24. The Diner
It was around the end of my first residency year that I discovered this 24-hour diner just one block away from Brooklyn’s hospital. I was starving after a long on-call day when Jane told me about this place.
‘The food is great, and the coffee is free for hospital workers.’ She winked. ‘You’re gonna love it.’
And I did. It was a welcoming place with great service, so I became a regular. Lily, a 40-year-old waitress, was always serving my table when I was there. I brought Jax and Peter with me a couple of times and they loved it just the same.
‘Morning, Lisa.’ Lily said when I sat down. ‘The usual?’
‘Yes, please!’
It was Monday and I had spent almost the whole weekend at the hospital. The topics I needed to study were piling up, so I got my laptop from my bag and started reading about a condition we suspected one of my patients had. After about 10 minutes, Lily brought my coffee with two bagels, one garlic and one chocolate. I turned my eyes to the food she brought and noticed something on her hand, she had what looked like a rash on her knuckles.
‘Thank you.’ I said smiling and looking at my screen again, I didn’t want to stare.
That was weird. Familiar almost. I opened a new tab on chrome and googled Gottron papules. Yep, it looked a lot like what Lily had on her hands. Her’s weren’t so obvious though, it was a slight rash, with small papules, on her metacarpophalangeal joints, and maybe on her interphalangeal joints as well, I wasn’t sure. But it was definitely there. Still, I had been going to the diner for a month by then. How did I miss it?
I went back to my study, I would sometimes spend hours at the diner reading. For me, studying in a coffee shop or any place that had people talking in the background was always better than a silent library. But as hard as I tried, that day I couldn’t focus. I couldn’t stop thinking I should talk to Lily somehow. So I called Jax.
‘Hey, can you talk?’
‘Well, I was sleeping actually.’ he yawned. ‘But shoot.’
‘I have a dilemma. I think the waitress of the diner may have a disease. She has this rash on her hands.’
‘God, Lisa. Are you sure? We’ve talked about this, you need to stop diagnosing strangers.’
‘I know, I know. But hear me out. She has these raised papules on her knuckles that look like gottron’s papules.’
He thought for a moment. ‘Shit.’
‘Yeah. And she’s not a stranger by the way, I see her almost every day. What do I do?’
‘Look.’ he sighed. ‘If you really think that, maybe you should talk to her. Don’t freak her out. Just ask her about it, maybe it’s just some kind of contact dermatitis.’
‘Okay… I think you are right.’
‘I usually am.’
I laughed. ‘Thanks, jerk.’
I rehearsed what I would ask her a couple of times in my head. After a while, Lily came to get my plates, and that was my queue.
‘Lily, I hope you don’t mind me asking, but what happened to your hands?’ Maybe I really was being paranoid and it was just the detergent she was using.
‘Oh, I don’t mind at all! But I don’t have an answer for you… At first, I thought I was probably burning them in the kitchen without realizing it, but I started paying more attention and that’s not happening.’
‘I see… Is there anything else going on with you? Are you feeling weaker lately?’
She looked puzzled. ‘Actually, a little bit. I mean, nothing major, you know. I can still do my job, but carrying the trays has become harder these days. I even dropped one last week, and I hadn’t done that since I was your age.’ She laughed.
I nodded.
‘Look, that may sound a little sudden, but I think you should set a doctor’s appointment for you. Tell him about this rash and your other symptoms.’
‘You think?’ She looked a little worried.
‘I do. I am not sure if it is something, but if it is, maybe there’s a way to make you feel better.’ I reached for her hand. ‘If you want, I can help you set an appointment at the Hospital’s clinic.’
She thanked me and accepted my help. The next day, I went with her to set an appointment at the outpatient clinic.
About two weeks later, it was the day of her consultation. She asked me to go with her as a friend, so I did. I waited with her until the doctor called her in. He was a resident like me, I didn’t know him well but had seen him in the hallways sometimes.
After 30 minutes, Lily came out and hugged me.
‘Thank you, Lisa, for bringing me.’
She went on to tell me about what Dr. Henry had told her. I noticed she wasn’t wearing makeup anymore, he probably asked her to wash it off, and there it was: a heliotrope rash around her eyes.
‘He thinks I have Dermatomyositis. He ordered me some exams, and if they confirm it, he will give me a prescription for prednisone.’
‘That’s good, Lily! I hope you get better soon.’
I didn’t share with her some of my other worries at that time. Some cases of Dermatomyositis can be secondary to malignancies, like ovarian cancer. I silently prayed that wasn’t her case.
In her follow-up appointment, I was there with her again, in the waiting room.
‘I read about it, you know.’ She turned to me. ‘I know that it can be cancer.’
I didn’t know what to say so I kept silent.
‘Let’s wait and see, right?’ She was almost comforting me.
‘Right.’ I nodded.
…
Want to read more about Dermatomyositis?
https://rarediseases.org/rare-diseases/dermatomyositis/
Want to read a real case of Dermatomyositis?
https://www.researchgate.net/publication/297604088_Dermatomyositis_A_case_report
Clinical Board
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