When You Hear Footsteps, Think Zebra.

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His skin reminded me of a leather belt. His eyes were piercing under his overgrown eyebrows, and he gazed up at us all in our crisp white coats for a long minute before opening his mouth to reveal a gravelly voice that said, “I want to thank you all for what you’re striving for. I hope I can help your learning somehow.”

He wore soft, faded jeans and his careful sentences trailed with a hint of country twang. I imagined him as a cowboy in his past life. He told us he had always been healthy and active. Then the patches on his arm began appearing. Next it was the shortness of breath, and the fatigue, and the colds that kept him coughing while everyone around him recovered. The doctors dismissed it with a wave of the hand, and he did as well. Years passed, each a little worse than the last, until a chance X-ray revealed his tumor. It was the size of a cantaloupe.

He recovered from his surgery, and more months passed by while his symptoms continued to widen. He shrugged his shoulders as he spoke of the pain in his knees, attributing it to ‘getting older’. This was not a man to complain.

It wasn’t until the unrelenting diarrhea prompted him to get a colonoscopy, and a keen surgeon prepping his procedure saw a unique correlation in his symptoms. After countless months of doctors visits and tests and dismissals, he was finally tested for a simple molecule in his blood that had been overlooked.

He received the call before he even got home, confirming his diagnosis.

I will never forget the way he paused, trying to explain what he understood about his condition. “My little baby red blood cells were being killed off the second they left my bone marrow.”


“When you hear hoof steps, think horses. These are the patients you see every day: your common cold, pneumonia, a sinus infection. But when you keep hearing hoof steps, think zebras.”




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