Positive Scarf Sign

Reid, Joanne

“Positive Scarf Sign”

Finally….all settled into my Family Medicine clerkship rotation. Surgery done (Thank God!). Internal done. Pediatrics down. Obstetrics and gynecology over. Psych just finished. Now, onto my bread and butter, my glory days, my home base…my comfort zone…….the place I can truly take time to chat with patients, get to know families, order tests, …and make those diagnoses!....Awakening time!


“She’s back with belly pains. We’ve looked into this, and we’re thinking maybe anxiety-related. She’s the right age, right profile for it….See what you think”….and he hands me the file.

Easy enough right? What almost-fourth-year clerk can’t put ‘a little anxiety’ together in a 9 year old with abdo pain?

I trot down the hall, tap the door excited to meet a happy Mom who’s got it all figured out and her little one….BOOM! I open the door and see it….organic belly pains or not, there’s definitely an anxiety component. I don’t have to feel a belly, listen for bowel sounds, or do blood work to know. My heart skips three beats and sinks to my boots in empathy. There on the smiling mother’s bald head is a scarf, pink and tied neatly in the back, with tired blue eyes peeping out below an eyebrow-less forehead. Sitting beside her is a tired-looking, but proud and tall, 9 year old girl behind glasses smiling at me.

I calmly introduce myself and take a seat. Mom talks about the ongoing “belly pains” that seem to come and go. She says that her daughter has had urinary tract infections in the past, but the last test was negative, and she still gets these “belly pains” sometimes. “…but I think somebody worries about things…” she says, looking out of the corner of her eye at her pride and joy, who glances to the floor with red cheeks.

After a little discussion together, I ask if perhaps I could have a chat with the little girl alone. As Mom steps out, I start by asking about school and friends, and how Grade 4 is going. Then to the ‘meat’ of the issue. As I sit on my wheeled stool in front of her, I ask, “…and how are things at home with you and your Mom?” I suddenly see not a tall proud all-smiling 9 year old that was in the room with her mother a few seconds ago, but a little girl needing a hug, eyes filled with tears, saying “Ok, but I worry about her…”

I see so much strength behind those 9 year old eyes, so much love, and so much worry. We talk some more until I get another smile, then I invite Mom back into the room. I ask the little girl to hop up on the table for an exam of her belly. I listen, look, feel….but really, those 10 minutes before in the room talking with her, provided more details than any CBC, ultrasound, or palpation could ever tell….the heart, strength, and love of a 9 year old girl for her unwell mother …now sitting quietly pink scarf wrapped about her head…..

From that day onward, I came to appreciate more and more that these “abdominal migraines” and “chronic belly pains related to anxiety” may not be just “an anxious kid” but a normal response of a loving, caring, concerned, and strong child for their flesh and blood. It humbled me to know that regardless of what stage of my training I may be in, no diagnostic test is going to uncover this in black and white moreso than a timely chat with a tired and scared ‘9 year old girl’….

Theme: Death and Dying | Décès et le mourir
Theme: Family | Famille
Theme: Patients | Patients
Theme: Relationships | Relations
Theme: Teaching and Learning | Enseignement et apprentissage

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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