Derailed

Yesterday I saw 24 patients and left the clinic (with charting all done!) at 6 pm. That was a feat. This morning as I reflected on that, a fleeting thought passed through my head: That means a disaster of a day is around the corner. Cue today. Many forces can combine to cause my day to come off the rails, as I like to think of it. I'm only half way through today, and I can say with confidence that I've been utterly derailed. It's been one of those days where I feel like I'm hunched over from the weight of my patients' problems. This happens when you are a patient who... ...is a 40 something year old male refugee from Darfur, speaks no English, and there is one phone interpretor in the country who speaks your language. This means you come to clinic monthly but only get to be seen if said interpretor is available, which seems to happen approximately every third clinic appointment. You have likely lived through atrocities I can not imagine, and are convinced that your 12 years of weight loss and abdominal pain is caused by some medical illness that has evaded every family doctor, infectious disease specialist, and gastroenterologist in Seattle. You desperately need paperwork filled out (disability paperwork, of course), which provides a unique challenge for your current family doc (aka me) given you have no real diagnosis (aside from the very real depression and PTSD that you refuse to believe is the cause of your symptoms). You have had countless blood draws, x rays, CT scans, endoscopies and colonoscopies and are near tears when you hand me this paperwork to fill out. I, your disheartened family doc, call your DSHS caseworker to discuss your case. I say, "this patient makes me sad." She says, "me too." I've never felt that connected to a DSHS caseworker before. ...is a teenage male, never been seen in clinic for anything other than the usual upper respiratory infection or well child check, who is here today telling me he is severely depressed. He has been trying to get hit by cars, has been cutting his wrists, and hasn't been to school in 2 months because of taunting by other kids. You are tearful when you tell me these things, and reveal that you don't want to let anyone down in your life, but you just can't imagine living any more. I am so worried for your safety that I send you straight to the hospital for better coordination of care. ...is a 40 something year old woman who recently had an unwanted pregnancy end in miscarriage after a long struggle about keeping the pregnancy in the first place, then had an IUD placed with a painful complication that resulted in another painful procedure. You are tearful and frustrated when you tell me how alone you felt in the hospital, how you didn't know what was happening to you because you can't speak English. I wonder what the afternoon onslaught will bring.