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The Art of Medicine

Agate eyes

Maurer, Brian T. PA-C

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Journal of the American Academy of Physician Assistants: December 2019 - Volume 32 - Issue 12 - p 58
doi: 10.1097/
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“Your next patient is in Room 10. She's complaining of a sore throat. I've got a strep test running,” the nurse tells me. “Do you know this mother?”

I glance at the last name on the child's chart. “Not sure,” I muse.

“She's got breast cancer with mets to the liver, lung, and brain. She looks more frail each time she comes in. The grandmother's with them today.”

“Thanks for the heads up,” I say.

I retire to an empty examination room to review the chart. An entry from 2 years back jogs my memory. This woman had learned she has breast cancer midway through her last pregnancy. She elected to forgo treatment and carry her baby to term. Radiation and chemotherapy were started immediately after the birth of the child. It had been a rocky course. I close the chart, walk down the hallway, and rap gently on the examination room door.

The 6-year-old girl rests in her mother's lap; her long hair cascades down, partially hiding her face. The mother smiles a weak hello. The grandmother rests in the chair by her side, arm across the back of the mother's chair.

“I understand somebody's got a sore throat,” I say, mustering a slight smile. “Who could that be?”

The girl buries her face in her mother's arms. “She got sick to her stomach last night,” the mother says. “I gave her some fluids, but she couldn't keep them down. The fever came early this morning. It's probably just a virus, but I wanted to have her checked before the long weekend.”

“Good idea,” I say. “If she's got strep, we can start her on some antibiotics and nip this in the bud.” I settle into the stool and reach for a tongue blade and the throat lamp. “Can you open wide so I can see your throat?”

The girl's hands fly up to cover her mouth; she squeezes tears from her eyes and shakes her head. “It's okay,” the mother says. “He's not going to swab your throat—the nurse already did that. He just wants to have a look, that's all.”

“Won't hurt, I promise,” I say.

The girl hesitates, drops her hands, and opens her mouth. I catch a glimpse of the posterior pharynx. “She does have a red throat,” I say. “Let's have a look in her ears—”

Immediately, the door flies open and the nurse appears with a new toothbrush, the sine qua non that substantiates the diagnosis. “Her strep test is positive,” the nurse says, handing the envelope to the mother.

“She just had strep last month,” the grandmother says. “Do you think it might have come back?”

“This is probably a new infection,” I say. “Not a relapse.”

The grandmother's face tightens. Silently, I regret the word choice. The mother merely smiles. “At least she'll feel better soon,” she says.

“Yes, probably by tomorrow morning,” I say, handing her the prescription. She reaches out a thin white hand to accept the paper. I realize that this could be the last time that I see this mother. I search for words, but nothing comes into my head. What to say? I know your prognosis; I'm so sorry. How are you feeling? Try to get some rest. Mere turns of phrase, all inadequate.

I sit back and study the girl's face as she rests her head back on her mother's chest. Those eyes, such a rare color: a swirling mixture of blue-green, turquoise like the Caribbean Sea.

“Your daughter has such beautiful eyes,” I say, almost without thinking. “They remind me of the color of an agate that you might find on the beach of a Caribbean island.”

A gentle smile forms on the mother's face.

“What a lovely thing to say!” the grandmother says. “Have you been to the Caribbean before?”

“Many years ago, when I was in the service,” I say. “The color of the sea down there is breathtaking—so vivid, so beautiful.”

I reach out a hand and rest it briefly on the little girl's head.

The nurse returns with a lollipop. “Watermelon!” she says, offering it to the little girl. “I had to dig down deep into the basket to find it.”

The girl's face brightens; agate eyes glisten: in this moment, all prior trespasses are forgiven.

Copyright © 2019 American Academy of Physician Assistants