November 13th, 2017



Name: Juan Valdez Simpson
Nickname: “Dez”
Age: 10
Race: Undetermined
Chief Complaint: “My leg hurts”




History of Present Illness:
Scraped left knee sliding into second base on Tuesday.

“Yer Out!”
Cleaned with peroxide at home.

“Where’s my momma?”


Outer bands felt Thursday morning. Windgusts and a hard rain (landfall) by evening.

Already on our way out, up (North), away…
Traffic not moving. Standstill.




Got out and starting walking up the interstate.

Like everyone else.
Dark. Wet. Bugs. Smells.



Moms carrying cryin’ babies.

“Hey mister, what did you say?”
Don’t talk to my momma that way.
Don’t look at my momma that way.


“Where’s my momma?”



Past Medical History:
“My asthma’s bad”
Meds: “Puffer”
Allergies: Mold, cockroaches (but isn’t everybody?)

Family History:
Mom alive and well, pregnant “but you can’t tell yet”
Dad — “My mom says he’s a good-for-noth…”)
Dad — out of picture…

Social history:
Fifth grade, likes math. And baseball and bikes.
“No, I don’t smoke, I’m only 10!”

Vitals: Temp 101.4
Exam: “Oww, that really, really hurts!”


No sleep when the flood came.
Washed away.
Scared. Alone. “My leg hurts.”


Grab at something, anything, to pull me up, higher, drier.
Wet, sad.

Wonder if Billy got out. And Raul. Natalie and Taneshia, too.
Fifth grade, you know.
“I feel cold.”



Plan: “Xray over here
CBC, thick smear”
IV pain meds
“Feeling better now, Dez?”


“Not going back.
I seen the news. Nothing left.
No one…”



Juan Valdez “Dez” Simpson
Age 10.

Cellulitis of left leg s/p mild trauma.
Can’t find his mother.

Climate refuge.




(Google Images)


3 Responses to Case Study

  1. This is so incredible and so strange that it must be fact—rather than fiction. I felt like I was watching a movie!

    • Well, it’s based on true stories. I presented my slideshow on climate change and health to a group of healthcare professionals today and was asked (a month ago) if I could begin with a case study. That inspired me to write this blog post. Alas, I didn’t present it as part of my talk — too much other information to convey.

  2. I think the stark, unframed presentation of the story gives it a piercing, eerie quality which alarms the reader and gets the point across!


    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 

  • Note: The information included in these posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

  • Tags

  • Archives

    • 2018 (54)
    • 2017 (365)
    • 2016 (368)
    • 2015 (372)
    • 2014 (378)
    • 2013 (442)
    • 2012 (202)
  • Contact Us