“No, nothing unusual. Just school and home, like always. I assumed it was just a seasonal infection, but they’re both getting worse.”
“But they haven’t had a fever?”
“Nope, not at all.”
I check their charts for the vitals already obtained by the nurse. Not only do neither of the twins have a fever, but both their temperatures are a little lower than I’d expect, which is strange.
“Emma, can you follow my finger with your eyes?” I ask, moving my index finger slowly across her field of vision. Shecomplies, but I notice a slight lag in her tracking. I repeat the test with Evan and observe the same delay.
“I’m going to draw some blood for cultures,” I tell Lila, keeping my voice calm despite my growing concern. “And I’d like to get urine samples from both children as well.”
“Is it serious?” Lila’s scent spikes with anxiety.
“It’s difficult to say without test results,” I answer honestly. “The symptoms could be from an infection, but we need to determine exactly what we’re dealing with.”
As I prepare the equipment for blood draws, I notice Evan’s hands trembling slightly. “How long has the tremor been present?”
Lila’s eyes widen. “I... I didn’t notice that before.”
“That’s okay. I’ll just make a note of it.”
I work efficiently, collecting blood samples and throat cultures from both children while keeping up a stream of light conversation to distract them. They’re remarkably stoic patients for eight-year-olds, barely flinching when the needles pierce their skin.
“Dr. Chang,” Emma says suddenly as I label her blood vials, “my mouth tastes like pennies all the time. Is that because I’m sick?”
I pause, adding this new symptom to my mental checklist. Metallic taste isn’t typical of most common childhood infections, though it isn’t impossible.
“Maybe,” I tell her, though my mind is racing through possibilities. “But I’m going to find out for sure just as soon as I can.”
Once I’ve collected all the samples and completed a thorough examination, I sit down across from Lila, choosing my words carefully.
“I’m ordering blood cultures to check for bacterial infection, plus a comprehensive metabolic panel and complete bloodcount,” I explain. “The results won’t be back for a few days, but they’ll help us determine what’s causing their symptoms.”
“What do we do until then?” Lila’s voice breaks slightly.
“I don’t want to start antibiotics unless we know what we’re dealing with. Keep them hydrated, use acetaminophen for fever and pain, and monitor for any new symptoms.” I write down my instructions. “If they develop any difficulty breathing, severe headache, confusion, or if the tremors worsen, bring them back immediately.”
I pause, looking directly at the twins. “And I want to see you again in seventy-two hours no matter what, or sooner if symptoms don’t begin improving.”
“What do you think it is?” Lila asks, unable to hide her fear.
“It’s hard to say, but an infection isn’t off the table,” I say, maintaining professional detachment despite my concerns. “The testing will help. For now, I just want you to keep paying attention for any new symptoms, and I’ll call you when we get the test results.”
I help the children down from the examination table, noticing how they both wince when their feet hit the floor, another indication of joint pain.
“Thank you, Dr. Chang,” Lila says, gathering her children close. The genuine gratitude in her voice makes my chest tighten.
“You’re welcome. Please don’t hesitate to call if anything changes before your next appointment.”
After they leave, I stand alone in the examination room, reviewing my notes. Something about this case feels wrong. The constellation of symptoms doesn’t neatly fit any common childhood illness.
I’m also not a family medicine or pediatric specialist, by deliberate choice. Maybe I’m looking for zebras because I haven’t seen enough plain old horses in person.
Though something tells me that pawning off what is probably a bad case of the flu on me wasn’t an accident.
Maybe if I do enough of Dr. Klinkhart’s grunt work, he’ll eventually let me go solo on the types of cases that I actually came here to see.
SEVEN
