37 y/o African American female presents with pain in the right ear. She walks in with a cane, struggling to walk and sit in the chair in her room. Her language slurs as she speaks.
“How long have you had this pain in your right ear?”
“Since my stroke on Friday”
M4 and i masked how stunned we were.
“You had a stroke on Friday? Tell me more about what happened.”
“On Thursday my head was hurting me. I went to urgent care and they told me I had a headache so I went home. On Friday the pain worsened so I called my sister and she told me to go to the emergency room. When I went they took a whole bunch of tests on me and an MRI of my head. The neurologist said I had a migraine and made me promise to follow up with her a week from then. When I got home I was reading my discharge papers and saw CVA. I didn’t know what that stood for so I googled it and google said I had a stroke.”
M4 reached out for a box of Kleenex to give to the patient. Confusion filled the room. M4 did a neuro exam on her. “Follow the light. Follow my finger. Push against my hand with your right hand, push against my hand with your left hand. Pull my hand toward you with your right hand, now with your left. Kick with your right leg, kick with your left.
Smile for me.”
Her crooked smile.
“Smile and show me your teeth.”
Her crooked smile.
“We’ll be right with you, hang tight.”
M4 walks out of the room, his hand and the wall met. “That’s the kind of shit you’re gonna see in medicine.”
Her smile looked so real. Her eyes winked as she pulled her cheeks in tight. The right side of her smile drooped, but I wouldn’t have noticed if I saw her outside of the office. Goes to show you that anyone can smile, crooked or not, and mask so much pain and suffering.

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