A Super Infection and a Not-so-super Sleuth

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"Hi, I'm Dr. Manning. I work with Dr. Resident, and he told me a lot about you. Would it be okay if I looked at your arm? We always discuss every patient together since we believe two brains is always better than one."

"Ohh. . . .okay. . . " She looked unusually nervous. I did my best to allay her obvious concern.

"So it's my understanding that this started out as a mosquito bite on your arm that you began scratching?"

"Yeah. . .I kept picking at it. . .I know I shouldn't have. . . .then it got like this on the third day or so." She thrust her forearm out for me to inspect. A well circumscribed area of redness surrounded what was likely the original insect bite.

Placing my hand over the affected area, I looked at her and said, "Hmmm, it feels kind of warm.  Your doctor wants to be on the safe side and give you some antibiotics for this.  From looking at it, I completely agree. "  I quickly performed a few other parts of the examination, confirmed that she had normal vital signs, and excused myself from the room.

A few moments later I remembered that I hadn't asked her if she had any prior skin infections or if she'd had any medication allergies.  I stepped back over the room and gave a quick knock to the already ajar door.

"Hey there. . . . Miss Johnson?"

I was stunned to find her in the room weeping into her cell phone hysterically. She was shaking like a leaf and looking terrified.  I was sure something else had happened, completely unrelated to the visit.

"Let me go. . . I'll see you in a minute," she sniffled to the caller and promptly slid her cell phone back into her purse.  "I'm sorry."

"Miss Johnson. . .are you okay?" I asked quietly. I didn't want to intrude too much, but it was hard to just ignore how upset she was.

"I think I will be," she answered while wiping her eyes. She stared out of the nearby window in the clinic room.

I studied her thin frame and overall appearance. She was well nourished and did not appear to have any signs of trauma. I thought about the scenario: a young woman sitting in the room weeping. Looking afraid. Wait--was there more to this? She was groomed appropriately, and seemed to take good care of her twenty-something year old body.  Even still, I knew I needed to ask the questions to know for sure that she was indeed safe.

"Miss Johnson. . . I just need to be sure. . . .are you in a safe environment? I mean. . . . has anyone harmed you or threatened you physically or emotionally?"

I immediately wished that my friend and fellow Grady doctor, Sheryl H., were there to tell me all of the best ways to ask questions about intimate partner violence.  I couldn't remember any of her tips, but I did remember hearing her say, "Just ask."

Miss Johnson looked puzzled. "Excuse me?"

"I saw you crying. . .and I just want to be sure that you are safe. If you need my help, this is a safe place and anything you say to us is confidential. I just wanted to be sure. . ."

She started crying again and shaking her head. "What?  I'm not crying because I am getting beat up! I wouldn't never let nobody put their hands on me!" she declared firmly. "I'm crying because y'all said I had a 'superinfection' and I'm scared that could lead to something bad like needing surgery."

Wait, huh?

"That other doctor kept saying I had a super infection.  Then you came in here and you said you 'totally agree.'"  She sobbed some more and looked at me with fear in her eyes.

Wow, Manning. What a loser.

"Umm. . . Miss Johnson?  I am so, so sorry for the confusion. When you scratched your mosquito bite and germs got into it, it got infected. When someone has a sore or something and then on top of that, it gets bacteria into it, we call the infection on top of what was already there a 'super infection' because it's superimposed on something else. We should have been more careful explaining that to you."

"So you saying that don't mean it's a way worse infection, like a super one?"

"No, ma'am. We shouldn't have used that word to describe it while talking to you. I'm sorry."

I felt like such a dork.  Here I am thinking I've saved the next Rihanna from some horrible assailant and the assailant was actually us.  Great.

"Can you tell my mama that on the phone? I told her I had a super infection, and she was crying, too."

I nodded.

"Super," she replied with a relieved smile.

Yeah, super.