Purple Bags

"You know you could have allergies or hay fever. That's why you have those purple bags under your eyes," according to the rheumatology and immunology internist I followed as part of my preceptorship.

Hay fever is unlikely (I'm sure). Hay fever is typically causes by allergens and pollens that induce an overactive immune response, typically causing itchy eyes, a runny nose, and sneezing. Allergies-- maybe.

I did not go to my preceptorship expecting to be diagnosed with something or gain some explanation for why I have bags under my eyes (which I have assumed may be due to a lack of sleep). It comes as a bonus learning point, I suppose.

While my classmate and I were walking to our first day at our preceptor's office, we passed an Armani Exchange, BeBe, and a number of upscale restaurants and other fashion boutiques.

His sixth floor office overlooks the SF Marena. On one side of the room, his wall shines with frames documenting his professional achievements and affiliations. The other side of the room has a wall dedicated to framed and signed photographs of 49ers from their heyday in the 1980's and early 1990's.

Football memorabilia, including a few signed footballs and figurines, fill the corner of his office. The plush red carpet matches nicely with all the visible 49er uniforms. Wooden mallard models sit on the front of his desk, surrounding his name plate. His name is adorned with 2 stars, one on each side, for his military service.

Our preceptor has an extremely dynamic career; he has a doctorate in immunology, has served as a General in the military for decades, as well as the allergy doctor for the 49ers, and the current allergist for the SF Giants. He has worked for most of his lifetime in medicine and continues to work in private practice three times a week in his office and also spends time in the hospital. On some days, Poncho, his dog comes to the office. At the time he graduated from medical school, he was married with four children.

In opening his practice to my classmate and I, our preceptor has introduced us to his world. A world concerned with allergens, antibodies, inflammation, immune disorders, pain, and unusual diagnoses. Today, we saw four patients, with variable chief complaints, everything from leg pain to congestion to asthma to wrist pain.

"Look at this nose and notice how it's inflamed on the inside. This is a good example of an allergic nose." (Our preceptor's instructions to us as he passed us a scope)

Today, we primarily shadowed our preceptor, following him and his cues during patient visits. When instructed, we placed our stethoscopes on a patent's lung or chest, listened to their breathing or heart beat, or looked into their nose, or observed their sinuses.

For the patient, it must have been strange to have 3 white coats in the room, 3 sets of eyes up their nose, and 3 cold stethoscopes on their back. And to be discussed like a case of allergies or pain, when still present in the room, must have been odd for the patient.

"What does that mean?" (a common patient question when their condition was being discussed openly)

And to be frank, I really don't know. The language of immunology is completely new to me.

Our preceptor is very friendly and receptive to our needs, asking us what we are interested in learning and what we hope to gain from our experiences. He always meets with his patients in his office after the initial exam. He even showed us the fridge, where we could find "soda-pops" if we ever got thirsty. How nice.

For now, I will expand my vocabulary with the assigned terms: Asthma, tendonitis, inflammation, fibromyalgia, rhinitis, allergies, hay fever etc. Our next preceptor meeting will be in November. And before then, I will either determine what causes these dark bags under my eyes, or maybe I'll just catch up on some sleep (and they may just magically disappear). Right?

***Image Source: "Hay Fever." http://upload.wikimedia.org/wikipedia/commons/a/a4/Misc_pollen.jpg