The Art of Medicine: Evaluating the adolescent patient

I glance at the nursing note. Weight is recorded as 241 lb, a gain of 20 lb over the past 10 months. “Big kid,” I remark. The student nods her head. I rap on the door and we step across the threshold into the room. more»

Interested readers can now access my latest Art of Medicine column — An exercise in evaluating the adolescent patient — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.

Shattered leaves

The crickets continued to chirp late this year, well into the weeks when the leaves turned golden scarlet. The evening sun streamed through the yellow-orange leaves as they fell from the trees like shattered stained glass from ancient cathedral windows.

A huge icon of the Madonna and Christ child towered above the paneled altar, its entire background set in gold leaf. An arch depicting Christ and the Apostles at the Last Supper framed the dome above the open casket where the wooden remains of an adolescent girl rested. Just to the right of the casket another framed icon rested on an easel draped in crimson cloth. The people who filed in to pay their respects to the family focused on the framed icon, and some cast fleeting glances at the brown form before turning away.

We sat on the hard wooden pews and stood as the priest directed, following the lead of the family, front and center before the casket. The priest intoned the words in English; an elderly cantor echoed in Greek. At some point a censer was swung on either side and at the head and foot of the casket, and the odor of burning incense wafted back through the pews.

One of the cantors read a passage from Saint Paul’s Epistle to the Thessalonians, then the priest read a selection from the Gospel according to Saint John.

Afterwards the priest brought out a small lectern and stood to deliver the eulogy. He spoke about the need to peel back our layers of pain to see the image of God in another person. He spoke of the need for heightened awareness: to be attentive to warning signs we might see in others to allow for timely interventions before it was too late.

Then he spoke about the artistic gift that the girl had had: the innate ability to capture light in color and line to create an image — an impression, an icon — the way the world looked to her. At the end I suppose she could no longer see the goodness of it, could no longer bear the pain of living in it; and the light inside went dark.

Again the words, again the prayerful chant. One by one we stood and filed forward one last time, then filtered out through the doorways into the morning brightness.

The golden leaves tumbling down from the blue-grey trees shattered in the brightness of the noonday sun.

Van Gogh_Wheatfield with Crows


My recent diagnosis of onychomadesis in a 5-year-old boy led to an online search of the medical literature for verification of the most likely etiology — with favorable results. more»

Onychomadesis is the spontaneous, complete shedding of the nail from its proximal side, without pain or inflammation, following nail matrix arrest.

Interested readers can peruse my case report — Nailing down a diagnosis — recently published in the Online Journal of Community and Person-Centered Dermatology.

The Online Journal of Community and Person-Centered Dermatology (OJCPCD) is a free, post-publication peer-reviewed, full text open-access online publication that addresses all aspects of skin disease that concern patients, their families and practitioners.