***
"First, we are going to discuss misdiagnosis," Stella said. An air of confidence swirled around her. Elegantly clad in her white uniform, her composure flaunted her job satisfaction.
She moved in a dignified way, head held high, eyes stable as she addressed the students before her. "Like I said, it's an interactive lecture. Who can say a thing or two about misdiagnosis?"
I let my mind wander as she swept her eyes around the hall. Who could have thought that I, Victoria Brown, the esteemed late comer of Western High, would be early enough to witness Stella's pre-class address?
"Yes, you." She pointed at a junior. His face didn't ring a bell. Then again, who said I had to know everyone in my school?
"In my own words, I think it's...em ..." the boy said. "I really don't know how to put it."
I rolled my eyes. Fools will always be fools. Why had he raised his hand in the first place?
"Anyone?" Stella asked. "Anyone? Yes. You."
"Misdiagnosis is a form of clinical negligence," a girl said. "Simply put, it is a wrong diagnosis."
"Brilliant!" Stella said. "Brilliant. Simple and accurate. What is your name, please?"
"Stella," the girl said. I could feel her grin. Murmurs snaked around the hall.
"Ah, my namesake. You should take after me. Major in medicine."
"I plan to be a physicist," the teenage Stella said.
"Oh, that's a fine choice." Holding her hands behind her back, Stella stood still, staring at the chattering students with an exaggerated scowl. "Are you done now?"
It took a moment for the noise to subside. "Brilliant. Now, let's proceed. As she rightly said, misdiagnosis is a form of clinical negligence. There are two main forms of misdiagnosis. One, undiagnosis. And two, incorrect diagnosis. Both of these are equally harmful. Let's take the first one, undiagnosis. As the name implies, it refers to when a condition is completely undiagnosed. For example, Mr. A has a certain health problem and visits his doctor, but the doctor is unable to diagnose his problem."
"What could prevent a doctor, qualified as he is, from identifying a person's health problem?" From the boys queue to my right, a classmate's high-pitched voice sailed to my hearing. Alex. Cynthia's heartthrob. Until Raheem came into the picture, stealing her over with barely even a glance.
"What is your name?" Stella asked.
"Alex."
"Alex. As brilliant as that question is, do you mind saving it for the end of this lecture?" Stella asked, the softness of her voice pleading 'no offense'.
Although she had made it clear from the start that questions would only be entertained when she rounded up, I had hoped Alex's well-thought question would make her compromise.
"So, where were we?" she asked, eyes locked on mine.
Anxiety reared its ugly head. I turned around, hoping Stella had directed her question at Flora who stood directly behind me. But Flora's blank face made hope crumble at my feet. Grimacing, I turned to face Stella.
"Mis...misdiagnosis," I muttered.
"Great," Stella said. "I mentioned that the second form of misdiagnosis is-?"
"Incorrect diagnosis," I said, hating the thinness of my voice.
To my relief, she returned to her lecture, "Incorrect diagnosis, as the name implies, is a totally wrong diagnosis. You are diagnosed of one thing, when in reality, you have the other. Forms of incorrect diagnosis include underdiagnosis and overdiagnosis. These are easy to explain. When you hear underdiagnosis, what comes to mind? Do you not think of under treatment? And for overdiagnosis, overtreatment?
"H. Gilbert Welch, a professor of medicine and director of the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice said something about overdiagnosis. He posited that the biggest problem is that overdiagnosis triggers overtreatment, and all of our treatments carry some harm. What do you think of that statement? While you try to assimilate Gilbert Welch's words, let's listen to Victoria Brown give an example of incorrect diagnosis."
Lost in thoughts about how my life had dramatically changed for the better-at least to an extent-my head snapped toward Stella at the mention of my name. She had just asked me to speak. But about what?
"Sorry, what's the question?" I asked Flora.
"An example of incorrect diagnosis," she whispered.
"Oh, that." I returned my focus to Stella. What example could I give? My mind drifted to the last injury Cynthia had inflicted on me during a football practice session. I had sprained an ankle. There. The perfect example.
"For example a fractured ankle is diagnosed as a sprained ankle," I said.
"Did you guys hear her?" Stella asked.
"Noooooo!" the students roared in unison.
"Come over here. Maybe then you can be heard." Stella gestured me over with her left pointer. I found it bossy. But what could I do?
I cursed under my breath. She no doubt believed this would force my real self out of hiding. And I feared it would. She smirked as though sensing my discomfort. Tentatively, I moved to stand before the crowd. Eyes pierced through me, holding different expressions. Mockery. Attention. Attention. Pity.
Quiet descended upon the hall as everyone waited for me to speak. Eyes held the intensity of sunlight, blinding me. I squinted. I remembered the words Stella had told me on our way from the hospital yesterday. 'Remember this. Always let your voice be heard. Always.'
It wouldn't hurt being me for a moment, would it? Shoulders back and lifting my chin, I faced the crowd. "An example of an incorrect diagnosis is the diagnosis of a fractured ankle as a sprained ankle. Another example is being diagnosed with tumor when in fact the person has no tumor. He probably has an infection or abscess. Even metabolic conditions could cause tumor-like soft tissue masses to form. These and others can easily be mistaken for tumors."
"Fine examples," Stella commended. "And what would that be? Underdiagnosis or overdiagnosis? We're starting with the first example."
I wished I had chosen a less complicated answer. I wished I had used sore throat and cough as my example. Stella seemed to understand my plight.
"First, tell us how to tell a fracture from a sprain," she said. "That way you can figure out if it's underdiagnosis or overdiagnosis."
"A fracture refers to a break in the ankle bones," I said. "These bones include the tibia and fibula of our lower leg and the talus of our feet. They meet at the ankle, and are held together by elastic bands of tissues called ligaments. An overstretching of the ligaments holding these bones in place is called a sprain."
A deafening silence accompanied my last word. I looked over to Amarachi and found her gaping at me with folded hands. My schoolmates-especially classmates-gazed at me like a second head had sprouted from my neck. They had matching looks in their eyes. A look I could easily recognize. Respect, admiration, and for a few unfortunate ones nicknamed the triple goddess, envy. I focused on one emotion. Respect. And I loved the feel of it. I just might get used to it and never return to my other personality.
Stella's face swelled with pride, igniting a new kind of flame within me. She had changed my image from unfavorable to favorable. She had turned me from zero to hero. How could I ever repay her?
A clap broke the silence. First, a pair of hands. And then two. A roar filled the hall as everyone-except the triple goddess who folded their hands in defiance-joined Amarachi and Flora in the applause.
My head swelled with pride, an overwhelming feeling I dared not push aside. Welcoming this feeling, I let a smug smile stretch my lips. I had awakened as an ordinary girl. But here I stood before a great crowd, hailed like a star.
"You are so well informed," Stella said. "It baffles me that you are not a science student and you know this much."
That's what you get when you have a Biology teacher as good as Sir Andrew. I spotted him down the hall, beaming at me. I had made him proud. I smiled back at him, and against my will, my smile broke into a full-teethed grin.
Ushering me back to
my line, Stella went on with her lecture, "Do you know that incorrect diagnosis rates range from eight to forty percent? Let's look at breast cancer screening for instance. A research review states that one in three of the cancers detected are overdiagnosed. This brings more harm than good. Do you know what it means to receive treatment for a medical condition you don't even have? Think of the inconveniences of rescheduling appointments with doctors, the higher health care costs, drug side effects, surgical complications and of course, the psychological detriments involved. When there is nothing to fix, doctors in their desperation administer treatments, inflicting great harm. And in a few unfortunate cases, death is a sure thing, sitting around the corner with its legs crossed."
"Is it dressed in black?" a student asked.
Stella's eyes roamed the crowd, and for a moment I feared she would take offense. But then she smiled when her gaze settled on the student. "Yes. The blackest of blacks."
"Carries a pitchfork?" another asked.
"That too," Stella said.
"Wears a cloak?"
"That too." More seriously, Stella said, "Stop self-diagnosis today. Schedule appointments with your doctor at least twice a year. Be health conscious." The roar of applause and side-talks muted her next words.
She held out a hand, retrieving the lost quietude. "Now, please, hit me with your questions."
Her gaze rested on Alex. "Your question was about how a qualified doctor could make a wrong diagnosis, yes?"
Alex nodded. I glanced at my watch. In five minutes time, the bell would ring for first period.
"I'll allow you answer it yourself," Stella said. "I'll guide you to the answer though. Let's see...A hospital wants to expand the market for its existing drugs, how do they achieve this?"
"Sell more drugs," Alex said.
Stella nodded. She seemed to be expecting more answers though.
Alex thought again. "Admit more patients?"
"Does this answer your question?"
"In a way, yes." Alex bent his neck to the left and then to the right. He always did that when he organized his next line of thoughts. It slightly amused me, though. It seemed as though his head overweighed him and he had to bend his neck every now and then for a measure of relief.
"Actually, there are two aspects to my question," he said, gesticulating in a way that spoke of his intelligence and esteem. "First aspect. The doctor brings up a health problem when there is none. This you have already clarified. Now let's move to the second. The doctor sees no problem where there is one. What causes this?"
"A number of things. Incompetence of medical staff-"
"Don't forget we are dealing with a very qualified doctor," Alex cut in. I could hear the challenge in his voice.
"As qualified as your doctor is, what happens when he relies on inaccurate laboratory test results, radiology films, and the likes of them?"
Folding his hands, Alex nodded. "Oh, I get it now. Curiosity satisfied."
Poor Alex if he thought his comment would dismiss the case. He would shrink underneath the weight of disappointment.
Stella had obviously taken this personally. She went on, "On one hand are instrument associated errors, and on the other are human errors. While instrument errors involve the use of faulty diagnostic equipment, human errors involve contaminated samples, improper procedures employed by technicians, incorrectly interpreted test results, omissions in CT, MRI, X-ray or pathology slides. Does this answer your question, Mr. Alex, or do I have to go deep?" She shot him a challenging look.
Alex smiled. "Let's leave it at that."
I noted how a simple smile transformed Alex's features from handsome to super handsome. Now I could see why Cynthia had agreed to date him. How would he react to her ditching him for the white guy?
Cynthia had a reputation for dating the cutest, richest kids in school. With Raheem's coming, Alex would fall in line with her other exes. Although Raheem had put up an out-of-your-league show, I knew it would only be a matter of time before he became Cynthia's new boytoy.
I scanned the 12th grade boys queue as subtly as I could. It held no sign of Raheem Kadir, giving me one more reason to smile. It appeared he would not be in school today.