8. The Plumber


'Morning, Vincent! Everything okay over there?'

The Hospital was undergoing some repairs that month due to leaking pipes, so a few workers were there. Vincent was the plumber. He must have been like 52-years-old at the time, but he looked incredibly sharp. I already knew him because he had fixed some pipes in my apartment one day.

'Still has some leaks, Dr. Diaz, but don't worry, we'll be out of your way soon.' He smiled widely.

'If it was up to me you could stay as long as you want.’

‘Hi, Kate, how are you?’

‘Tired but happy.’ She yawned.

‘Well, get used to it. That’s residency.’ I smiled. ‘Did you see your patients yet?’

‘Yes, can we go over them before rounds?’


Kate and I started doing quick briefs to each other about our patients in common. That way we had more heads to think and less chance of missing something. It was fun and it made us feel more confident in rounds.

We saw a few patients that day but none of them are the reason I am telling you this story. Vincent is the reason. When I was coming back from lunch with Kate, I offered Vincent one of the donuts I had gotten for us at the cafeteria.

‘Oh, thank you Dr. Diaz, but I’m gonna pass today. I've been having some difficulty swallowing in the past weeks.’

‘Really? Why is that?’ I frowned.

‘I don’t know. But every time I try to eat solid food I feel my chest tightening.’

‘You should get that checked out.’ I tried not to show how worried I was. ‘Do you want me to make an appointment for you at the clinic?’

‘Oh doc, you know I don’t have time for that.’ He smiled. ‘But it’s okay, I’ll figure something out. Maybe it’s just my gastric reflux.’

‘Okay, Vincent. But if you don’t get better I am going to schedule you an appointment and make you go.’ He laughed.

A couple weeks went by. Vincent was there every day and even though he told me he felt better, I didn't believe him. He never ate anything and was looking thinner. I was worried. So I started to watch him more closely.

His nails were weirdly shaped like something had deformed them. Could it be related to his job? I wasn’t sure. And his mouth looked reddish at the corner. But I still hadn’t figured out what was wrong with him.

A few days later we were all having lunch at the cafeteria, me, Peter, Jax, and Kate. Jax was telling some funny stories about his new dog.

‘Speaking of which, when are you going to find a new roommate Lisa?’ He turned to me.

‘Oh that’s right, you’re living alone now.’ Peter said. ‘But that’s probably better than living with this idiot anyway.’ He pushed Jax.

‘Damn right!’ I joined the teasing. But actually, I could use a roommate. I liked having my own space, but I also missed having someone to talk to when I got home. Living alone can get very quiet.

Then they went back to talking about Jax’s new dog - Ted? Ed? I don’t recall his name anymore and it didn’t last, Meg wanted him out by the end of the month after he ruined the sofa. But I stopped paying attention when I saw Vincent working at the corner of the cafeteria.

He didn’t look as healthy as the other workers, but I was having a hard time pinpointing exactly what was wrong. It was actually Kate that made me realize what it was.

‘Vincent looks so pale, doesn’t he? He looks almost as white as the wall.’

I stared at Vincent some more and then it hit me.

‘Oh my, you are right.’ I stared at Vincent some more. ‘He is very pale.’

‘Why do you look so excited about this?’ She laughed in a confused manner.

‘Do you remember when I offered him donuts and he denied it because he was having dysphagia?’ She nodded. ‘I was worried about him, so I kept noticing him, his nails, his lip, but something was missing, and that was it! Pallor!’

She thought about it for a few seconds.

‘Oh! Plummer-Vinson?' She asked and I nodded. 'Smart.' She continued. 'It makes sense. Iron deficiency anemia, esophageal webs, angular cheilitis, and koilonychia.’

‘Yes!’ I was excited. ‘But damn it.’ I laid my head in my hands.


‘Now I have to talk to him. That’s the hard part of diagnosing people out of the office.’ I laughed.

‘True. But you’ll have to admit that it’s fun.’ She smiled and looked at her watch. ‘I have to go. Good luck talking to him, Lisa.’

I don’t remember exactly what I told him but for sure I didn’t tell him the name of what I thought it was - Plummer-Vinson Syndrome sounds scary, I left that for the actual appointment. But the important part is that he tested and treated his anemia and his other symptoms. To this day when we see each other, he always brags about me.

‘You know that girl right there? She found out I had this weird syndrome just because I denied her a donut. Can you believe it?’

Want to know more about Plummer-Vinson Syndrome?


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IDA: iron-deficiency anemia; Esophag: esophageal; MC: most common

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