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Stubbed Toe

Posted by Duncan Maru


[This poem was written by Duncan Maru, co-founder and President of Nyaya Health.]


You have come to me for a busted toe,

an accident, you say.

Dressed in your loose black shirt

with a large Christian cross on it,

grey sagging sweat pants.

Your face, round, youthful, inquisitive,

impresses me.

You speak respectfully, calmly.

I could be lulled into thinking

that the busted toe is all that ails you.

But then you rattle off your medication list

like state capitols.

This awakes me from my

“musculoskeletal chief complaint”

slumber where most problems resolve.

I now see in your chart where you have been,

raped, hit, punched, kicked, abandoned.

Etiology of your condition is not “mechanical trauma”

but predation,



While you were suffering a lifetime of abuse,

I was in medical school

learning about tendons




and now here’s your lifetime of chronic diseases: 

Metformin, amlodipine: for adult-type diabetes and hypertension

Risperidone: for psychosis

Celexa: for depression

Trazodone: for sleep

Truvada: for prophylaxis against a deadly virus since you were raped

again, this month.

How I wish I could prescribe better laws, better communities,

better protections, better families.

But back to the purpose of our 15-minute visit:

you stubbed your toe.

I don’t think it is broken but owing to clinical prediction rules

and perhaps my own cognitive and emotional needs

you need an X-Ray.

So I order that, and give you the usual advice for

mild musculoskeletal injuries.

You smile graciously and move on.



Duncan Maru, MD, PhD is a co-founder and President of Nyaya Health. He is currently a resident in the Internal Medicine – Pediatrics program and fellow in Global Health Equity at Brigham and Women’s Hospital and Children’s Hospital of Boston.  

One Response to “Stubbed Toe”

  1. Borgny Ween says:

    X-rays help, as radiographers also care for the patients. Even a single toe can take a long time.

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