"One More Thing"
and I do have time for it
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My visit with Sheila was hilarious.
It quite literally involved her telling me to “sit my ass back down” and ended with both of us in tears laughing.
But it didn’t start that way. At first, it was… well, kind of boring.
Sheila talked about her skin. A spot here, another there. She had a crude sense of humor, called herself a “grumpy old woman,” and winked a lot. She always laughed at her own jokes before finishing them, her smoker’s chuckle dissolving into a wet cough.
Still, something told me the humor was a cover. She was uncomfortable.
So, I did my best to ease her in. I kept my eyes off the computer except when necessary. I faced her and made sure we were at eye level. I let her finish her (sometimes terrible) jokes and laughed along. But the whole time, I had a feeling we were circling something unspoken.
Or maybe I was wrong. Maybe the spots were all she wanted to talk about.
I stood to leave. “Sheila, it was so nice meeting you. My nurse will be in soon to set up your next appointment.” My hand was on the doorknob.
“Uh… just one more thing.”
There it is.
Doorknob questions can be exasperating.
The “Oh, by the way, I have chest pain” kind—the kind that wrecks your schedule and turns your day upside down.
Or the “Can I show you a picture of my daughter’s rash?” kind, when you barely have time for the patients actually in the office, let alone an unscheduled plus-one.
Yeah. Those.
But Sheila’s “one more thing” felt different. And I was ready for it.
It reminded me of morning markets in Beijing with my mother—how we’d pretend to walk away after haggling, waiting for the vendor to cave. “Fine, fine! Two dollars less!” Our shared, knowing smile just before turning back.
I had that same grin now, hand on the doorknob.
Gotcha.
“Alright,” I sat back down, angling my laptop away. “I’m all ears.”
Sheila exhaled, resigned. “I was too damn embarrassed to say it earlier. But you seem cool.” She lowered her voice. “I got this itch. Down there. It’s driving me nuts. I scratch all day, all night. My son won’t even take me to the store ‘cause I be sittin’ there scratchin’.” She winced and mimicked the motion.
I nodded. “Alright, Sheila. Let me take a look.”
“Do you have to?” she tried.
I gave her a look that said: come on now.
She groaned. “Fine. Fine. I guess you’ve seen one or two of these before.”
“Oh my goodness, Sheila. You’ve scratched yourself raw! That must be miserable.”
It wasn’t the worst case of lichen simplex chronicus (LSC) I’d seen, but I wanted her to know I was taking it seriously.
LSC is a skin condition that happens when an area becomes extremely itchy. And the more you scratch it, the worse it gets. It’s an itch-scratch cycle that never ends. When LSC affects the vaginal area, the vulva, or the scrotum, it can be really uncomfortable. People often describe an unbearable itch that keeps them up at night. The skin can become thickened, leathery, and sometimes darker due to constant scratching. Over time, even clothes or underwear brushing against the area can trigger more itching. Many feel embarrassed to bring it up. And doctors misdiagnose it often, assuming it’s a yeast infection or dismissing it all together. LSC can be treated by breaking the itch-scratch cycle with prescription-strength steroid creams to calm the inflammation and avoiding scratching.
Sheila pulled her pants back up and sighed. “This is actually why I came in. All that other stuff? I was just bullshittin’ ya ‘cause I was embarrassed.”
My Beijing market-trained BS detector was spot on.
Sheila’s “one more thing” was the thing.
We decided on a biopsy to confirm the diagnosis. Quick and simple. I stood to leave after. Again.
“Alright, Sheila, I’ll call you with the results. We’ll figure this out. But no more ‘one more thing’ today, OK?”
She smirked. “Oh, come on, doc!”
I wagged a playful finger. “I do have to see my next patient, you know.”
She giggled. “Now, sit your ass down, and let me tell you one more joke!”
“You should’ve told her to make another appointment,” a colleague suggested when I shared that Sheila’s story changed my opinion about the “one more thing.”
That didn’t sit right with me. But I wasn’t in the mood to argue.
It’s not that simple.
Seeing a doctor isn’t like running to the store—where if you forget something, you just go back. Easy.
Patients spend days, weeks, years working up the courage to speak. They rehearse their words, hoping to be taken seriously. They bring a friend for support. They joke to mask fear and ask about our day to remind us they’re human too. They come to us vulnerable, scared, in pain—sometimes ashamed.
But Sheila’s hesitation wasn’t just embarrassment.
For two years, she begged doctors to hear her. Instead, they made her lie back, feet in stirrups, speculum in hand.
“I kept telling them—it’s not my vagina, it’s outside! But they just kept saying, ‘Scoot down, scoot down.’ If I scooted any more, I’d fall off the damn table and break my hip!”
She already walked with a cane. One exam hurt so much that her blood pressure spiked. The doctor peered up and asked, “Are you having a heart attack?”
Sheila was furious. And tired. After all that? She stopped trying. Why keep asking for help when no one listens?
And let’s talk about waiting.
The 2022 Merritt Hawkins survey found that in big cities the average wait for a new primary care appointment is 26 days. Specialists? Months. And once they arrive, patients can wait hours in the office. They bring books. Watch movies. Sit in silence.
They wait for us.
While Sheila’s jokes didn’t always have a punchline, here is mine:
If we ask people to spend so much of their lives waiting for us, then we can hear them out for their one more thing.
When Sheila came for her follow-up two months later, I was running behind.
“I’m so sorry for the wait!” I said, rushing in.
“Don’t you worry! I won’t take long. Just came to tell you—my itch is gone!”
Since the biopsy confirmed the diagnosis, I’d treated her accordingly. And now, after two years and countless doctor visits, she was finally better.
Sheila nearly jumped out of her chair in excitement—then remembered her lousy hip and stopped.
I laughed, hugged her, and we walked out together.
Then she turned to me, eyes twinkling.
“One more thing!”
Our inside joke.
“My faith in the medical system was in the gutter before you. You made me think maybe not all doctors are full of shit.”
It was one of the nicest things anyone has ever said to me.
And, of course, it came as a doorknob comment.
Wonderful post, once again, and yup, you got a VERY high compliment with “My faith in the medical system was in the gutter before you. You made me think maybe not all doctors are full of shit.” ❤️❤️❤️
Please go teach this to medical students, then again to the interns , and again to the residents. Then go find the hospitalist who glosses over every patient comment bc his interest is in doc schedules and open beds and insurance coverage. Docs need to hear this, over and over.