The Hair Not There
Bustling out from another freshly finished triage encounter, I spin a corner and position myself in my chair, prepared to triage my next patient. I look at the little boy, about 4 years old, seated in his mother's lap. Next to him on a chair is his 7 year old brother. As I ask his mother what brought her son to the ER, she begins to relate the story of gastrointestinal symptoms affecting her son. He has been vomiting and had a few bouts with diarrhea.
As she speaks, I study the child, who looks simply pitiful. Yes, his eyes are a little hollow looking and complexion a wee pallid. Vital signs not outside of a panic margin. He is alert and interactive with decent capillary refill. But the vision that prompts me to exert an effort to not look at her with sad eyes is his head. Patchy spots of scalp present everywhere, soft hair looking like it was coming out in handfuls. The patternless, random, and shocking loss of hair makes his appearance very dramatic. I see a trace of ink on his scalp. He looks at me, sighs, and lays his head on his mother's chest. She appears to me to be holding up well, considering what is no doubt a deep pothole on a very rough road with this child.
After vitals and chief complaint, I steel myself and ask about past medical history. I do this with all the sensitivity I can muster, knowing that the answer will be difficult for her to give. I tilt my head in an expression of sympathy and see no trace of grief or fatigue in her face. Still, I am ready to hear the words. Chemotherapy. Cancer. Radiation. Name of oncologist. Dates of treatment, surgeries. "Tell me," I think, "I am ready to hear you now."
"Oh, he's very healthy, generally," Mom tells me.
"Denial?" I think.
I press on, "Any history of serious illnesses, surgeries? Is he currently under any therapy?"
"No," states Mom, pleasantly.
"Anything at all?" I let the question hang in the air and lean forward slightly.
"No, except for what's going on today, he's really healthy."
I am completely baffled. Finally, I cannot think past this illogical presentation. I try not to stammer when I ask, "...but his hair? What is the reason..?" I get no farther than this when his brother, calm and quiet to this point buries his head in his arms. "Uh oh, I thought, he understands how ill his brother is".
Mom, now aware of my repeated questioning motives suddenly laughs. She gestures to the patient's brother and says, "His brother here...he sort of cut his hair today". Guess a little magic marker action was all part of it, perhaps trying to hide the glare of the scalp, or just adding a creative touch.
Mom and I have a chuckle. Patient gets taken back, treated, and released doing much better. I, of course, initially accompanied the child to the ER room to make sure the primary nurse understood the alopecia etiology. I wonder if she would have jumped to the same conclusion I did, but of course will never know. What I do know, is that despite the boy's illness, he was able to spread some good humor that day.
LatteGuzzler has '30' year(s) of experience and specializes in 'ER, amb surg, home health'. From 'seattle'; 59 Years Old; Joined Aug '02; Posts: 25; Likes: 15.
Must Read Topics