way as to produce useful, honest answers. So as she examined Katie’s eyes, nose, ears and throat, Allison pumped the teenager for information.
“How’d the soccer team do?”
“Decent. Fourteen and four.”
“School’s good?”
“It’s nice being the highest grade in middle school. I can’t believe how young the fifth graders are.”
“Already on the way to being old and gray,” Allison chuckled. “Like me.”
“No way! You’re a cougar. Half the boys in my class have a crush on you.”
“Cougar, huh?” Allison smiled.
“Definitely.”
“How are the grades?”
“All A’s.”
“How’s your dad?”
“Okay, I guess. He misses Mom a lot.”
“How about you?”
“I miss her. Lots of times I wish I could talk to her. I talk to Dad but it’s not the same and it’s awkward with some stuff.”
“Like boys?”
“Yeah and other, you know, girl things. Sometimes boys can be so dorky.”
Alison laughed. “You have a boyfriend?” It wasn’t a social question. Having a boyfriend meant a whole array of potential health issues a physician needed to watch out for, from pregnancy to abuse.
Katie eyed her seriously. Allison saw in the girl a wariness—and weariness—beyond her years, a wisdom born of sorrow. Losing a parent at such a formative age, she knew, did things to a kid. Death was the great betrayer. Childhood’s end. Trust always became an issue.
Allison wanted to enfold this girl, this lovely daughter of her deceased friend, in her arms and shield her from life’s many hurts and assure her that everything would be okay. But that in itself would be a betrayal of sorts and a lie. No one could protect anyone else from anything. Allison was positive of that. In the end, she knew, each of us runs life’s gauntlet alone.
“This is just between us girls,” Allison added quickly.
“I have friends that are boys.”
Allison smiled. Despite the coy answer, she was getting more from Katie than she did from most teens, especially boys who generally responded to her inquiries with grunts. She plunged ahead.
“Has your father had the ‘birds and bees’ talk with you yet?”
“No. He tried but . . .” She crossed her arms over her chest and said, “Anyway, we learned that in school.” Allison knew she had pushed things about as far as she could. But there was one more question she needed to ask.
“What about sex . . . ?”
Katie flushed tomato red. “What? Me? Of course not!”
“I’m glad to hear that. That’s a good decision for your health and for many other reasons. But if you are ever considering it, you should talk to me. Will you do that?”
Again, the wary eyes. “Okay. But why?”
“So I can try to talk you out of it, of course.” Allison gave her a crooked grin. “And, if I can’t, to make sure you’re prepared.” She steered the conversation back to simpler topics. “Any asthma or breathing problems?”
Kate shook her head.
“Fevers? Night sweats? Trouble going to the bathroom?” Another head shake. “Aches, pains?”
“My leg.”
“Tell me about it.”
Katie pointed to her left leg directly below her knee. “It started about a month ago. It hurts if I press it.”
“Does it ever hurt on its own?”
“Sometimes.”
“Has it gotten worse?”
“I’m not sure. But Dad said we should see you because it hasn’t gotten better.”
Allison applied moderate pressure with her thumb. Katie winced. “Tender.” Allison observed.
“It’s not bad. I’ve been able to play through it.”
Allison massaged the joint. She felt nothing amiss structurally. She noticed a bruise. “Did you get kicked here?”
“Of course,” Katie laughed. “And everywhere else.”
Allison had Katie dangle her legs over the edge of the table and thwacked her left knee with a rubber-headed hammer. Katie’s leg shot forward. She repeated the test on the right leg with the same result. “Reflexes normal,” Allison said. “Could you have injured it any other way?”
“Maybe. It started hurting a few days after I jumped out of a tree.”
Allison compared Katie’s right leg to her left. She found no apparent differences. “What were you doing in a tree?”
“Getting a soccer ball that got stuck up there.”
“How high did you jump from?”
“Not very high.”
“Higher than you are tall?”
“Yeah.”
“But you don’t remember your leg hurting when you landed.”
“No.”
Allison considered the possibilities. Katie’s mobility wasn’t compromised, so she felt she could rule out a tear of the meniscus as well as damage to either of the collateral ligaments—good news since both injuries often required surgery and could be career-ending. A torn or strained muscle was similarly unlikely. That left two obvious culprits: bleeding between the leg bone and the periosteum—a deep bone bruise in layman’s terms, likely the result of being kicked above the shin guard—or a stress fracture, perhaps from so much soccer, perhaps from jumping from the tree. Unlike a regular fracture, the precipitating event for a particular stress fracture could rarely be determined.
Bone bruises were painful but generally required no treatment. Stress fractures were another matter, usually requiring at least a month of limited activity. A stress fracture would mean no soccer.
Allison leaned toward the bone bruise diagnosis. The pain from a stress fracture was likely to be more constant than the occasional symptoms Katie had reported. That she had noticed the pain after jumping from the tree was likely coincidental, although the jolt could have aggravated the bruise. But she couldn’t be sure.
“Probably a bone bruise,” she told Katie. “Once you stop getting kicked in the shins every day, I suspect this
