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The Spider

Bruckner, Julia Michie MD, MPH

doi: 10.1097/ACM.0000000000001846
Teaching and Learning Moments
AM Rounds Blog Post

J.M. Bruckner is instructor, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado; e-mail: julia.bruckner@ucdenver.edu; Twitter: @JuliaMDWriter.

Author’s Note: The name and identifying information in this essay have been changed to protect the identity of the individuals described.

An Academic Medicine Podcast episode featuring this article is available through iTunes.

I lifted the crusted gauze delicately, peeling away the sticky layers of her dressing to reveal raw pink skin underneath.

“Ooh, child,” she winced. “That’s rough.”

“Sorry it’s uncomfortable, not many changes left,” I assured her.

“I know, I know,” she whispered.

Mrs. Williams had been admitted to the hospital earlier that month for care of the large burns on her legs. As a fresh third-year medical student on my general surgery rotation, I inherited the daily task of her wound care.

The student who had cared for Mrs. Williams previously briefed me on her history.

“She’s a 79-year-old lady with hypertension, diabetes, and peripheral vascular disease. She saw a spider, tried to light it on fire and lit herself up instead. Quite the story, huh? I think it’s some cultural thing, sending the spider away with fire. You know, she’s Caribbean,” he admonished, proud of using his “cultural competency.”

I soon learned that Mrs. Williams was a narrator of life. She occupied the many hours in her hospital bed by filling several notebooks with her stories. She regaled me with tales of her childhood in Barbados chasing chickens and chewing sugar cane, shared gossip from her neighbors in Brooklyn, and advised me how best to find a husband.

Soon a visiting nurse would become her audience. Her burns were healing well; she would be discharged that afternoon. As I cut strips of pungent Vaseline gauze for my final bandage, I pondered that inciting spider and Mrs. Williams’s curious method of pest control.

“You know, we never really talked about how you got these burns.”

“True, child. I can tell you, you like listening.”

She began, her accent captivating and eyes bright. “I was sitting on my bed, ready to say my prayers. I lit my candles. Then I seen a spider just crawling up to me. I knew I had to kill it, kill it good. So I grabbed my candle. You know, if that first spider die from burning, its spirit will tell the others to stay away.”

I nodded, though unfamiliar with such lore.

“And just quick, the fire lit up my sheets, then me. And that spider—all big, black, and purple, hairy with those red eyes—he laughed at me.”

I paused before placing the tape on her new dressing. “Wow. That must have been a strange spider. How big was it?”

“Oh about a dozen inches around I’d guess.”

That was certainly no Brooklyn spider, I thought, worried.

“Ah, so much better now,” she exclaimed, admiring the bright white gauze now hiding her wounds.

I glanced over at the open notebooks on her bed, realizing the random words and scribbles were not tales of a vivid imagination, but the products of a mind unhinged.

We’d presumed the spider and its fiery fate were a cultural myth; after a few probing questions, they became evidence of an ailing brain.

The surgery resident sighed when I told her of my discovery.

“Well, I guess we won’t be discharging her yet,” she grumbled, grabbing the phone to dial Mrs. Williams’s son.

“She’d been telling me about the spiders for months,” her son recounted. “Said she was always swatting them with a broom. I sent an exterminator but he didn’t find anything.”

Mrs. Williams at last received the broader evaluation she needed. Now every spider I encounter reminds me how dangerous assumptions can be in the practice of medicine. An extra moment, a deeper question, and a healthy skepticism can make all the difference.

Julia Michie Bruckner, MD, MPH

J.M. Bruckner is instructor, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado; e-mail: julia.bruckner@ucdenver.edu; Twitter: @JuliaMDWriter.

© 2017 by the Association of American Medical Colleges