She looked too healthy.

I spotted her in the waiting room. Her hair sat neatly made in a French twist, smooth bangs parted on her right. She wore blue cargo pants and a green sweater, and she was reading a book on Baruch Spinoza. What was she doing in my medical clinic?

Most of my patients arrive to clinic in a state of chronic or acute illness. Many of them are appropriately dressed, but they look sick. Many of them are in constant pain. Some of them want their fix, their benzodiazepines or their narcotics. Others just want their blood pressure medications refilled. This is not to say that the average decent human being who is a patient in Resident Medical Clinic and who happens to be homeless, uninsured, or disabled can't also look fabulous.

However, I have yet to catch any of them reading a book on one of the most compelling and complicated philosophers in history.

"Hi."

"Hi."

"I'm Chloe. I'll be your physician today."

"Lindsey. Nice to meet you."

"So."

"So."

"What can I help you with?"

She explained her problem with occasionally seeing blood in her sometimes liquid, sometimes formed stool. I quickly settled into my comfortable medical place where there is one complaint and I can beat it to no end with specific, detailed questions, until--

"I don't really remember my 20's." [Laughs.]

"Really? Why not?"

"I was smacked out on heroin."

[Silence. Not many jokes I can make about heroin. She smoothes the front of her sweater.]

"I guess that's why I'm so jittery now," she continued.

"Right. Are you still doing..."

"Oh, NO. Nonono. I was on Methadone and Suboxone, now I'm completely clean." [Smiles]

I knew that was coming. The interview was too easy up to that point.

The rest of the history-taking went well. She seemed pleasant and sincere. She brought all her medications. She knew her allergies. She's been trying to get her masters in Philosophy at a local college, but she had to quit her job the week prior due to unending and embarrassing diarrhea. I worked up malabsorption and wrote a referral to the GI folks down the hall. Her mother has a history of ulcerative colitis. She might need a colonoscopy.

The plan was set. I felt like I knew what I was doing. I even had a full fifteen minutes before my next patient, then--

"So the GI Clinic will call you with an appointment. Is this your correct phone number?"

"Yes."

"I noticed it's in another state. How long did it take you to drive here?"

"Umm, about and hour and a half. Not that long."

"An hour and a half?"

"Yeah, I just didn't want my boyfriend to know I was coming here. "

"Oh, why not?"

"Well, he's kind of controlling."

"How so?"

"He yells sometimes. And he restricts my allowance. Since I can't work, I get an allowance from him."

"I have to ask you--"

"Does he hit me?"

"Yeah."

"Sometimes."

I remembered seeing bruises of various ages on her hip, arms and legs. She told me just minutes ago they just appeared out of nowhere, that she must have bumped into things at work or at home. How did I miss the possibility that their etiology could have been something other than what she was telling me?

After a long sob, the patient smoothes the part in her hair and buttons the top button of her sweater. She shakes my hand and promises to get those lab tests I ordered and make those appointments I recommended and to see me again in a month.

I haven't seen her since.