Another Mouth To Speak

Prompt Day #8: I’ve developed a mouth on my chest, just above my heart. Why? What does it want? Write a first person tale or mock journal entry that reveals the answers.

 Ok, I am a day behind. I am moving to a new home/new town and keep getting sidetracked. Not cool, I know, But we all have lives and I know you understand. It looks like the next few prompts are more B-movie type and less horror. So I’m going to have to work a little harder on them. Tomorrow I will catch up with two posts, I promise!

Another Mouth to Speak

 

Progress Note                                                                                                                                   Date: 5/15/15

Pt. Name: Marielle Tucker                                                                                                          D.O.B. 4/17/90

Patient is a 25 y.o. single woman who is seen today for a complaint of red, itchy rash over left breast. Patient states it erupted yesterday, blotchy red, raised oval shaped. Very itchy. Has over the last day become redder, swollen and blistered.

On exam, Vital signs are stable, afebrile. Ovoid red rash noted over left breast, above areola. Approx. 5cm in length and 2cm in width. Unknown etiology. Suspect contact dermatitis. Patient reassured, topical steroid cream given and follow up as needed.

Progress Note                                                                                                                                   Date: 5/22/15

Pt. Name: Marielle Tucker                                                                                                          D.O.B. 4/17/90

Patient returns today with worsening of left breast rash. Cream did not help. “It got much worse”. Now swollen, elevated significantly with fissure running horizontal length of oval. Above and below rash, skin is raised in almost thickened scar appearance. Biopsy taken from corner of fissure which includes both upper and lower rolled edge. Patient given antibiotic and plan to follow up in 1 week for pathology results.

Progress Note                                                                                                                                   Date: 5/29/15

Pt. Name: Marielle Tucker                                                                                                          D.O.B. 4/17/90

Patient here today for path report and follow up on left breast rash. Path report shows normal lip tissue including free red margin consistent with the border of normal skin and oral labial mucosa.

Patient tearful today. States the rash has caused a break-up in her relationship. She states that last night, during an “intimate session” the rash began to speak. Patient states it began to critique her boyfriend’s “sexual prowess” and abilities. She states that while she was vocalizing her pleasure, the rash began to yell “faking it! Faking all of it!”. She states her boyfriend became very upset and left. She states since then, the rash has been commenting constantly about her relationships and poor choices. She is requesting it be surgically removed as soon as possible.

On exam, I am surprised to find her rash has indeed developed into what appears to be a functioning mouth with oral cavity. During my exam, it became verbal. It consented to a thorough exam which revealed a tongue, full adult set of teeth, uvula and epiglottis. Patient states there is no sensation or discomfort to the exam. Using the flexible laparoscope, I was able to visualize vocal cords and just below these, what appears to be the right atrial cavity of the patient’s heart. (Refer to photos attached). At this point, I asked my nurse to come into the room and act as scribe while I interview the patient’s accessory oral cavity.

The accessory oral cavity calls itself “Venus”. It states that it is the voice for Marielle’s heart. “Venus” goes on to say that at the age of 25, Marielle has yet to find the right man. “Venus” states that when Marielle was 17, she dated a boy who she loved and wanted to marry but after graduation, he broke it off for college. She was heartbroken. “Literally. It hurt me, physically. It was all I could do to even beat. I was depressed and just felt exhausted. But after that, I started to get better. I tried to point out plenty of men who we would absolutely love. Men who made me want to beat again—vigorously, if you know what I mean. I want a man who can make me bang myself against the chest wall. But no. She stopped listening to me entirely.” At this point Marielle interrupted to say that she simply attempted to be more pragmatic about her choices in men. She states she would only date men with potential for a good career or who had a spotless record. She states “I always fell for the wrong type of guy. No more. I had to think with my head, not my heart.” Venus then stated that the wrong type of men that Marielle is referring to are men who made her laugh and who knew what to do when the lights were out. “Maybe they weren’t sure what they wanted to do with their lives, sure. Maybe they wanted to see the world before entering the workforce. That’s still very romantic. And like the Beatles said: Love is all you need.” Marielle admits that she did have a lot more fun with the men that her heart chose but she needed to be smart for her future well-being. Venus then stated that Marielle was sounding more and more like her mother. At this point Marielle became very upset, asked for a role of surgical tape and a 4×4 gauze pad. She affixed them over her accessory oral cavity. Marielle then stated that she wants “this thing” removed immediately. She states that it has gone beyond giving its opinion on her dates but is now interrupting them and shouting insults to the men.

I have referred Marielle and Venus to a relationship counselor. I explained that at this point I do not feel that surgical removal is in her best interest. I did, however obtain her consent to submit this case to the New England Journal of Medicine and explained that she may be asked to attend a conference or two. Meanwhile, I think she should give her heart a chance to speak to a counselor and can offer it an antidepressant if necessary. Marielle agrees to speak with a counselor but states she would like a follow up appointment in 1 month. If there is no improvement in her relationship with her heart, I will refer her to both a cardiovascular surgeon and well as a plastic surgeon to seek removal of the oral cavity.

Follow up: 1 month.

Dr. Corazon

Advertisements