"MARY, A CANADIAN JUST OVER 40, was petite and polite, with a reverence in her demeanor. She had been my patient for eight years, along with her husband and their three children. There was a shyness in her smile, as if she slightly criticized herself. She laughed easily. When her wonderfully youthful face lit up, it was impossible not to respond with kindness. Even today, when I think of Mary, I feel a warmth inside me but also a tightness from sadness.
Mary and I hadn't talked much until the first symptoms of the illness that would cost her life appeared. It started in a very innocent way: she pricked the tip of one of her fingers with a sewing needle, and the wound wouldn't heal for months. The problem turned out to be Raynaud's syndrome, in which the small arteries that supply blood to the fingers narrow and, consequently, the tissues are not oxygenated. It can lead to gangrene, and unfortunately, this happened to Mary. Despite being hospitalized several times for surgeries, within a year she had reached the point of begging for amputation to be relieved of the intense pain in her finger. When her wish was fulfilled, the disease was already out of control, and even the strongest painkillers couldn't help her endure the continuous pain.
Raynaud's syndrome can appear independently or in combination with other conditions. Smokers are at greater risk, and Mary had smoked heavily since her teenage years. I hoped that if she quit smoking, the normal blood flow to her fingers would return. She tried many times and eventually succeeded. Unfortunately, Raynaud's syndrome was the precursor to a much worse disease: Mary was diagnosed with scleroderma, which is one of the autoimmune diseases, like rheumatoid arthritis, ulcerative colitis, systemic lupus erythematosus (SLE), and many others that are not always categorized as autoimmune in origin, such as diabetes, multiple sclerosis, and possibly Alzheimer's disease. Their common characteristic is that the immune system itself attacks the body, causing damage to the joints, connective tissue, or almost any organ, such as the eyes, nerves, skin, intestines, liver, or brain."
