The Art of Diagnosis

 

It’s important when symptoms strike that you get yourself directly to the doctor’s office so when your name is called and you walk down the hall to the exam room they can all disappear. The symptoms I mean.

This at least is how it works with some of us.

Something of a physical nature will be nagging and that still small voice will whisper ‘now when was it you last were at the docs?’ and so I’ll go ahead and make the damn appointment and then sit around with the other fine people in the damn waiting room preparing my words in my mind and determining on a scale of one to ten exactly how weird the sensation is so that I can tell the doc, and when the nurse comes out and says the doctor will see me now, and I get up and walk through that one door and down that hallway to the third door on the right just as she directs me, it’s just about then all my symptoms disappear.

This is a little awkward, seeing as how I’m there to talk about my symptoms, but it’s a two-sided coin: on the one hand you’re feeling like an idiot for being in here at all and bothering these nice people; on the other hand, you feel great! The ache or the burn or the sharp twinge along this or that extremity is entirely absent from your body. Who wouldn’t be happy about that?

It violates medical protocol though to turn around and run for the door telling the nurse on the way out that you forgot something in the car, so I go through the motions of preparing for the exam just as though I needed it. Which apparently now I don't.

When the fellow comes in, as fine a doctor as you’d ever want to know, the conversation goes something like this, the good doctor speaking first in this back-and-forth vaudeville routine.

“It’s good to see you!”

“It’s good to see you too!”

“Tell me about the family.”

“Tell me about your family!”

“Can you believe this weather?”

“No one can say we don’t get the seasons here, can they?”

“Now what brings you…”

“Remember how hot it was last summer?”

“Yes, a real steamer. Now, these symptoms of…”

“Mercy, I don’t know how many days in a row it climbed above ninety-five!”

“Are we talking about your chest area or your legs…”

“No, wait, I surely do, as a matter of fact, I surely do. Thirteen! That’s right, thirteen days in a row it got above ninety-five!”

About this time the doctor is looking out his window and wondering why he got into medicine in the first place, and I’m trying to think of other good weather stories I’d like to relate.

My thinking is that at some point my time will be up and our little chat will be over and I can get on my way.

They teach these doctors discipline there in medical school though, and he’s having none of this.

“Tell me what’s wrong,” he says sternly.

I can tell by the way he says it that it seems to him that I’m avoiding the subject out of some inner motive, perhaps blind fear, and that he had better buckle down to it and see what it is that ails me before it kills me right there in his office.

For my part, I’m following my own inner logic, which tells me that I’d better come up with some symptoms and fast, otherwise I’ll be blacklisted by all the medical establishments in town as an out-and-out nut.

But my thinking, always subtle, doesn’t stop there.

It’s important to me that I describe nothing to him in the way of symptoms that could possibly be cause for alarm, because by the look in his eye his cautionary nature is now roused, and anything that gives him the slightest cause for concern will set me off for a round of medical tests that I won’t emerge from till later in the year.

He says again, “now tell me about these symptoms.”

“Well, it’s kinda hard to describe. It starts right here…”

“You keep moving your hand around. Are you saying it starts in your ribs, your temple, or in your earlobes?”

“Well, that’s the thing, it’s a kind of migrating sensation, it alternates between my ribs, my temple, and my earlobes. The darndest thing.”

“Well, where is it right now?”

“More temple-ish I would say.”

“Hmm, that sounds a bit like…”

“Nope, nope, there it goes right now, back to the earlobes. Yes, it’s definitely an earlobe thing, preponderantly.”

I’m hopeful that the use of the big word will show that I’m taking this seriously and have given it a lot of thought.

Though I’m sure it’s out there somewhere, you just don’t hear of a lot of bad news concerning the earlobes, which cheers me and guides my strategy.

If you had to pick an element of the human anatomy that seeks to cause as little trouble as possible for its owner and makes a point of getting along with all the other parts of the ensemble, the earlobe must surely be it.  

“We don’t see much migrating earlobe pain around here.”

“That’s my point exactly! Because it’s so rare, we common folk just don’t have a lot of practice describing it! That must have been what got me sidetracked on the whole temple thing! You see, what it really feels like is that I swallowed a cell phone somehow and it’s one of those new fancy ones that you can play music on? And it’s as though it’s playing one of those hip-hop songs from behind my ribs with the horrible words and the heavy bass? You know the ones I mean? Anyway, it’s like I’m feeling the bass vibrate all the way up from my ribcage, along my vertebrae, up through my jaw, and into to my earlobe.”

I think this has a nice ring to it. 

Well, you can tell that even though he may have graduated head of his class back there in Advanced Facial Anatomy, nothing is ringing any bells earlobe-wise, but it’s not as if he’s going to admit it. Problem is, the human earlobe doesn’t quite allow for tapping on it as you would a knee, nor for taking the temperature of.

He studies my earlobes carefully. “Hmm, left lobe or right?”

“Left,” I say firmly, happy to finally be able to provide some concrete answers.

He looks it over, and then says judiciously, “well, let’s keep an eye on it. We could run you through all sorts of tests but let’s just take another look at it in three months. If it bothers you in the meantime, make an appointment with my nurse and we can take it from there.”

When I leave him, thanking him profusely, he’s a little distracted, thinking longingly perhaps of what it will be like when he retires and finally no longer has to deal with people like me. 

As for me, as I walk out to the parking lot I sort through my feeling.

I’m second to none in my admiration for this doc as an all around general practitioner, but even I have to admit that he lacks a little something in his diagnostic skills. \

I mean, he should have been able to fine something wrong earlobe-wise, Lord knows I just about spilled my guts to him on the topic.

And then, right as I climb in the car, that very moment... you know that strange sensation I was telling you about that brought me into the doctor’s office in the first place? The ache or the burn or the sharp twinge along this or that extremity? Guess what’s back.