Chapter 2: An Unusual Sore

I asked if the sore was really painful, already planning to write for a mouth rinse. Canker sores hurt like crazy for a week, then vanish. Not a big deal—certainly not life or death. "Does it really hurt, or is it just annoying?" I asked, my hand hovering over the prescription pad. I tried to lighten it up: "Canker sores are like mosquitoes at a barbecue—annoying, but they don’t stick around forever."

To my surprise, she said it wasn’t really painful, just uncomfortable. She shook her head, chewing on her lip. "Not really. It’s more like... there’s something there that shouldn't be, you know?" If not for the singing competition, she wouldn’t have bothered with the ER. Her friend chimed in, "Swear, she only made me come because of her big solo. If not, we’d be on the couch, crushing pepperoni slices and rewatching Jim propose to Pam."

She’d already tried mouthwash, numbing sprays, every home remedy in the book, but nothing worked. The sore had lasted almost two weeks and wasn’t getting better. She rattled off her attempts: "I did saltwater rinses, numbing sprays, even honey like my mom told me... Nothing. It's just stubborn."

That was weird. Even in a noisy ER, something not adding up makes all the background noise fade for a second. "Could it be from stress?" Alex, my resident, muttered, channeling that classic American wisdom—blame finals for everything. Alex leaned in, just loud enough for me to hear. "I heard finals can make you break out in weird places."

Then she started up with her own story, pitching a home remedy with Midwest enthusiasm. "You know, my grandma swears by chamomile tea with honey. Clears up anything." The patient offered a wry smile. "I've had so much tea this week, I think I'm starting to sweat it. Still nothing."

Alex wanted to keep brainstorming, but I cut her off with a look that said, "Dial it back." She bit her tongue, getting the message. But this wasn’t just stress. Why would a canker sore from stress not be painful? When I got them in med school, even Gatorade felt like lava. Besides, there’s no textbook diagnosis for “stress sore.”

I bit back a groan. This was classic ER—everyone’s an expert after two minutes on WebMD. I muttered under my breath to Alex, "Not exactly a medical diagnosis," hoping she’d take the hint. I snapped on my gloves and asked the patient to say "ahh." Inside her mouth, I found several oval, red erosions on her lower lip and palate. Some had ulcerated. The biggest was nearly half an inch across—enough to make anyone flinch. No wonder she was worried about singing. I’d be nervous, too, if I had to belt out a solo with that going on. But such big sores, and not painful? That didn’t add up. I glanced at her, searching for any sign she was downplaying things. Most people would be chugging Tylenol or begging for something stronger.