Lady Spencer
Bouncing back to the bench, Lady Godiva harkens to Lady Spencer with her version of a gentle voice, “The Doc will see ya’!” The Lady Spencer takes her cue from her companion by approaching with a smile that disappears when she sits. The Lady launches into rapid monologue, “I am worried, Doc. I got eczema. It’s a problem. It hurt. Sometime it’ll git infected and I been to da hospital to git my eczema treated. Dey had to use IV antibiotics and everything. One time, it formed an abscess and dey cut it open. Took forever to heal. I’m worried to deafth about this eczema. It could happen anytime. It ain’t only in one place. Sometime it small and go away. Sometime it git worse and hurt and it stay. Maybe it be an allergy to something. Whadda you think, Doc?”
I examine The Lady Spencer. There are marks on her neck, arms, hands, tibia, and feet. None of the lesions are acutely infected, but resolving irritation of varying age overlies each punctate lesion. The diagnosis is clear— but most clear on her neck. The skin is thickened in the submandibular triangle with scarring from long-term and repeated episodes of significant irritation. The hyperpigmentation extends from the lesions and follows the veins. These are track marks.
I ask The Lady if she smokes cigarettes to which she responds, “Yeah, maybe a pack a day. Ok, maybe a pack-and-a-half.” I ask if she drinks alcohol to which admits. These are warm-up questions. I ask whether she uses needle drugs to which she answers, “No, no. I don’t do that. I would not never do that.”
Sadly, it is a familiar response. Surprisingly, more people answer this question with honesty than not. Either way, I understand. In a few minutes, Lady Spencer will understand as well.
Completing the physical exam including heart, lungs, abdomen, and nervous system, helps The Lady sense that her well-being is carefully assessed. I find more than track marks to address, but they must wait for another day.
The time has come to answer her question and reveal my thoughts. “There are a few things that cause eczema. Sometimes, eczema is caused by an over-reaction of the immune system that attacks part of the skin. Sometimes, eczema is caused by a reaction to an irritating substance like certain perfumes, lotions, or needle drugs.” To the mention of needle drugs, she searches my eyes looking for condemnation, which is absent. The truth hovers without criticism, judgement, or rejection. Now, she understands.
I continue, “The best way to avoid this problem is to avoid the substance irritating the skin.” I hand her a topical antibiotic. “This should help prevent an infection and promote healing. But, if you continue to expose your skin to the irritant, this antibiotic will not help. In fact, your heart valves may eventually become infected. Of course, that could mean death.”
Her eyes reveal understanding and her smile shines appreciation.
Episode 5: Count of Monte Cristo
more to come…
We encourage you to take to the streets and get to know the people, the struggles, and the stories for yourself. Bring food, socks, and an open heart.