I’ve spent years caring for patients in small-town Virginia, where every cough, fever, and tear has its own story. Sometimes, the stories I remember most aren’t about dramatic diagnoses or heroic saves—they’re about a child with a sore throat and a worried parent by her side. In the exam room, medicine and humanity meet in a hundred small moments of curiosity, comfort, and hope. Here’s one of those moments.
“I CAN ONLY eat popsicles, cuz my throat hurts,” says five-year-old Rosie, rubbing snot from her nose with the back of her hand. It congeals into green paste. A paste full of germs.
But it doesn’t bother me.
This is my job, deciphering the sights, sounds, and smells of the human body. They provide the clues I’ll need to play detective as I search for the culprit that brings Rosie to my office today.
I ask mom the usual questions:
How long has she been sick? Three days.
Fever? Yes.
Cough? Yes.
Runny nose? Like a faucet.
Vomiting? Yes.
It’s time to examine her. She gives me a coy smile from the safety of her mother’s lap, revealing a gap where her two front teeth were once. A head of dark curls encircles her chubby-cheeked face. These cheeks wear a rouge the color of bright pink roses, but I don’t think this blush comes from a CoverGirl compact. This little girl has a fever.
I touch her forehead with the back of my hand. It’s warm, like a fresh sunburn after that first day at the pool. I slide my thermometer across her forehead: 102.5 F.
Rosie climbs onto the exam table. The paper crinkles as she slides into place, then rips as she adjusts herself. Kids love to play with the paper, shifting and wiggling to make funny noises. She swings her legs, a nervous tick among young children, distrustful of the instruments lining the walls and counters.
I listen to her heart. It’s pounding. Thump-thump, thump-thump.
I ask her, “Have you ever heard your heart?”
She shakes her head no.
“Would you like to?”
She shakes her head yes.
The earbuds of my stethoscope barely fit in her little ear canals. I put the diaphragm over her heart. Her eyes widen as she hears the stampede in her chest.
I love that part.
I ask her to take some deep breaths, listening for whooshes like ocean waves. No snap, crackle, or pop of air through mucous in the air sacs. Rosie’s lungs get the all clear.
Next, I check her ears, asking if she has kitties or unicorns hidden in there. That gets a giggle.
The left ear has a healthy coating of wax, brown and sticky, like caramel, but with an acrid odor—organic and pungent. The ear drum resembles a pearl, no larger than a small button. Its iridescence reflects the beam of my otoscope like sunlight on a still lake. Through the paper-thin membrane, I see tiny ossicles, the smallest bones in the body, easy to identify in Rosie’s healthy middle ear.
Now to her right ear. She winces as I insert the otoscope tip.
“Does that hurt?”
A vigorous nod.
More wax. But the membrane beyond is angry—bright red with tiny, dilated vessels snaking across it. It bulges like a balloon, and behind it, I can’t see the ossicles—just tiny bubbles trapped in thick yellow pus.
I palpate behind her ears and feel the telltale lump of an angry lymph node. It’s firm like a frozen pea and tender like a bruise. I feel further down her neck, the chain of nodes on the right side revealing the same: firm, tender, angry.
Finally, I check her throat—her tonsils nearly kiss, they’re so swollen. And they’re coated in white exudate, the hallmark of strep throat.
No doubt about it, Rosie has the double whammy—strep throat and a nasty ear infection.
But thanks to Sir Alexander Flemming, a ten-day course of penicillin will have her turning cartwheels in no time.
Every chart, every child, every parent’s worry—there’s a little story tucked inside, waiting for a kind eye and a popsicle.
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