1. i've been doing prenatal care with this 17 year old girl whose mother has been cruel to her throughout the pregnancy, because she didn't want the girl to have the baby. then the girl had to go to the hospital bc she thought her waters had broken, and the mother was given a copy of the prenatal record to take home - in which i had carefully documented how the girl had been depressed and tearful because of how mean her mother was to her. and now the mother comes to all the prenatals with her and is actually quite protective of her, and tells little stories about how wonderful it was, the day her daughter was born, and how hard it is to see your baby grow up - "no matter how old she is, she'll always be my baby," which i emphatically endorse, and the girl just rolls her eyes and grins.
2. my little (i mean little - maybe five-four) 70 year old puerto rican guy comes in for a complete physical exam, which is normal. he comes with a male interpreter, thank god, because i am so not trying to do a rectal exam and explain how to use the stool testing cards and persuade him into a colonoscopy with the VERY DEFICIENT and almost always female telephone-speaker interpreter. he knows i worry about him, because last year his wife died suddenly and he has nobody to watch his diet and figure out all his medications. he does the best he can. his only questions are, why does my blood pressure keep getting higher? why don't the blood sugar medicines work? and i tell him i know he's doing everything right; diabetes just naturally keeps getting worse, even when you do everything right. we just keep doing the best we can. we are all in the hands of god (not something i would normally say, but appropriate for this guy). i hope the interpreter is getting the nuances. as he's leaving, i stick my hand out to shake, thanking him for coming in, and he throws his arms around my neck.
3. my paranoid schizophrenic guy comes in, telling the nurse he is here for right shoulder pain. when i come in, he says his ankles are swollen (they're not). finally he says he's "having emotional problems." these started on christmas eve. he is the sole support and caregiver of his very demented father, who on xmas eve stole his car and drove away. "i didn't know your dad could still drive!" i said. "nobody did," he says glumly. my patient says he had the living room full of people praying all day and all night (i couldn't help but wonder how many were corporeal and how many weren't). my patient was so distraught that the police wanted to take him to the psych hospital then and there, but he refused - "i wasn't going anywhere until i found my dad." finally the police found him about 75 miles away, at one a.m. on christmas day. ever since then, my patient has been having more trouble with god and the devil - he's under a lot of pressure. he stated he'd be all right over the weekend - he was going to watch the game and go to church, and he didn't need to go to the gas station or grocery store (particularly difficult for him when he's hallucinating). he agreed to come back and see me on tuesday. when i told all this to my attending, she said, "oh my god - they found him!" and showed me on the internets where the runaway demented father had been heavily covered by the local news. i thought the statement my patient gave to the press at the time was pretty poignant: "dad - try to keep warm, and trust someone."
4. 60-year-old alcoholic lady comes in, stinking of scotch, sitting in a wheelchair vomiting into a bucket, hiccuping and sobbing because her stomach hurts. what do you visualize? well, you're wrong. she's wearing a cashmere sweater set, her hair is professionally done, she's got a manicure and diamond earrings. i call the ambulance, and off to the hospital with her - third pancreatitis admission in one year for her. before she goes, she clutches my sleeve and says, "i'm afraid i'm going to die! ...can i go outside for a cigarette?" she was kind of charmingly sad. she is what she is.
5. one of the hardest working women in the world comes in with her daughter. i've been seeing her nine-year-old, who has a hearing loss, a seizure disorder, and developmental delay. she brings her six-year-old, who has sickle cell disease, because she her stomach hurts all the time and she wets herself, not only at night ("they all do that," the mother says tiredly), but at school every day too. at the children's hospital, they treated her presumptively for a urinary tract infection, but the mother is worried that her daughter might have been sexually abused. the kids' dad was killed last year & new boyfriend just moved in, and even though mother supervises the boyfriend and the kids as closely as she can, she had herself been sexually abused as a child, and remembers that her stomach hurt all the time, so... the little girl's exam is normal, except for the skin down to the thighs all rough and scaly from soaking in pee all the time, and the smell... the best i can do for now is interview carefully (a blank), refer to a peds urologist (a waitlist), and ask her to come back every two weeks so i can get a sense of what the heck is going on (work excuse after work excuse to the dollar store where she works). i notice in the chart that the little girl has been hospitalized with pain crises from sickle cell, every few months since 18 months old. the mom must have the most generous dollar-store bosses ever in history. the mom's eleven-year-old - he seems to be okay. the mom herself? 26 years old, one of the tallest, most dignified, most beautiful women you can even imagine.
6. lady comes in, whom i've only talked to on the phone, because she can't get off work to come in - she works in a doctor's office, of course, so can't get time off work for her own health care. she's kind of defiant, because she expects to get the runaround. she's had a headache since 2001, since shortly before her home was invaded and a robber dropped a 32-inch television on her face. she states she's always been told there's nothing wrong with her physically, it's all in her head, she needs a psychiatrist. so she goes to a psychiatrist - "i KNOW i'm crazy!" - but she still has a headache. i review her chart, and sure enough, she was told to see a psychiatrist; migraine drugs didn't work; stopping all pain meds didn't work; and, well, as she said, she's kind of crazy. in addition, she has had uncontrollable weight gain since 2000 when her son was born. "i gained 30 pounds in 2 weeks after i started the birth control patch." she recites the longest list of weight-loss program attempts i've ever heard. (i start to say, "do you still eat meat?" but then her cellphone rang.) she's mollified when i take her history in a matter-of-fact way, not arguing or challenging what she says, and her face visibly relaxes, and she's able to smile... then i turn off the lights to look at her retinas. sure enough, they're red and swollen-looking, with engorged blood vessels, plain to see even with the crappy wall scopes we use - my attending comes and looks too, and says, "yup." when i tell the patient why i'm concerned, it's like she doesn't understand at first - something might really be wrong - something might be really wrong - then she just looks sad. later that day i talk to my friendly neighborhood neurologist, and then leave a voicemail for her. she'll spend next week getting visual-field and dilated fundoscopic exams, a brain mri, an mri of the venous drainage of the brain, and a spinal tap - then see the neurologist. hope she can get off work. we'll talk about a vegetarian diet next month.
7. teenage muslim girl comes in. not the girl i delivered, but her sister, bringing her 2-month-old in for a well-baby checkup. her tiredly smiling mother, who is also my patient, is with her; her teenage sister is with her, the one i delivered, with her 4-month-old. her other teenage sister is with her, 40 weeks pregnant and on her way to the hospital to have her labor induced. (i couldn't do the prenatal and birth care for the 2 sisters because their u.s. insurance didn't kick in soon enough when they came back from overseas - they had to go to the low-income obstetrics clinic & take pot luck instead.) so the six of them all talking and laughing at once in the little exam room, beaded headscarves and long skirts and fat nursing babies in matching tigger costumes; they've been through so much, i can't imagine. their mother - my age, but looking much older - is a newly single mother - abandoned somehow, it seems, by dad overseas, but not actually divorced - with these three unmarried daughters and two young schoolboys - arabic-speaking only, on welfare, which means she is obliged to take a class to learn how to work in a day care center, which makes it hard for her to get her daughters to all their prenatal appointments; god only knows what happened with all the girls last summer in their far-away homeland, away from their mother, coming home pregnant one by one; god only knows what hopes and fears they carry along with them. young teenage girls, such careful mothers, looking after their little brothers as well, being cool and staying in school. i wished i were as big as a house, so i could gather them all up and hold them, just hold them. they are all very excited because the last sister is scheduled to have a baby girl - the other two had boys.
8. gave a presentation on countertransference - "the surfacing of a physician's own repressed feelings through identification with the emotions, experiences, or problems of a patient." i talked about my gently-smiling brain-damaged lady, who got her new baby taken away from her on christmas day, which gave me nightmares. my presentation was well received. however, nobody commented on my astute use of talking dinosaur slides.
