Heart Strings

Here's another secret to being a primary care provider: You need those more benign complaints to take your mind of the enormity of other patient's problems and your inability to change those problems. I realized this yesterday in the middle of Patients That Tug on Your Heart Strings theme day.

When I start to think my life is hard, I just think about Mr. D, a patent of mine from Sudan who speaks a language called Dinka. Never heard of Dinka? Well, sometimes neither does the ATT interpreter phone service. It is extremely challenging to get a Dinka interpreter on the phone (forget about an in person interpreter), so much so that this patient has been in the clinic two times before yesterday but had to be turned away both those times due to lack of an interpreter on the phone. Aside from being unable to communicate with anyone around him, just to complicate things further, he is homeless. He apparently is on a waiting list for housing, but without a phone and language abilities, he hasn't been able to advocate for himself very well. Oh, and his medical issues? Mr. D has had body pain, weight loss, no appetite, nausea for years. He has seen a potpourri of specialists and had multiple thorough work ups that have yielded nothing. He has seen our behavioral health specialists multiple times (depression, somatization disorder), but he hasn't bought into the whole concept of mental health and stopped going to his appointments.

So there I sit, facing this man who likely has lived through horrors I can't imagine, the clock ticking down on his 15 minutes of face time with me, wondering what I possibly can do to help. I recommend more behavioral health sessions, some lab tests, medications, all of which he says he's done without avail. He says he's frustrated and doesn't have anyone else to turn to but me. Somehow I can't seem to find the answers to this one on dynamed.

My other major heart string tugger of the day came in the form of a sullen 14 year old boy in for a well child check. After politely asking his mother to leave the room, I start digging in:

Optimistic primary care md (OPMD): How's school?

Sullen teenage boy (STB): Uh, I'm failing most of my classes.

OPMD: Are you doing drugs?

STB: Sometimes. with my friends.

OPMD: Have you been getting in trouble?

STB: I only have one shoplifting offense on my record.

OPMD: Are you having sex?

STB: Yeah.

OPMD: Are you using condoms?

STB: No. But I'm only doing 1 girl and she's on birth control.

And that's the very abridged version. I'll spare you any further details of the discussion, but let's just say that my role as OPMD quickly changed to DPMD (dejected PMD). I mean, honestly, where to begin? Can I actually say or do anything to change this young man's trajectory? Am I wasting my breath? Should I just give him his Tdap and move on?

Sometimes it feels like there isn't anything primary about primary care. Sometimes it feels more like extremely and utterly complicated care.