or weight gain.
“I’m not sure,” she said. There was a pause. “I try not to look in the mirror too much.”
My heart twisted. I knew that feeling. She grimaced again.
“Is the pain right here?” I asked, pointing to her left side. She nodded. “I’m going to press on your stomach, sweetheart. If you have to pass gas, go for it. You’ll feel a lot better.”
“I can’t fart in front of you!” she said.
“Honey, people have vomited on me, pooped on me, peed on me, bled on me.” I pushed gently with the palm of my hand. “Once, I was doing a rectal exam, and the second I took my finger out, the patient pretty much exploded with diarrhea.”
She laughed...and passed gas. A lot of gas.
“Oh, man, I’m so sorry,” she said, her sweet round face turning scarlet.
“But you feel better,” I said.
“I do.” She sounded amazed.
I palpated her abdomen again, but she seemed cured. “What did you have to eat today?”
“I didn’t want to tell my dad,” she admitted, “because he hates when Mom and I do this, but we ate Oreos and drank a lot of soda. We pig out and watch movies. It’s... Well, it’s fun. Kind of. I do try to eat right most of the time.” She looked chagrined. “It’s just that Mom and my little brother are skinny, so they don’t think about that.”
I ran my hand along her spine. It curved at the base of the neck. Dowager’s hump, as it was unkindly called. “Are your periods regular, Audrey?”
“Not really. Every few months.”
“How old are you again?”
“Fifteen.”
I looked at her chart on the laptop. She was five-one and weighed 195 pounds. “How about backaches?” I asked. “Do you get those a lot?”
“Yeah. How did you know?”
“Another way-too-personal question—are you a little hairier than you’d expect?”
She covered her mouth with her hand. “Yes. It’s so embarrassing.”
She had Cushing’s disease. I was almost sure of it.
“Okay, here’s the deal,” I said, sitting on the bed with her. “Your stomach pain was probably just gas from the Oreos and soda, which is a pretty horrible combination for your gut. But I think you might have something else going on. Something treatable that would explain some of the other things we’ve talked about. Is it okay to get your dad?”
She nodded, and I went to the waiting room, where Sullivan was pacing and Teeny was whispering into her phone.
“She’s feeling much better,” I said. Sully sagged with relief, then ran his hand through his hair. “Come on in, Sullivan.” Teeny stood up.
“Stay here, Ma,” he said, not looking at her.
“I’m coming in.”
“Stay!” he barked. I liked him even more, knowing he took no shit from that harridan.
In Audrey’s exam room, I gestured for Sullivan to sit down. Timmy came in, too. I made sure Sully could see me and spoke carefully so he’d catch every word.
“The pain seems to have been just gas, which can cause really bad abdominal cramps. That’s resolved now, so she can go home tonight. But Audrey also has some markers for Cushing’s disease, and I’d like her to get tested.”
I explained what the disease was—a possible tumor on her pituitary gland, which then produced too much cortisol, resulting in just about everything Audrey had going on. The obesity in her stomach, her much thinner arms and legs, the extra hair, the full, round face, the curve in her spine.
“Mom, please,” Sullivan said.
“Does Grandma need to be here?” Audrey whispered.
“Nope,” I said. “Teeny, would you mind waiting out front, please?”
“I’m staying.” She folded her arms.
“Go, Mom,” Sully said. “There’s no need for you to be here.”
She didn’t move. “Tim, would you escort Mrs. Fletcher to the waiting room?” I said, not looking away from Audrey. Her face was a little flushed.
There was a hiss behind me, Timmy’s low voice. Good.
“Is it her appendix?” Sullivan asked.
“Let’s find out. Okay if I feel your belly?” I asked Audrey, pulling on exam gloves.
“Sure.” She rolled onto her back, grimacing.
“Any vomiting or diarrhea?” She shook her head. “When did you first start feeling this?”
“Um...this afternoon. And then it got really bad after Mom dropped me off at Dad’s.”
“Did you eat anything unusual?” I pressed on McBurney’s point. No flinch, so it wasn’t her appendix.
“No. Not really.”
“Have you ever had pain like this before?” I asked.
She glanced at her father. “Um...maybe? Once or twice.”
“Any blood in your stool?”
“Stool?”
“Poop.”
“Oh.” She blushed. “No. I don’t think so.”
“Have you lost any weight recently?”
“I wish.” Her face got even more red.
She winced as I felt her left lower quadrant. “When was the last time you pooped?”
“Dad, can you go or something? This is so embarrassing.”
“Yeah, and I changed your diapers. I’m not leaving.”
I looked at him and smiled. “I don’t think it’s appendicitis, Sully. But maybe Audrey would be more comfortable talking without you here.”
“I definitely would be,” she said.
“I’ll stay.”
“I need to be Audrey’s doctor right now,” I told him. “She’s still a minor, so you can stay if you really want to, but you’re making her uncomfortable.”
“Indeed you are, Dad.” Snark. Always a good sign.
He frowned, twin lines appearing between his eyebrows. “Okay,” he grumbled. “I’ll be right outside, angel.” He kissed her forehead, sucker punching me in the heart.
“I’ll take good care of her,” I said.
He nodded and walked out, wiping his eyes with the heels of his hands, and for that, I fell in love with him a little bit.
“Nothing like an overprotective father,” I said.
“I don’t really like talking about my bodily functions with him here, that’s all.”
“Understandable. Okay, some of these questions are a little embarrassing, but I can’t treat you for the right thing if I don’t have honest answers. Okay?”
She nodded.
“Last time you pooped?”
“This morning.”
“And it was normal?”
“Yes.”
“Good. Next question—are you sexually active?”
“No! God, no. I probably won’t be for another thirty years. Or I’ll die a virgin.”
I squeezed her hand. “How would you describe the pain?”
“It’s like there’s a knot in my stomach. Down lower, actually.”
I felt where she pointed. She was significantly overweight, so it was a little tough to get a read on her organs. “Turn on your side, honey.”
She did, and I saw that she had two purple stripes on her skin. “Have you always had these?” I said. They looked like stretch marks and could’ve been—lots of kids got them during sudden growth spurts or weight gain.
“I’m not sure,” she said. There was a pause. “I try not to look in the mirror too much.”
My heart twisted. I knew that feeling. She grimaced again.
“Is the pain right here?” I asked, pointing to her left side. She nodded. “I’m going to press on your stomach, sweetheart. If you have to pass gas, go for it. You’ll feel a lot better.”
“I can’t fart in front of you!” she said.
“Honey, people have vomited on me, pooped on me, peed on me, bled on me.” I pushed gently with the palm of my hand. “Once, I was doing a rectal exam, and the second I took my finger out, the patient pretty much exploded with diarrhea.”
She laughed...and passed gas. A lot of gas.
“Oh, man, I’m so sorry,” she said, her sweet round face turning scarlet.
“But you feel better,” I said.
“I do.” She sounded amazed.
I palpated her abdomen again, but she seemed cured. “What did you have to eat today?”
“I didn’t want to tell my dad,” she admitted, “because he hates when Mom and I do this, but we ate Oreos and drank a lot of soda. We pig out and watch movies. It’s... Well, it’s fun. Kind of. I do try to eat right most of the time.” She looked chagrined. “It’s just that Mom and my little brother are skinny, so they don’t think about that.”
I ran my hand along her spine. It curved at the base of the neck. Dowager’s hump, as it was unkindly called. “Are your periods regular, Audrey?”
“Not really. Every few months.”
“How old are you again?”
“Fifteen.”
I looked at her chart on the laptop. She was five-one and weighed 195 pounds. “How about backaches?” I asked. “Do you get those a lot?”
“Yeah. How did you know?”
“Another way-too-personal question—are you a little hairier than you’d expect?”
She covered her mouth with her hand. “Yes. It’s so embarrassing.”
She had Cushing’s disease. I was almost sure of it.
“Okay, here’s the deal,” I said, sitting on the bed with her. “Your stomach pain was probably just gas from the Oreos and soda, which is a pretty horrible combination for your gut. But I think you might have something else going on. Something treatable that would explain some of the other things we’ve talked about. Is it okay to get your dad?”
She nodded, and I went to the waiting room, where Sullivan was pacing and Teeny was whispering into her phone.
“She’s feeling much better,” I said. Sully sagged with relief, then ran his hand through his hair. “Come on in, Sullivan.” Teeny stood up.
“Stay here, Ma,” he said, not looking at her.
“I’m coming in.”
“Stay!” he barked. I liked him even more, knowing he took no shit from that harridan.
In Audrey’s exam room, I gestured for Sullivan to sit down. Timmy came in, too. I made sure Sully could see me and spoke carefully so he’d catch every word.
“The pain seems to have been just gas, which can cause really bad abdominal cramps. That’s resolved now, so she can go home tonight. But Audrey also has some markers for Cushing’s disease, and I’d like her to get tested.”
I explained what the disease was—a possible tumor on her pituitary gland, which then produced too much cortisol, resulting in just about everything Audrey had going on. The obesity in her stomach, her much thinner arms and legs, the extra hair, the full, round face, the curve in her spine.
