He sat there fidgety in his chair inside our exam room, while I reviewed the test that he just performed.
He was a lanky 18 year-old kid. He just graduated from high school. Full of hope and full of dreams. His whole life is ahead of him.
Perhaps he was really patriotic and wanted to defend the name of this country that he loved so much. Or perhaps he was born to serve and wanted to be a hero. Or perhaps it was really his dream to pursue a career in this field. Or maybe this was his only way out of a difficult life.
Whatever his purpose was, he wanted to join the military.
He already applied and was seen at the Military Entrance Processing Station (MEPS). But there was one problem. In his medical history, he had childhood asthma, even though he claimed it was only mild and in fact he said that he had no more asthma attacks since he was 11 years old. An active asthma will most likely disqualify him from entering the service.
And that was what brought him here to our clinic as a referral. He needed to pass a breathing test.
The breathing test is called Methacholine Challenge. It is a sort of breathing “stress test” where we try to induce an “asthma attack” on the subject. We let them inhale an increasing concentration of methacholine, which can cause bronchoconstriction. If we see a reduction (20% or more) from their baseline number after the challenge, the test is considered positive. That signify that they have asthma.
As I examined the kid I could feel the tension in the room. I could almost hear his heartbeat even without placing my stethoscope on his chest. I could sense his anxious sighing. His pleading eyes were looking at me, searching, as I pondered on the result of his test.
His future career hung in a balance. It was me and the result of the test that were standing in the way in his pursuit of his dream.
But why was a dream crushed before it even had a chance to take-off? How do you break a bad news without breaking a heart?
The result of his test was positive.
I laid it down to him as gentle as I could. I knew he was devastated, though he tried not to show it, at least not obviously. But I knew as well that there was no words of encouragement I could muster to change the results of the test.
Maybe someday he would come to know why it was not meant for him to be a soldier. Maybe someday he would find satisfaction in a different career he never dreamed of. Maybe. But today, it was all disappointment.
I swear I saw tears welling in the corner of his eyes as he left our office. Or maybe it was in mine.
(*photo from here)