On my schedule for the final hour of my urgent care day in a rural Arizona community was a family of three, a middle-school-aged girl joined by her high school brother and mother. Both kids needed a sports physical examination to participate in boxing for the academic year.

Twelve-year-old Lucy was a slightly fragile, 4’6” and was easily towered over by her more physically dominating brother, Leon, age 14. Yet, her beaming smile and insistence to go first led me to believe that she could hold her own, boxing ring and all.

Halfway through Lucy’s examination, I asked who started the sport first. The mother admitted that her oldest son, age 16, decided to try boxing just for the exercise. Lucy chimed in adding that boxing wasn’t initially her sport as much as it was a self-defense tactic. “I’m the youngest of two brothers so I had to learn to defend myself growing up,” she explained. 

The mother shared that they have all been active boxers in a local club for five years with over 65 combined ribbons and trophies earned between them.

While I tested Lucy’s muscle strength, she recounted the first time she fell in love with boxing. It happened at age 7 when Lucy watched her oldest brother in his first sparring drill. “The other guy’s reaction was slow, and my brother’s jab-cross-hook punch took his breath away,” she said.

I abruptly stepped back just before auscultating her lungs and must have shown my surprise and concern. She immediately assured me that the opponent quickly recovered and said playfully, “‘Hey, is that all you’ve got?’ ” 

Prior to entering the exam room, I noticed on Lucy’s visual acuity report that her eyesight was impaired. She had 20/40 in her right eye, 20/50 in her left eye, and 20/40 in both eyes, while her brother scored 20/25 bilaterally. Realizing Lucy was a strong, determined fighter who didn’t like to talk weakness, I brought up the topic of eyesight gingerly, yet directly.

“With gloves flying toward your face, I bet you want your vision to be as clear as possible so that you know when to swing, duck, or sidestep, right?” I said with a smile. She agreeably nodded her head.

I asked if she had noticed recent squinting, frequent blinking, or blurry vision. “Well, a little,” Lucy said with hesitation, then turned toward her mother. “But with Zoom classrooms, mom, I don’t need to see the board anymore, so I just forgot about it.” She shrugged her shoulders.

Her mother was surprised by the news and concerned that her daughter might avoid wearing glasses, given its disadvantage in the boxing ring. Lucy blurted out, “I’ll wear contacts, not glasses!” I proceeded with the exam while the mother texted her husband. Less than a minute later she assured me that scheduling an eye exam was a priority.

I gave the mother some local, low-cost options for getting an exam and prescription for corrective eyeglasses and/or contact lenses. Additionally, I encouraged her to follow up with the pediatrician and ask if any vision changes had been identified at recent well-child visits.

As we neared the end of our time together, I asked the mother if she had any additional concerns. She said the coach had told Lucy to get her nose cauterized to avoid frequent nose bleeds while sparring. While I supported the notion that her nose bleeds could be secondary to dry air or nose picking, I thought to myself that my nose would bleed, too, if punches repeatedly hit my face!

After giving the mother a few basic prophylactic suggestions, such as application of petroleum jelly, use of a humidifier, and ensuring adequate hydration, I explained that improving Lucy’s eyesight would be a first line of defense against incoming punches.

As the family left the exam room, Leon mildly jabbed Lucy and said, “Leave it to me. I’ll show you how to avoid those blows.”

“Brothers!” she mused, looking at me. “They’re always trying to make me a better boxer.”

While I had cleared her without restrictions to continue boxing, had I too helped her become a better boxer with exposing the sight unseen? Would I ever know when or if the patient pursued a more detailed ocular exam or followed up with her pediatrician? In general, that is a lingering question that urgent/emergent care providers have – albeit significantly less so for family medicine providers – when accepting their role in the continuum of primary patient care. This uncertainty unsettled me.  

After sharing the encounter with my supervising physician assistant, he matter-of-factly said, “Yes and likely no.” By the end of my shift, I thought back to my colleague’s insight. Knowing I had played a role in continuity of care, albeit minor, on Lucy’s path to improved health allowed me to ultimately accept an uncertainty that I will likely never see.

Download a copy of A Boxer’s Sight Unseen – Donna La May Newman, PA-C

Bio: Donna La May Newman, PA-C, graduated from USC’s Keck School of Medicine and practices urgent care and urology medicine. She is an avid writer with contributions published and forthcoming in the Journal of the American Academy of Physician Assistants and the Fellowship of Christian Physician Assistants, among others. Writing is therapeutic for her; it hones and merges empathy with the humanistic side of medicine and provides a kinship of sentiment and encouragement. Through words, she champions a FIGHT ON & HEAL ON spirit.