Connecting with Marco – wayne centrone

I carry a picture in my wallet. I have for over 20 years. The photo reminds me that our work is all about connection.

One of the boys in the photo holds a special place in my heart. On one of our Team Peru trips, we had a clinic at the Casa Girasoles for the boys and staff. The home had over 40 children at the time, and the staff visits included all their family members.

At the end of a long day, a staff person approached me and asked if I would see one of the younger boys. She explained to me that the boy was timid and self-conscious. She told me he had been “suffering” from a rash. She described the intense irritation and itch the boy had been dealing with for weeks.

The boy, I will call him Marco, was small in stature and much younger looking than his eight years of age. His shyness was almost overwhelming as he sat in the chair, unable to make eye contact and mumbling responses to my questions. The caregiver accompanying him provided most of the child’s history, and the boy confirmed with subtle gestures.

His skin was indurated and chaffed from the weeks of intense scratching. He had a secondary skin infection that developed from the extensive irritation. He squirmed uncomfortably in the chair and barely said a word. The pained look on his face gave away the silence.

Having spent much of my clinical training and career working with people living in the experience of homelessness, I had little trouble identifying the cause of his symptoms. Working with the caregiver, we outlined the steps to disinfect his clothing and bedding. We provided topical treatment to eradicate the scabies mite and started him on an antibiotic to treat the skin infection.

His treatment plan was comprehensive and also included topical steroid cream to decrease the irritation and inflammation and oral antihistamines to help with the pruritis. I was worried – Marco and his caregiver had a told of steps to juggle before he would get the relief he deserved.

A few days later, having been consumed with our school outreach campaign (the subject of another day), I went to check on Marco. I knew the treatment often made a patient more irritated and uncomfortable before they felt better. I first reached his caregiver. I expressed my concerns and sheepishly asked for an update. She excitedly told me that Marco was doing great. She said it was the first time she had seen him smile in weeks.

The caregiver told me Marco was eager to see “his” doctor. She informed me how excited he was to tell me something.

To my surprise, the Marco I met that evening was not the same shy boy I had seen a few days before. He had a smile from ear to ear. His eye contact was startling and comforting. He hugged me and told me thank you. Uncertain of what thanks I deserved, I asked him how he was doing. He informed me that he had been able to sleep for the first time in quite a while. He expressed gratitude for the relief he was experiencing from the intense itching and irritation. He was a completely different boy.

Whatever concern may have lingered about how Marco was doing was quickly assuaged. He hugged me as we said goodbye and whispered, “Mi querido y amable doctor. Gracias por permitirme faltar a la escuela [estos últimos días]. Me he divertido mucho (My dear kind doctor, thank you for allowing me to miss school these past few days. I have had a lot of fun).”

I often think about Marco, wondering where and how he is doing. I wonder if he knows how much he impacted me.