Tuesday, August 16, 2011

The Art of Differential Diagnosis.

I awkwardly unscrewed the top off the dishwasher door. The two young women stood above me approvingly. I acted like I knew what to do.

It was a new machine but I already drove out twice in the last six months. Damn latch. I didn't have the heart to tell the girls that I couldn't fix it. Or to explain how, as a child, I avoided the cabinets full of tools that my father left behind when he died. So much material but no capable hands to teach me how the hell to use it.

So I grew up in a mother centered household. We didn't fix things. We called someone.

As I pulled the cover off the door my mind raced back to the office. To the image of the uncoordinated violinist.

She taught music until the economic downturn. Saddled with impatient debt and screaming debtors she started to perform regularly. Until the day she noticed something wrong.

I glanced blankly at the guts of the washing machine door. Gently I eased the latch out of its compartment and glared. Why was it stuck?

My violinist had lost control of her left index finger. Try as she might...she couldn't play the challenging pieces. The finger was lame...dumb. Slowly responding to the music while the others raced ahead obliviously. But the index could no longer keep pace on the finger board.

The latch was being held back by a catch. A safety mechanism perhaps?

I stared into her eyes. Her pupils were reactive. I weaved and bobbed through the neurological exam noting no abnormalities. At last I came to the hand. I compressed each nerve in the wrist carefully and watched for a response. Her pulses were normal. Then I asked her to place both hands on the exam table face up.

I greased the catch with DW40. It still wouldn't release the latch. Finally I removed the spring from the catch and watched it fall to the side. The latch now moved freely.

After concentrating for a few minutes I noticed it. A lump in her left wrist. It was small but placed perfectly to impinge on the long tendon that races through the hand and ends at the tip of the index finger.

I suspected a ganglion cyst. A quick procedure by the hand surgeon and her finger would dance again.

It took another thirty minutes to remember how to fit the latch back in and then screw the top on. I watched with satisfaction as I closed the door.

Flipped the latch...

and started the dishwasher.

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