The Blue Lady

By Marven Ewen, MD
Medical Director
allied medical training

Sometimes people are too reliant on internet information. Instead of carefully assessing their situation, they immediately search for an answer on Google. Too much sensational and typically inaccurate medical TV shows have raised the awareness of serious conditions, so much so that people jump to the conclusion that whatever symptom they are having is surely a sign of a life-threatening problem. With little medical knowledge, it is easy to misinterpret or misapply the facts.


The following is a typical example of this:


An 18-year-old woman presents to the ER in tears accompanied by her family, who appear distraught. Through sobs, she explains to the nurse that when she was getting ready to go to bed she noticed her legs were blue! She immediately consulted the internet which confirmed her initial impression that she was suffering from blood clots. By the time she was seen in the ER, she was tachycardic, mildly hypertensive, and had the sensation of tingling in her feet. The nurse began the initial assessment with some questions.


“Are you having any pain?”


“How about swelling anywhere?”


“Are you taking any medications such as oral contraception?”


“Have you missed a menstrual period recently?”



She was a healthy young woman with no significant history. There was no history of trauma. Well, this was a puzzle. With this preliminary history, I entered the room and noted a distraught young woman wearing an exam gown sitting on a stretcher with her clothing on a nearby chair. Her legs were indeed blue!


My first question was: “When did you get the new jeans?”

Somewhat taken aback by this unexpected question, she replied, “Today…why?”


I pulled out  an alcohol swab from my lab coat pocket. “I want to show you something,” I said as I unwrapped the swab from its package. I then used the swab to wipe a small patch of blue skin on her leg. The swab turned blue. “It’s ink from your new jeans.”


Sometimes the simple truth can be hard to accept but irrefutable. I explained the tingling in her extremities was from hyperventilating due to the anxiety of assuming her condition was something more serious.


On another occasion, I saw a 15-year-old suspected of having a stroke. When I entered the exam room, the patient’s mother immediately told me her daughter should have a CT scan because she is having a stroke. The daughter appeared alert and in no distress sitting on the side of a stretcher with normal vital signs. I asked what why she thought her daughter is having a stroke.


“Well, just look at her neck!” the mother shrieked. The patient seemed to have a dark ring around her neck. I informed her that it’s not a sign of a stroke and began to enquire about any neurological symptoms. But she cut me off and said, “My neighbor is a nurse and said that the dark area on her neck means it’s a stroke, so don’t waste any more time and get a scan!”


Not letting the mother in on my doubtfulness that her neighbor is indeed a registered nurse, I asked the patient if she wears jewelry around her neck. She replied yes, a metallic expanding type collar. I asked her what color it is. She indicated it was black. I pulled an alcohol swab out of my pocket, which I carry for just this type of occasion.

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