In his forties it came to him he'd never be a professor, write important papers, or teach a dozen worried residents. But a Lutheran minister's son ruptured his spleen, and a sharp old
doc down south of Carroll called him in. Homer took out his spleen and saved his life. Oh, he knew any surgeon worth his
salt could have done it, too. But he was the one who was there...
The splenectomy that night was Homer's turning point. From then on he was satisfied to be the surgeon who was there.
—George S. Bascom, "Being There."
She sits quietly on her mother's lap. A child's blanket is draped over the crook of her left arm, the corner clutched tightly in her left hand close to her mouth. The right arm lies pronated across her thigh. The mother strokes her hair, whispering into her ear. Together they form a portrait which might have been painted by Mary Cassatt.
"What's wrong?" I ask, holding the little girl's chart in my hand.
"She won't move her right arm," the mother tells me. "As near as we can tell, it looks like it's her wrist, but we're not sure."
"When did she start to favor it?"
The mother looks at the father, who sits on the small step stool at the far end of the exam room. "Sometime late yesterday afternoon," he says. "I had her out to the park."
"Did she trip or fall down?" I ask.
He shakes his head. "She was hanging on the monkey bars, but she didn't fall." He demonstrates by holding both hands clenched above his head—a gesture of helplessness.
"Did you pick her up and swing her around holding her by the hands?"
Once again he shakes his head.
"How did she sleep last night?"
"Terrible. She was up most of the night whimpering. We couldn't console her."
"Sounds like nobody got any sleep," I say. "Well, let's have a look."
Gently, I lift the child's hand from her lap. "Let's count your fingers," I say, checking each MCP joint in turn. I palpate the wrist and then move to the shoulder, running my fingers along the length of the clavicle. She doesn't wince once.
Next I drop my fingers to her elbow. When I attempt to supinate the forearm, she wrenches her face; tears well up in her eyes. Now I have my diagnosis.