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Authors: Peter Clement
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physique.
CVS: Normal heart sounds. BP 85/60; P 88
Chest: Clear
Abdomen: Non-tender, normal bowel sounds, no bruit, no masses, liver and spleen normal. Surgical scars RLQ and midline below the umbilicus consistent with history of appendectomy and laparotomy.
External genitalia: Normal
Limbs and extremities: Normal
Skin: No rashes at present.
EENT: Normal.
Head and Neck: Normal
Neurological Exam: Normal
Impression: Healthy young girl. Functional GI disorders and neurodermatitis, both secondary to stress.
Plan: Prescribed fun and sun. Good nutrition. Frank discussion with Mrs. McShane stressing the absence of any physical illness in her daughter. Follow up in one month to see how child is doing, or immediately if symptoms return (which isn’t likely).
Mark started to flip the page when he saw written faintly in pencil off to one side the word
Mother?
He smiled. His father had obviously nailed the problem, diagnosing Kelly’s symptoms as the result of a high-strung parent.
No further entries appeared on the other side of the paper. Clearly Kelly’s mother hadn’t brought her daughter back. Probably hadn’t liked the “frank discussion.”
He shivered. The dampness down here had already penetrated his bones, but now he felt a draft around his legs. He got up and walked over to the slat door that was taking the brunt of the wind. A flow of cool air from where the bottom had warped out of the frame ran across his feet. He grabbed an old coat and stuffed it into the opening.
Seated again, he came to a sheet not so faded, but nevertheless aged. It had brief entries running from July 1, 1970, to July 3, 1974. Each one was identical. Three words: Psychiatric support therapy. Mark let out a solitary quiet chuckle. He’d been right about Kelly discussing her issues with his father. But the man had done what he, Mark, did when the material was so sensitive the patient wanted it to be kept absolutely secret, even from people authorized to look at the record – simply recorded that the session took place, not what was said.
Discouraged, he went on to the third document, a sheet of flowered stationery folded in thirds.
Opening it, he read:
July, 14, 1974
Dear Doctor R,
The salutation made him smile. Kelly had always called his father Dr. R.
You were right. I was not being candid with you when we met two weeks ago. There is a reason I’m so happy, and you are the first and only person I can tell.
I’ve met a man.
A wonderful, caring man who loves me, and I love him.
What a release to be cherished, respected, and liked. I feel as if all the other garbage has fallen away, and I’m free, with a new life ahead of me. Whether it will be with him or not, I don’t know, but I’m full of hope. I haven’t decided yet what to do about it all, and look forward to talking over possible strategies with you. But I am ecstatic!
Regarding the other two matters, we must discuss those. Whatever I plan for myself, I can’t leave and let them go unresolved.
Can we have lunch at the Plaza on Saturday, the twenty-seventh? I can’t bear to go to the estate on weekends anymore, and have pleaded hospital work as my excuse to stay in the city. Waiting to see you then.
Love,
Kelly
Mark’s pulse leapt.
The
man
could be the mystery person in the cab. If his father had kept the appointment with her, she’d probably told him who it was.
He quickly pulled out and unfolded the next two sets of documents in the file, hoping to see a note or follow-up letter about their meeting.
No such luck. In his hands he held photocopies of some New York City Hospital M and M reports, or Death Rounds, the conference that reviews patient morbidity and mortality.
What the hell were these doing here? Scanning through them, he saw that they were accounts of two separate cases involving digitalis toxicity. The first patient had lived, the second had died, but there were no names listed, only chart numbers, standard practice
CVS: Normal heart sounds. BP 85/60; P 88
Chest: Clear
Abdomen: Non-tender, normal bowel sounds, no bruit, no masses, liver and spleen normal. Surgical scars RLQ and midline below the umbilicus consistent with history of appendectomy and laparotomy.
External genitalia: Normal
Limbs and extremities: Normal
Skin: No rashes at present.
EENT: Normal.
Head and Neck: Normal
Neurological Exam: Normal
Impression: Healthy young girl. Functional GI disorders and neurodermatitis, both secondary to stress.
Plan: Prescribed fun and sun. Good nutrition. Frank discussion with Mrs. McShane stressing the absence of any physical illness in her daughter. Follow up in one month to see how child is doing, or immediately if symptoms return (which isn’t likely).
Mark started to flip the page when he saw written faintly in pencil off to one side the word
Mother?
He smiled. His father had obviously nailed the problem, diagnosing Kelly’s symptoms as the result of a high-strung parent.
No further entries appeared on the other side of the paper. Clearly Kelly’s mother hadn’t brought her daughter back. Probably hadn’t liked the “frank discussion.”
He shivered. The dampness down here had already penetrated his bones, but now he felt a draft around his legs. He got up and walked over to the slat door that was taking the brunt of the wind. A flow of cool air from where the bottom had warped out of the frame ran across his feet. He grabbed an old coat and stuffed it into the opening.
Seated again, he came to a sheet not so faded, but nevertheless aged. It had brief entries running from July 1, 1970, to July 3, 1974. Each one was identical. Three words: Psychiatric support therapy. Mark let out a solitary quiet chuckle. He’d been right about Kelly discussing her issues with his father. But the man had done what he, Mark, did when the material was so sensitive the patient wanted it to be kept absolutely secret, even from people authorized to look at the record – simply recorded that the session took place, not what was said.
Discouraged, he went on to the third document, a sheet of flowered stationery folded in thirds.
Opening it, he read:
July, 14, 1974
Dear Doctor R,
The salutation made him smile. Kelly had always called his father Dr. R.
You were right. I was not being candid with you when we met two weeks ago. There is a reason I’m so happy, and you are the first and only person I can tell.
I’ve met a man.
A wonderful, caring man who loves me, and I love him.
What a release to be cherished, respected, and liked. I feel as if all the other garbage has fallen away, and I’m free, with a new life ahead of me. Whether it will be with him or not, I don’t know, but I’m full of hope. I haven’t decided yet what to do about it all, and look forward to talking over possible strategies with you. But I am ecstatic!
Regarding the other two matters, we must discuss those. Whatever I plan for myself, I can’t leave and let them go unresolved.
Can we have lunch at the Plaza on Saturday, the twenty-seventh? I can’t bear to go to the estate on weekends anymore, and have pleaded hospital work as my excuse to stay in the city. Waiting to see you then.
Love,
Kelly
Mark’s pulse leapt.
The
man
could be the mystery person in the cab. If his father had kept the appointment with her, she’d probably told him who it was.
He quickly pulled out and unfolded the next two sets of documents in the file, hoping to see a note or follow-up letter about their meeting.
No such luck. In his hands he held photocopies of some New York City Hospital M and M reports, or Death Rounds, the conference that reviews patient morbidity and mortality.
What the hell were these doing here? Scanning through them, he saw that they were accounts of two separate cases involving digitalis toxicity. The first patient had lived, the second had died, but there were no names listed, only chart numbers, standard practice
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