Hektoen International

A Journal of Medical Humanities

The novice

Charles Halsted
Davis, California, United States


Two nuns digging in the graveyard of a convent
The Vale of Rest. John Everett Millais. September 1858. Tate Britain. Via Wikimedia 

Living in the convent at age eighteen, the novice practiced vows of poverty, chastity, and obedience. All she ate was in vain, the more she prayed, the more weight she lost, the weaker she became.

I discovered her thin and frail in my clinic. Her stature was a striking feature, less than five feet in height. Her eye movements were normal. Her tongue was as smooth as a magazine cover, and her skin was pale with no rashes. Her lungs were clear, the heartbeats normal. Her belly was soft, the liver edge unremarkable. Her reflexes were delayed, her responses to pinpricks were dulled. When I asked her to walk across the room, her gait was widely based.

After the lab results had returned, I was on track for the answer. Her anemia was profound, while the red cells were microcytic, consistent with iron deficiency. The serum folate level was low, while that of B12 level was normal. A correct diagnosis required more proof.

I obtained another blood sample and sent it off to the lab. The results were consistent with intestinal malabsorption, with endomysial antibodies present and elevated serum level of transglutaminase. Finally, the clincher, my small intestinal biopsy demonstrated a flattened mucosa. All the features of celiac disease were present. Armed with this information, I referred her to a dietician who provided written instructions on a gluten-free diet and assured her that her weight would rise to a normal level.

When she returned to my clinic two months later, no changes could be found. More questioning revealed that though she followed the diet closely, she took a communion wafer twice daily.



CHARLES HALSTED, the son of a physician, grew up in Dedham, MA and Los Angeles, CA. He attended college at Stanford University, BA 1958, and medical school at the University of Rochester School of Medicine, MD 1962. After serving his military service at the US Naval Medical Research Unit #3 in Cairo, Egypt, he obtained specialty training in gastroenterology at Johns Hopkins Hospital. Following three years as a faculty member at Baltimore City Hospital, he obtained a position at the University of California Davis School of Medicine where he taught, conducted academic research, and practiced until his retirement as Professor Emeritus in 2015. His poetry education consisted of twelve consecutive online courses from Stanford Continuing Studies and six retreats with well-known poets in California, Oregon, and New Mexico. His poems have appeared in thirty-five different journals, one chapbook, Breaking Eighty, and two books, Extenuating Circumstances and On Razor-Thin Tires.


Highlighted Vignette Volume 13, Issue 2– Spring 2021

Winter 2021  |   Sections  |  Vignettes at Large

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