“It hurts when my sister steps on me and when I bump this spot on something in the house,” the enthusiastic boy said as he pointed to the offending bump on the big toe of his de-socked foot, eager to help me diagnose his problem.
I knew right away why the little guy’s foot hurt him. The recognition came to me not because I am an exceptionally experienced medical student or had just read and studied the differential for nine-year-old boys with foot pain, but because a large wart on his big toe was now staring me right in the face. I felt relief that this energetic young patient had presented with a problem that while uncomfortable, would be easy to treat and have no long lasting implications for him.
“I think you might have a wart. I’m going to bring in the doctor, and he will tell you what our options are for making you feel better and making it go away.” Only then did the thought cross my mind that treatment for the wart was likely to dampen some of that positive enthusiasm he had brought to the office visit.
I led my preceptor physician back into the patient room after discussing the case. He took a look at the boy’s foot. “So, have you named it yet?” my preceptor toyed. The boy laughed. “I hope you have, because we are going to get rid of this today. If you haven’t named it yet, it’s too late.”
The boy suddenly became suspicious. Perhaps he had friends at school who told stories of painful wart removals. Perhaps he had seen his little sister get a wart frozen off of a foot or a hand. Or maybe it was sheer instinct — fear at having anything that was a part of him, no matter how uncomfortably so, torn off. He became wide eyed, and with his big dark eyes looked up at the doctor and asked the dreaded but necessary question, “How?”
At this point, I had taken on a shadowing role, simply observing how the doctor was going to treat this common condition. I was most curious about how he would get permission from this young patient to spray the offending toe with negative 364 degrees Fahrenheit liquid nitrogen. Before I had much time to ponder, he just did it. Three sprays, ten seconds each. To the patient, I’m sure it seemed much longer. It undoubtedly hurt. I saw a single tear in the corner of his eye. Still, it was over quickly. End of treatment, end of problem … end of visit?
Not so quick. What I witnessed next made the biggest impression on me. My preceptor pulled a small red flower from his pocket. The boy’s attention quickly shifted from the pain on his toe to the unlikely object. The doctor then dropped the flower into the remaining liquid nitrogen; it instantly froze before the boy’s wide eyes. The doctor picked up the now solid flower and allowed the boy to crack the stem in two and snap off all of the frozen petals.
There was no longer a hint of pain in the boy’s eyes. Instead, he was looking in anticipation at the doctor in case he had any more “magic” to share. Even though the doctor had to inflict pain on the boy’s toe to rid him of the wart, he took the time to mend his relationship with the patient and send him on his way with a smile.
Achieving health is a difficult endeavor. Success is most easily reached when there is trust and a concerted effort between physician and patient. Even the smallest of actions on a physician’s part can go a long way to foster a positive relationship and make a huge impact on a patient’s health and life. Watching my preceptor take the time to maintain this connection with his patient after the medical procedure was completed reminded me that treatment does not end when a medical problem is eliminated. When a patient can leave the office reassured of his concerns and confident that he has a place to come back to with future health issues, only then the visit is over.