She was a 4 year old girl lying wrapped in a blanket on the exam table, eyes red from tears. I was going through my usual routine; I started with an interview of the parent asking about the course of the current illness. I systematically asked the when, how long, is it improving or getting worse, what have you given her to help with the pain and vomiting, etc. After gathering the story from the girl's mom, I approached the girl on the exam bed and began my exam. She was in clear distress, but it wasn't until I began my abdominal exam that I became really concerned. As I uncovered her and began to feel her abdomen, she began to cry and wail even more. I felt as deep as I could and she continued to be more distressed. Possible diagnoses were coming into my mind; acute gastroenteritis, appendicitis, sepsis, others. I was beginning to be more concerned that she may have need for surgery. I ended my exam and went to present to my resident. The resident came and did the exam as well,...
Excerpts of a rural hospitalist's thoughts and experiences