The patient was a petite 80-year-old white-haired woman in pressed Bermuda shorts. “It’s nice to meet you, Mrs. ?Schulman,” I said to her, trying my best not to gape. The medical resident, Charles, had warned me that her leg was seriously swollen, but I still almost did a double take when I saw it.
If her left leg was a slender maple, her right was a giant redwood. It measured about three times the circumference of the left and was swollen all the way from her ankle to the very top of her thigh. It was by far the biggest swelling I’d seen in my career.
“How long has it been swollen like this?” I asked Mrs. Schulman.
“More than a month,” she said. “And don’t tell me to elevate it; I have it up all the time. I can’t bend it, I can’t garden. It’s terrible!”
Charles filled me in on her medical history. She was on a blood thinner for an irregular heartbeat and a pill for high blood pressure. A few months earlier, she had tripped on a sidewalk and landed on her right knee. It still ached from time to time.
“Don’t forget my cancer,” Mrs. Schulman piped in. “I had lung cancer five years ago, and I beat it!”
Alarmed, I willed my eyebrows not to rise. It was painfully obvious that she might be wrong. Since cancer increases the risk of blood clots, a single swollen leg in a patient with a history of cancer was a blood clot until proved otherwise. I could see from Charles’s widened eyes that he hadn’t known about her cancer history until that moment…