Chapter 3: More Than Skin Deep

She sounded exasperated, the kind of frustration that comes from caring too much. I could tell she’d been pushing him to get help, and he’d been resisting. Classic stubborn Midwestern guy.

I gently asked him to turn around, lifting his shirt further. The skin on his back told a different story—a constellation of lesions, some angry and red, others crowned with small pustules. I felt a cold trickle of concern down my spine.

The sight was unsettling. Allergies don’t usually look like this. I tried to keep my face neutral, but inside, I was already running through my Rolodex of skin conditions, each one worse than the last.

I thought about the on-call list, knowing there wouldn’t be a derm specialist until morning. Still, I owed them an honest assessment, even if it meant a long night for all of us.

She wasn’t done advocating for him—her concern was fierce and unwavering, the kind that turns ordinary partners into experts overnight.

Her eyes pleaded for hope, for a label that didn’t sound like a life sentence. The word 'psoriasis' hung between us, heavy with memories from her own family.

He looked down, fiddling with his sleeves. The anxiety that had hovered in the background now surged forward, raw and unfiltered. I recognized that look—a man caught between fear of the unknown and fear of the truth.

I studied the pattern, the way the scales caught the light. Psoriasis was on the list, but so were a dozen other, less benign options. The ER doesn’t always offer answers—sometimes it just gives you more questions.

Mislabeling something like this could change the course of their lives. I knew that all too well—one wrong word, and you might as well be handing out a scarlet letter. In American culture, a diagnosis can carry a social weight almost as heavy as the disease itself.

I explained, "Psoriasis can be genetic—sometimes it runs in families. But sometimes, it just shows up out of nowhere." I tried to strike a balance between concern and reassurance.

I watched for his reaction—sometimes people remember distant relatives or old stories that hold the answer. Family history can be a minefield, but it’s always worth asking.

He almost smiled, as if willing the answer to be enough. I could tell he wanted me to confirm he was in the clear, that everything would go back to normal soon.

I tried to ask gently, knowing that sometimes the stress of a secret can leave physical marks. In America, we talk about stress in whispers and jokes, but it’s as real as any rash.

He shrugged, downplaying his struggles. I could tell he was holding back, not wanting to admit how hard the last month had been.

She spoke up again, the worry in her voice sharper now. Nightmares, insomnia, anxiety—it all piles up, especially when you’re keeping secrets.

I nodded thoughtfully, choosing my words with care. "Stress and anxiety can definitely make skin problems worse. Sometimes, our bodies carry the weight of our worries." The truth hung in the air, unsaid but understood by everyone in the room. But before I could finish, the lab results flashed onto my screen—and what I saw made my heart skip a beat.