Apr 25th, 2015
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Illness Not as MetaphorI was precepting in the continuity clinic, when an intern came to get me. She had already presented the 5-year-old child with fever and sore throat and indicated that she wanted to do a rapid strep, and I'd taken a look at the child, who had obligingly opened her mouth for me, and agreed that she looked reasonably comfortable, well-hydrated, no respiratory distress, and her tonsils were enlarged and erythematous. Yup, I'd said, do the rapid strep and then we'll talk. And I'd returned to the precepting area.Now the intern was embarrassed and apologetic. "I can't get it," she said. "The child won't let me get the rapid strep. She won't say `Ah.' I'm really sorry, but now I've got her all upset. What should I do?"I was supportive and reassuring. It could happen to anyone, I said, knowing that she was thinking I was just being supportive and reassuring, that it couldn't really happen to someone competent. Let me come help you, I said.And then I came up against the demon child from hell. Let me rephrase that: the child, who was already feeling sick, was now emotionally distressed and unwilling to cooperate with the insertion of a cotton swab into the back of her oropharynx. She signified this unwillingness by keeping her teeth absolutely clenched, against all the best efforts of her mother, the intern, and me. And she was successful. In the process of being successful, she made more noise than you'd think a child could make with her mouth closed and gen

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