At the Buncombe County Health Department

Today I spent the day in the heart of Asheville, in western North Carolina, shadowing Dr. Mary Scott Hayes, a family practitioner at the Buncombe (pronounced "bunkum") County Health Department. She and her CNA assistant ran a pretty tight clinic, and the two exam rooms were kept occupied all day with a steady stream of patients.

The "Monday mornings"- that is, her more acute cases that called in for same-day scheduling, came first. Along with a gamut of migraines, belly aches, and mysterious viral fevers and coughs, we also saw a classic "disease and its complications" combo. A little girl with beautiful black braids came in with a fever and sore throat (but no sniffles or cough), classic strep symptoms. Sure enough, when we examined her more closely, she had the classic "sandpaper" rash (or should I say a fine, maculopapular erythematous rash) characteristic of strep, and white pustules on her tonsils (fun!). The diagnosis was confirmed with a strep test, and we sent her home with 10 days of antibiotics.

Later that morning, a young woman came in with a sore throat and fatigue. Her pain became more apparent when she could barely speak during the exam, much less say "ahhhh." She opened her mouth about a centimeter, and Dr. Hayes called me over, saying "I can't believe you're seeing this on your first day." The area surrounding her right tonsil was distended and red, blocking nearly half of the back of her throat. It was a peritonsillar abscess, a rare and extremely painful complication of strep infection. Unfortunately, this patient had "no payer," that is to say, she was uninsured, and getting an ear nose and throat doctor (ENT) to drain the abscess (which is a surgical procedure) would be complicated. Finally, she was referred to an ENT through "Project Access," the health department's organized way of distributing charity care for those in need. She was immediately sent over to the office for evaluation and (hopefully- fingers crossed) treatment. An abscess like hers could be fatal if not treated, so we're waiting to see how it all turned out.

Dr. Hayes spent the rest of the day marveling the fact that I saw these two cases back to back- I will never forget either!