Physical Diagnosis

(abridged from "Consider the Season " by R. Merliss)

The afternoons were devoted to a new course, physical diagnosis, in which the students practiced the technique of examination on one another. Dan and Noble again were partners. They spent a whole week learning to use a stethoscope.

"Take a deep breath. Now hold it. Now cough." After the cough Dan heard something odd in the right lung. He put the stethoscope down. "I think you've got rales in the right lung".

"What do you think it means?" "Maybe a cold."

Noble looked around. Then he said quietly, "My mother and father died of tuberculosis".

"Have you been swimming lately? Maybe you got some water in your lungs"

"I've lost eleven pounds."

"Maybe you ought to get an X-ray."

"Be quiet," Noble whispered fiercely. "If they find out about this I'll be put in a sanitarium. I won't get out for a couple of years, and I won't finish the medical school then. I'll be out of money."

"Are you sweating at night?"

"Sometimes I sweat. Don't you?

"Not much. You ever run a fever?"

Noble felt his own forehead. "I don't know," he said.

"Get a thermometer. Take your temperature whenever you get a chance, particularly in the late afternoon."

Noble looked at him. "Don't tell anybody about this," he said.

"You ought to see a doctor. The school doesn't have to know anything about this."

"It's a reportable disease."

Dan had forgotten. All cases of tuberculosis had to be reported.

In the evening Dan took Noble to the laboratory after everybody had left. They looked at Noble's sputumunder the microscope.

"They look like ТВ germs tome", Noble said. "I ran a fever and sweated a lot last night. I lost three more pounds. I can't eat at all now."

"You ought to go to a doctor. You have to get an X-ray."

"I'm not going to a doctor. Don't give me away."

So Dan managed to get Noble into X-ray unnoticed. He took his chest X-ray and developed the film. When Noble looked at the picture he was sure it was tuberculosis. Dan was not sure. He showed the picture to Dr. Rosenthal, who said that the picture was badly overexposedand he couldn’t tell a thing.

That night Noble didn't go home. His sister had a little baby and he was afraid that he was contagious. He slept at Dan's. All through the night Dan heard him moving restlessly and coughing. In the morning Dan droved directly to the hospital and took Noble to Dr. Rosenthal. The doctor took out his stethoscope. After a while he asked Dan where he had heard those rales. Dan showed him. The doctor handed him the scope. "Find them for me." Dan heard nothing but the soft movement of air in Noble's lungs. Then Dr. Rosenthal listened again.

"Have you had a cold?"

Noble nodded. "I'm just getting over one."

Rosenthal shrugged. "You got mixed up between coarse rales and fine rales." He said to Dan.

"What?" Noble said, "I can't eat and I've been sweating and I'm feeling lousy."

"I'd feel the same way if I thought I had tuberculosis. All you have is a cold," Dr. Rosenthal said.