Dermatologic Drama

For many years I've sent starry-eyed youths off to New York and Los Angeles to seek their fortune on Broadway or in Hollywood. I wish them luck, asking only that when they win their Tony or Oscar they remember who cleared up their skin. If their goal is to write, I ask that they pen a work starring a dermatologist.

I'm still waiting. Medicine has been fertile ground for many gripping movie and TV dramas, but these seem to center on emergency rooms, charismatic neurosurgeons, or internists with character disorders. Not a skin doctor in the bunch.

The only TV show that paid much attention to our specialty was "Seinfeld." Who can forget Jerry itching after shaving his chest hair; Jerry finding a tube of antifungal cream in his girlfriend's medicine chest; or Jerry deriding a dermatologist date as "Pimple Popper, M.D.," only to have an adjacent diner offer profound thanks for her lifesaving discovery of his melanoma?

So skin has had its moments. But no matter how we value our specialty's contribution to human happiness, we must acknowledge that the sometimes obsessive details of our daily work can play for laughs but not for pathos.

Nevertheless, I want to share the one episode in my career I can recall that did have real dramatic tension. If any reader wants to develop this incident into a TV pilot, have your people contact my people.

It happened this way: One day a friend called to say that 17-year-old Melvin was in the hospital with infections in both armpits. Oral antibiotics having failed, his physician admitted him for intravenous therapy, again with no results. The family suggested a dermatology consult, and the physician agreed. Would I come over?

Of course I would! I rarely visit hospitals anymore, but the opportunity to help out a family friend was welcome - especially since I was pretty sure I knew what he had and what to do about it. I expected no direct communication from the attending physician, and got none. I finished up at the office, drew up some Kenalog, packed alcohol pads and gauze, and headed over to the hospital.

There, I found Melvin flanked at the bedside by his anxious mother and a family friend. Both were married to physicians, raising the stakes. They explained the situation: Melvin had an infection so severe that even intravenous antibiotics had failed. What could be done?

I asked whether Melvin had ever had anything like this before. He had not. I examined him and found the expected.

I stood up and faced the family. In grave tones of reassurance and sagacity learned from reruns of "Masterpiece Theater," I said, "Melvin does not have an infection. He has hidradenitis suppurativa." This sounded more like an incantation than a diagnosis.

"Is that serious?" asked the mother.

"It can be easily treated," I explained. "In fact, I brought the treatment with me."

"But this must be a serious infection!" Melvin said. "Even IVs aren't helping."

"They aren't helping," I replied evenly, "not because you have a serious infection, but because you have no infection at all."

(Swelling violins. Cut to station break.)

After some further discussion, I convinced Melvin, his mother, and the friend that intralesional steroids were appropriate. I injected the swellings under each arm and promised to return the following day, departing to thanks tempered by anxiety. Could this exotic diagnosis with so many syllables be correct? Would the treatment actually work?

When I entered Melvin's room early the next morning, I was met with smiles of profound relief and heartfelt gratitude. The swelling was gone! The patient relieved! The unpronounceable presumption validated!

The transference in the room was thick enough to cut with a knife. I accepted the family's encomia with becoming modesty, of course, but couldn't resist the thought: How truly neat. Sure diagnosis and prompt success at the hospital bedside - by a dermatologist!

(Clashing cymbals. Cut to scenes from next week's episode.)

Well, maybe there won't be an episode next week. Though I still savor the unique circumstances of this small drama, I must admit that some medical specialties are just not cut out for prime time. But at least we're not alone.

Can you imagine "CSI: Miami, Forensic Urologists"?

Me neither.

For many years I've sent starry-eyed youths off to New York and Los Angeles to seek their fortune on Broadway or in Hollywood. I wish them luck, asking only that when they win their Tony or Oscar they remember who cleared up their skin. If their goal is to write, I ask that they pen a work starring a dermatologist.

I'm still waiting. Medicine has been fertile ground for many gripping movie and TV dramas, but these seem to center on emergency rooms, charismatic neurosurgeons, or internists with character disorders. Not a skin doctor in the bunch.

The only TV show that paid much attention to our specialty was "Seinfeld." Who can forget Jerry itching after shaving his chest hair; Jerry finding a tube of antifungal cream in his girlfriend's medicine chest; or Jerry deriding a dermatologist date as "Pimple Popper, M.D.," only to have an adjacent diner offer profound thanks for her lifesaving discovery of his melanoma?

So skin has had its moments. But no matter how we value our specialty's contribution to human happiness, we must acknowledge that the sometimes obsessive details of our daily work can play for laughs but not for pathos.

Nevertheless, I want to share the one episode in my career I can recall that did have real dramatic tension. If any reader wants to develop this incident into a TV pilot, have your people contact my people.

It happened this way: One day a friend called to say that 17-year-old Melvin was in the hospital with infections in both armpits. Oral antibiotics having failed, his physician admitted him for intravenous therapy, again with no results. The family suggested a dermatology consult, and the physician agreed. Would I come over?

Of course I would! I rarely visit hospitals anymore, but the opportunity to help out a family friend was welcome - especially since I was pretty sure I knew what he had and what to do about it. I expected no direct communication from the attending physician, and got none. I finished up at the office, drew up some Kenalog, packed alcohol pads and gauze, and headed over to the hospital.

There, I found Melvin flanked at the bedside by his anxious mother and a family friend. Both were married to physicians, raising the stakes. They explained the situation: Melvin had an infection so severe that even intravenous antibiotics had failed. What could be done?

I asked whether Melvin had ever had anything like this before. He had not. I examined him and found the expected.

I stood up and faced the family. In grave tones of reassurance and sagacity learned from reruns of "Masterpiece Theater," I said, "Melvin does not have an infection. He has hidradenitis suppurativa." This sounded more like an incantation than a diagnosis.

"Is that serious?" asked the mother.

"It can be easily treated," I explained. "In fact, I brought the treatment with me."

"But this must be a serious infection!" Melvin said. "Even IVs aren't helping."

"They aren't helping," I replied evenly, "not because you have a serious infection, but because you have no infection at all."

(Swelling violins. Cut to station break.)

After some further discussion, I convinced Melvin, his mother, and the friend that intralesional steroids were appropriate. I injected the swellings under each arm and promised to return the following day, departing to thanks tempered by anxiety. Could this exotic diagnosis with so many syllables be correct? Would the treatment actually work?

When I entered Melvin's room early the next morning, I was met with smiles of profound relief and heartfelt gratitude. The swelling was gone! The patient relieved! The unpronounceable presumption validated!

The transference in the room was thick enough to cut with a knife. I accepted the family's encomia with becoming modesty, of course, but couldn't resist the thought: How truly neat. Sure diagnosis and prompt success at the hospital bedside - by a dermatologist!

(Clashing cymbals. Cut to scenes from next week's episode.)

Well, maybe there won't be an episode next week. Though I still savor the unique circumstances of this small drama, I must admit that some medical specialties are just not cut out for prime time. But at least we're not alone.

Can you imagine "CSI: Miami, Forensic Urologists"?

Me neither.

For many years I've sent starry-eyed youths off to New York and Los Angeles to seek their fortune on Broadway or in Hollywood. I wish them luck, asking only that when they win their Tony or Oscar they remember who cleared up their skin. If their goal is to write, I ask that they pen a work starring a dermatologist.

I'm still waiting. Medicine has been fertile ground for many gripping movie and TV dramas, but these seem to center on emergency rooms, charismatic neurosurgeons, or internists with character disorders. Not a skin doctor in the bunch.

The only TV show that paid much attention to our specialty was "Seinfeld." Who can forget Jerry itching after shaving his chest hair; Jerry finding a tube of antifungal cream in his girlfriend's medicine chest; or Jerry deriding a dermatologist date as "Pimple Popper, M.D.," only to have an adjacent diner offer profound thanks for her lifesaving discovery of his melanoma?

So skin has had its moments. But no matter how we value our specialty's contribution to human happiness, we must acknowledge that the sometimes obsessive details of our daily work can play for laughs but not for pathos.

Nevertheless, I want to share the one episode in my career I can recall that did have real dramatic tension. If any reader wants to develop this incident into a TV pilot, have your people contact my people.

It happened this way: One day a friend called to say that 17-year-old Melvin was in the hospital with infections in both armpits. Oral antibiotics having failed, his physician admitted him for intravenous therapy, again with no results. The family suggested a dermatology consult, and the physician agreed. Would I come over?

Of course I would! I rarely visit hospitals anymore, but the opportunity to help out a family friend was welcome - especially since I was pretty sure I knew what he had and what to do about it. I expected no direct communication from the attending physician, and got none. I finished up at the office, drew up some Kenalog, packed alcohol pads and gauze, and headed over to the hospital.

There, I found Melvin flanked at the bedside by his anxious mother and a family friend. Both were married to physicians, raising the stakes. They explained the situation: Melvin had an infection so severe that even intravenous antibiotics had failed. What could be done?

I asked whether Melvin had ever had anything like this before. He had not. I examined him and found the expected.

I stood up and faced the family. In grave tones of reassurance and sagacity learned from reruns of "Masterpiece Theater," I said, "Melvin does not have an infection. He has hidradenitis suppurativa." This sounded more like an incantation than a diagnosis.

"Is that serious?" asked the mother.

"It can be easily treated," I explained. "In fact, I brought the treatment with me."

"But this must be a serious infection!" Melvin said. "Even IVs aren't helping."

"They aren't helping," I replied evenly, "not because you have a serious infection, but because you have no infection at all."

(Swelling violins. Cut to station break.)

After some further discussion, I convinced Melvin, his mother, and the friend that intralesional steroids were appropriate. I injected the swellings under each arm and promised to return the following day, departing to thanks tempered by anxiety. Could this exotic diagnosis with so many syllables be correct? Would the treatment actually work?

When I entered Melvin's room early the next morning, I was met with smiles of profound relief and heartfelt gratitude. The swelling was gone! The patient relieved! The unpronounceable presumption validated!

The transference in the room was thick enough to cut with a knife. I accepted the family's encomia with becoming modesty, of course, but couldn't resist the thought: How truly neat. Sure diagnosis and prompt success at the hospital bedside - by a dermatologist!

(Clashing cymbals. Cut to scenes from next week's episode.)

Well, maybe there won't be an episode next week. Though I still savor the unique circumstances of this small drama, I must admit that some medical specialties are just not cut out for prime time. But at least we're not alone.

Can you imagine "CSI: Miami, Forensic Urologists"?

Me neither.