Sunday morning. I was rounding with my residents. We moved as a group to the ICU, stopping at each bed. A middle-aged woman with a heart attack. A boy fighting malaria. A young man battling HIV and TB. We checked their vitals, reviewed test results, and adjusted their treatment.

At bed 7, a young woman lay still. A feeding tube ran through her nose. A cannula in her vein. A catheter in her bladder. Blisters covered her body—some dry, others raw. Her eyes, mouth, and genitals were crusted and ulcerated.

“Stevens-Johnson syndrome,” my residents said. A rare reaction where skin dies and peels off. We talked about triggers—how a simple drug could ignite such destruction. We debated its deadlier variant, toxic epidermal necrolysis. We weighed the uncertain role of steroids. I was ready to move on when I saw her mother’s face—worn, worried, waiting. I turned back.

“Tell me what happened,” I said.

“She had a fever. A doctor in our village examined her and found nothing wrong. He gave her an injection and a pill. She swallowed it. Hours later, her skin caught fire. It turned red and burned. We ran from one doctor to another. No one knew what was happening. We hired an auto-rickshaw and paid 500 rupees to get here.”

My residents filled in the gaps. On admission, her skin had a few target-like rashes. Then, lesions spread, covering her body in blisters. Over days, her skin peeled off. Her mouth burned. Her eyes turned red. She could not eat or drink. She needed 3,000 calories a day. She needed fluids, electrolytes, antibiotics, weeks of care—ideally, in a burn unit.

I asked about her life. A village girl, married at 16. Her husband, an unskilled laborer. Her mother-in-law, bedridden after a stroke. A little daughter in school.

Her mother clutched her hand as she sipped water. Her husband ran back and forth between her bed and the hospital pharmacy, buying steroids, catheters, emollients. Our hospital offers subsidized care, but patients still pay for drugs and food. Each prescription drained his pocket. He had gone back to the village, broke and desperate. His wife needed two more weeks in the hospital. No one was home to care for his ailing mother. He had two choices—borrow money or sell what little he owned.

In rounds, we talk to patients, examine them, analyze tests, argue about treatments. We love rare diagnoses, the thrill of solving a case, the pride of quoting research. But how often do we think about the cost of illness? How often do we ask what a disease does to a family’s income, savings, and future?

Our students, interns, and residents must know that a hospital stay is not just a medical event. It can wreck a family’s finances. If we want patients to leave not just cured but whole, we must bring health economics into our bedside conversations.

Like beauty, medicine is skin deep.