“My throat hurts,”says five-year-old Rosie, rubbing snot from her nose with the back of her hand. It congeals into green paste, a paste full of germs. But it doesn’t bother me. This is my job, deciphering the sights and sounds, smells and textures of the human body. These are the clues that allow me to play detective as I identify the culprit that brings Rosie to my office today.
I ask mom the usual questions:
How long has she been sick? Three days.
Runny nose? Like a faucet.
It’s time to examine her. She smiles coyly at me from the safety of her mother’s lap, revealing a gulf where her two front teeth once were. A head of dark hair that might reach her shoulders were it not for unruly curls encircles her chubby-cheeked face. These cheeks wear a rouge the color of pale pink roses, but this blush comes not from a CoverGirl compact but rather from a fever. I touch her forehead with the back of my hand. It feels warm, like a new sunburn after that first day at the pool. I slide my temporal thermometer across her crimson brow: 102.5 F.
Rosie climbs onto the exam table. The protective paper crinkles as she slides into place, then rips as she adjusts herself. Kids love to play with the paper, shifting and wiggling as the crinkly covering protests in a symphony ofcrackles and creaks. She swings her legs rhythmically, a playful yet nervous tick among young children, distrustful of the display of instruments lining the walls and counters.
I listen to her heart, which pounds like the hooves of a hundred horses. Thump-thump, thump-thump. “Have you ever heard your heart?” I ask her. She shakes her head no. “Would you like to?” She shakes her head yes. The earbuds of my stethoscope fill her little ear canals. I place the diaphragm over her heart. Her eyes widen as she hears the stampede in her chest. I love that part.
I ask her to take some deep breaths, listening to each inspiration and expiration, a whooshing sound, like a the ocean’s tide coming in and going out. No snap, crackle, or pop of air forcing through unwelcome mucous trapped in air sacs. Her lungs get the all clear.
Next, I check her ears, asking if she has kitties or unicorns hidden in there, soliciting a giggle that rings in the quiet exam room, like the unexpected tinkling of wind chimes on a breezeless day. The left ear has a healthy coat of wax, brown and sticky, like caramel, with an acrid odor, sweetly organic, yet decidedly pungent. The ear drum resembles a pearl, no larger than a small button. Its iridescence reflects the glow of my otoscope like sunlight on a still lake. Through the paper-thin membrane, I can see tiny ossicles, the smallest bones in the body, like small chicken bones planted in Rosie’s healthy middle ear.
Now to her right ear. She winces as I insert the otoscope tip into her canal. “Does that hurt?” A vigorous nod. Again I see the wax, clinging to the canal like tiny stalactites. But the membrane beyond looks angry, bright red with tiny vessels dilated and snaking across the normally unblemished ear drum. It bulges outward like an overblown crimson balloon, and behind it I see tiny bubbles, trapped in a pool of thick yellow pus.
I palpate behind her ears and feel the telltale lump of an angry lymph node. It’s firm like a frozen pea and tender like a bruise. I feel further down her neck, the chain of nodes on the right side revealing the same: firm, tender, angry.
Finally, I check her throat, and her tonsils nearly kiss, looking more like rocks with crevices than discreet, innocuous deposits of lymph tissue. A white substance, like cottage cheese, coats the painful stones, the hallmark of strep throat. Her breath smells of sickness, rotten like something gone bad in the refrigerator. It’s warm and moist, her tongue red and swollen, her mucous membranes dry like a sponge that has not soaked water in a long time.
No doubt about it, Rosie has received the double whammy–strep throat and a nasty ear infection.
But thanks to Sir Alexander Flemming, a 10-day course of penicillin will have Rosie turning cartwheels in no time. But for now, it’s fluids, rest, and most important of all, popsicles. Never forget the popsicles. You will seriously regret it if you do!