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There really is no appropriate title I can think of for a blog entry like this one. 

It's been a mix of weather lately, so even though it's almost May tonight proved to be a brisk night, probably in the 40s, and people coming into triage had their jackets & sweatshirts on.  I thought nothing of the scrawny 14-year old (who looked more like he was 11) when he limped in with his grandfather.  The child was complaining of generalized abdominal pain, holding his stomach and appearing all around uncomfortable and in pain.  Nothing unusual.  While I changed out the adult for the pediatric blood pressure cuff he pulled up his sleeve and stretched his arm out towards me.  My jaw almost hit the floor.  What's that, black-blue veins along the forearm and A/C region?  Perhaps noticing my hesitation the grandfather chimes in "He's Hep C positive, he did Heroin, he just got out of inpatient psych today".  I don't know how many more times I stuttered through the triage questions, but I did not think it was possible for my tongue to turn to ask a 14-year old "when was the last time you used, what did you use, and have you used anything else".