Differential Diagnosis

by CategoricalGrant

Chapter 1: DDx

Suddenly, there was a knock at the door.

Without even a second passing, the door swung open and a purple stallion clad in a white coat marched his way into the room. “Good afternoon, my name is Doctor Function,” he declared in a seamless introduction while glancing at a clipboard. “It’s an honor to take care of the Princess of F-”

The doctor stopped suddenly as he spied not only his patient, but five other ponies seated in the room next to her. On the far side of the room, a tiny dragon fiddled with an electronic setup.

Pursing his lips, the doctor continued. “Uh...So, is it alright if we talk with everyone here?”

Princess Twilight Sparkle’s pretty purple ears perked up. “Oh, yes of course! These are my close friends,” she proudly chirped, gesturing to the rainbow of colors surrounding her. “Since we’re so well known in Equestria-”

“As heroes!” Rainbow Dash interrupted, holding a hoof in the air.

Twilight winced. “Yes, it’s a little embarrassing, but since ponies seem to look up to us we thought we’d go get health checkups to promote Princess Celestia’s new public health campaign about primary care. My assistant Spike is filming the documentary portion.”

A small gear fell out of the crystal camera and clattered to the floor, causing the dragon to mumble something unrepeatable to himself as he stooped to pick it up.

The doctor’s eyes scanned back and forth over those present, the flickering of his eyes revealing touches of both curiosity and hesitation. “And you want me to deliver all your results, with you together, on camera?”

“If you don’t mind!” Twilight Sparkle chirped, tilting her head just slightly to one side. “We want all of it, the good and the bad, so ponies can learn how important it is to come and see their doctor regularly!”

“Mmmhmm!” the ponies all hummed in simultaneous agreement.

Across the room, another metallic clank was heard as a small ball bearing rolled across the floor. This time, the accompanying profanity was slightly louder.

The doctor cracked a smile. “Well, I thought you all looked familiar. And as long as you want the results of the physicals I gave you together, no harm is done, I guess. Who would like to go first?” he asked openly, taking a seat on a rolling stool nearby.

“Hold on,” Twilight paused, holding up a hoof as she turned to her assistant. “Are we ready to start rolling, Spike?”

“Cinema is art,” the dragon responded, squinting into the camera. “I was born ready.”

“Okay, I guess I’ll go first then!” Twilight responded.

“Aaaaalrighty,” the physician stalled as he flipped the page on his clipboard and scanned the page quickly. “Ah, yes, that’s right. There are a couple of things I wanted to talk about, but, generally, you seem to be in pretty good health, Princess.”

Twilight sat up, beaming in glee as the praise began.

“Not really any big red flags on the physical,” he muttered to himself. “We talked a little bit about your mental health; it seems like you might have a little bit of a problem with anxiety.”

“Phhh,” Twilight puffed, waving off the mere thought of such an assertion with a sweep of her front hoof. “That’s ridiculous, I do-”

“Listen to the good doctor, Twilight,” Spike begged from behind the camera. “If you won’t listen to us, listen to him.”

“Taking control of your anxiety can be have very positive effects on your life, you know,” Doctor Function continued. “You might not even have to see a specialist. Lifestyle interventions like deep breathing, hugging a friend, and even taking herbal supplements can make a big difference.”

“Well…” Twilight moaned, biting her lip in thought as she shimmied uncomfortably in her seat, “I...I guess you’re right, I’ll look into it.”

Her friends released a collective sigh of relief as Twilight finished, with a few of them casting surreptitious grins at each other.

“That’s great!” the doctor responded. “Now, I think that’s it, but let me just...Oh! That’s right, silly me,” he chuckled as he scanned further down the list. “The only other thing is that when I was listening to your heart-”

“Do you mean auscultating me?” Twilight displayed smugly.

The other ponies groaned and rolled their eyes.

The doctor merely furrowed his brow. “Uh, yes, that’s correct. You have quite a grasp of basic medical terminology.”

“Thank you!”

“While I was auscultating you I noticed the presence of something we call S3 and S4; they are abnormal heart beats.”

Twilight’s brow furrowed as she scanned through the useless repository of knowledge she had gained from anatomy textbooks; or rather, trashy medical romance novels where the main characters had read anatomy textbooks. “Like a murmur?”

“Hey, look at you with more science words!” the doctor praised. “No, actually, this is something called a gallop rhythm. Since you’re young, otherwise healthy, and have great blood pressure, it’s probably just caused by your anxiety, but I still want you to get it checked out by a cardiologist.”

Twilight’s body seemed to freeze. “What? Why? If it’s just my anxiety, why do I have to go see a cardiologist!?”

“It’s probably your anxiety, but I just want to be sure.”

“Well, what else can cause it to happen!?” Twilight asked impatiently, her eyes flickering between the doctor’s gaze and the clipboard in front of him, as if trying to siphon off information.

“Oh, a number of things,” the doctor dismissed. “Just a bunch of medical gobbledegook you should let us doctors worry about. Things like dilated cardiomyopathy, mitral regurgitation, endocarditis...silly stuff.”

“...WHAT!?” Twilight screeched, shooting up from her chair. “I COULD HAVE HEART FAILURE?”

The doctor sucked in a tight breath and anxiously began tapping his pen on his clipboard with his magic. “Shoot. You know, usually patients don’t know what any of those words mean and just sort of sit there contently, but I should have had you pegged as more medically knowledgeable.”

“WHY IS MY HEART INFLAMED!?” she cried, crawling on her stomach towards the doctor. “WHERE IS MY CONGENITAL DEFECT!? HOW LONG DO I HAVE!?”

“Twahlight, calm down,” Applejack called. “Yer not dying.”

“How do you know!? You’ve never had anyone you know die!”

Applejack inhaled deeply and raised a hoof before Rarity shoved a hoof into her mouth. “Don’t respond to that in kind, darling, Twilight is just having a moment.”

“Where will the funeral be!?” Twilight sobbed. “Who will take my place as Princess of Friendship!?” Her eyes jolted open quickly. “My last wish is that it be anyone but Trixie!”

“Calm down, Princess,” the doctor shushed. “You’re just going to make it worse if your heart rate goes up.”

“Ohmygosh, I’m wasting my last few moments on this plane! Squandering them! I...I…”

“Here,” Doctor Function said, using his magic to shove a little white pill into Twilight’s blathering muzzle. “Take this if you want to live.”

Twilight swallowed and her screaming slowly faded into incoherent sobs. Fluttershy rushed over to care for her friend.

“Man, do I love this job,” Doctor Function hummed as he flipped to the next page in his chart. “Always keeps me on the tips of my hooves.”

“What about Twilight?” Rarity asked. “Is she going to be okay?”

“Hm? Who?”

Twilight. The patient sobbing at your hooves, doctor.”

“Ah, I dunno. Anxiety is really a silent killer.”

“What about her heart?” Rarity clarified.

“Oh! Pffffh,” he scoffed. “If I thought that was anything more than a minor glitch in the system I would have sent her to the hospital. The heart wonks will take care of her just fine. Now, who is next?”

Three of the ponies who remained seated cast concerned looks at each other. The other, however, could barely withhold her excitement.

Pinkie Pie’s hoof shot up. “Oh! OH! Me! Me next!” A pink blur formed as she waved her leg furiously back and forth.

“Okay, Ms. Pie,” the doctor chirped back with a smile. “I love your attitude.”

“You can call me Pinkie!”

“And on a casual, first-name basis too! I like you, Pinkie. My first name is Wave, by the way.”

Pinkie Pie snorted happily. “I like that name, it’s Wave-y!” she chittered, moving her hooves in a corresponding pattern. “I like you, doctor! You should come to my parties!”

The doctor’s smile fell slightly as he read the chart. “Yes, ah...thank you for the invitation. Now, Pinkie, I have some news for you, and it might be startling.”

“Ooooooooooh! Startling!”

The doctor cringed slightly. “Yes, well, your hemoglobin A1c is at 6.5%. This is a very sobering number and makes me think your blood sugar is not well controlled. To be brutally honest, you’re a dozen doughnuts away from full-blown diabetes.

Pinkie Pie beamed back. “Sounds fun!”

“There is nothing fun about insulin resistance,” he admonished. “This puts you at serious long-term risk for a number of other conditions, and it’s important that we cut down on your sugar intake. Now,” the doctor glanced down at his papers before looking up again, “you mentioned that your activity level is- did you just eat a cupcake?”

“No,” Pinkie responded quickly, crumbs plastered around her lips.

The doctor grimaced. “You know, your random capillary glucose was reported as 1039...I thought maybe it was a misreported 139… but now I’m not so sure.”

Pinkie Pie slowly raised another cupcake to her mouth and took a slow, deliberate bite. “Don werri,” she slurred as she chewed. “Dis one ish organik.

Doctor Function pursed his lips and hummed uncomfortably. “Okay, I’m going to move on to your friends and we’ll cycle back to this.”

Rainbow Dash snorted from the chair next to Pinkie Pie, her hooves crossed and face contorted in an expression of boredom and mild disdain. “Why don’t you just do it now and get it over with?”

“Because I’m stalling for time to figure out how to deal with her...And thank you for volunteering!” He quickly transitioned. “Now, you must be Shutter Butter.”

Rainbow Dash squinted. “I’m Rainbow Dash. You know, the famous flying star you examined three days ago? And you probably mean my friend Fluttershy.”

“Oh, so sorry about that,” the doctor replied halfheartedly. He blinked slowly as he haphazardly flipped through the chart. “I’m on my 28th consecutive hour of call and sometimes I slip into brief dissociative fugues. Now, as I recall, you seemed healthy but I was concerned about fourteen separate wing fractures in your medical record.”

Thirteen wing fractures,” Rainbow Dash objected, her hooves still crossed disdainfully across her barrel. “That business after the last Wonderbolt Derby doesn’t count.”

“Right...Well, your bone scan reveals that your bones are so light that they can literally float on water.”

“Uhh, I believe the word you’re looking for is ‘sleek’,” she corrected quickly. “I’m fast for a reason, you know.”

“And according to your genetic microarray, that reason is a dominant genetic disorder called osteogenesis imperfecta. Now, the good news is that it is a treatable-”

Rainbow Dash shot into the air, bearing her teeth. “Who are you calling imperfect!?” Diving down, she pressed her nose right up against the doctor’s. “I’m going to pound your flank right into the-”

“Really, for the sake of your bones, I wouldn’t suggest it,” Doctor Function cautioned, pushing her back gently with a free hoof. “Just some free medical advice.”

Rainbow Dash slowly floated back to her seat, grumbling and cursing all the way.

The doctor scanned those seated for his next victim, but halted as he saw Twilight in her chair. “Princess Twilight, you’re sitting again! How do you feel?”

“I feel good,” Twilight lazily slurred. “You’re a good doctor, the best doctor.”

“Thank you, I try very hard. Feel free to write a recommendation to the faculty so I can get out of this fellowship program and into an actual hospital.”

Applejack stared at her doped-out friend in awe. “She forgot completely about her heart! Doctor, what in Equestria did ya give ‘er? She’s loopier than a dehydrated hen in a July drought!”

“I gave her 5 milligrams of a potent benzodiazepine,” he responded matter-of-factly. “I sure don’t hope you ponies have to go save the world anytime in the next twenty hours, because you won’t be able to get her to worry about anything save for a lack of warm blankets.”

Twilight gasped audibly. “I looooove blankets. Can I have a blanket?” She yawned. “Somepony gimme a blanket while I nap.”

Spike chuckled from the corner of the room, hidden by the ornate camera apparatus. “Oh, yes. This is glorious footage.”

“Why don’t we concentrate on me, next?” Rarity asked, coiffing herself halfheartedly with a single hoof. “It’s going to be important to have somepony healthy for this campaign, and I have neither Rainbow Dash’s rough-and-tumble history of injury, nor Pinkie’s questionable lifestyle habits.”

“Oooh, well, not sure I’d give you a clean bill of health, exactly,” exhaled the doctor through clenched teeth.

Rarity pursed her lips in an only somewhat-dignified pout. “Well, what seems to be the matter, then?”

The doctor bit his lip and looked around at the others anxiously. “Well, I’m really not sure this is the best setting to discuss it…”

“Darling, please,’ Rarity huffed. “We all agreed to do this openly for the sake of public health. If you can tell my friends what is wrong with them, then you can do so with me.”


“No exceptions!”

The doctor sighed and looked into Rarity’s deep blue eyes with a strained determination. “All I’m going to say is that you should follow up with your Gynecologist.”

The color drained from Rarity’s already white face as a tense silence fell over the exam room.

“...As in, promptly,” the doctor added. “Today, ideally. ‘Emergent’ is a good word to use here.”

“Oh, come on!” Rainbow Dash spat. She squirmed uncomfortably as she spoke, as Twilight had fallen asleep on her shoulder. “Aren’t any of us healthy!?”

“Uhh...no,” Doctor Function candidly answered. “Fluttershy has gross anemia and a number of as-of-yet unidentified viruses of animal origin acquired by cross-species-transmission.”

“Oh...dear,” Fluttershy exclaimed softly, seemingly mildly worried. “Am I going to be-”

Doctor Function turned to his last target, Applejack. “And Applejack here has extremely high levels of androgens circulating in her blood that suggest either chronic anabolic steroid use, or the presence of internal testicles caused by a developmental error.”

Another silence fell, this one more awkward than tense.

“Well!?” Rainbow Dash asked Applejack, shoving Twilight’s unconscious body off of her shoulder again.

“Well what?” clarified Applejack.

“Well which is it, darling?” Rarity pressed. “There’s no judgement here, unless of course you’re a steroid user. Or secretly a stallion.”

Pinkie Pie hopped up from her chair before Applejack could offer any sort of response. “What about Spike? He’s healthy, isn’t he?”

The doctor stood up and approached Spike. “Hmmm,” he thought, pulling a forehead temperature reader out of his white coat. “They didn’t teach us much about dragons in medical school, but I can take a look.”

The doctor swiped the device across the forehead of Spike, who was more invested in his camera shot anyway.

“Well, his temperature is 150 degrees.”

“What does that mean?” asked Rarity.

“It means he’s dead,” the doctor noted clearly. “It also means that pony vital sign bounds are limited in their applicability.”

“You are a great doctor,” Twilight slurred again.

“Thank you again! This must be my day,” mused Doctor Function as he waltzed back to his stool. “I never get compliments like that.”

I wonder why,” spat Applejack under her breath.

“What was that?” The doctor inquired, squinting his blue eyes at her. “I can get you something for the irritability, if you want.”

“So, darling, just to be clear, none of us are healthy?” Rarity asked.

“Goodness no! I’d have trouble picking a random sample of six ponies who are worse off, to be honest. Especially given the fact you’re all young, big changes need to be made.”

“This is art,” Spike breathed sensually as he swept the camera’s angle across those assembled.

“Wow! This probably can’t get any worse,” Twilight declared, still smiling. “But I don’t care!”

“I hope I was of some help,” Doctor Function said, raising himself to his hooves. “Sorry to give you the bum’s rush, but I’ve got to run out. I’ve got a hot date tonight- she’s a unicorn and works as a guidance counselor at a school nearby...We’re going out to get cocoa. I’m not a big chocolate pony, but I like it a lot more than dying alone.”

“Wow!” Twilight exclaimed. “I was wrong! It did get worse! Can I have more pills?”

Removing a crystalline video card from the camera, Spike blew fire on it, vaporizing it into ash that magically weaved its way out the window and toward Canterlot in the distance. “For that piece of cinema,” he declared ecstatically, “I shall be remembered for all time!”

Author's Notes:

I put my OC in a story >:3c

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