Hustle and Bustle

The clinic day is all about hustle and bustle, time management, and not lingering too long on any one topic or task.  Yet, I cross paths with patients with life stories that make me pause for a while and just think.

Recently I saw a new patient, a 49 year old woman from Cambodia with Down's Syndrome. I started firing off the usual questions to diagnose her medical problem that caused our lives to intersect (abdominal pain) but quickly realized I was getting nowhere.  The patient's own language and cognitive barriers were a formidable obstacle, yet, neither her legal guardian (sister) nor her case manager serving as interpretor were able to provide detailed responses about the patient. 

I shifted gears and started simple: When did the patient come to the US? Who does she live with? Is she a citizen? Is she able to care for herself? Has she ever seen a doctor?

This is what I gleaned in nearly an hour:  She was born in Cambodia but fled with her sisters, and lived for some amount of time in Austria before coming to the US. Once in the US, at some point as an adult she was "given" to an older man who her family refers to as her husband.  She lived with her husband and his family for awhile, and one day was found by police walking down a highway half clothed with the older man (who apparently at this point had significant dementia).  Once the authorities were aware of her, they discovered she had been/was being abused by this man, both physically and sexually.  It appears the abuse may have lead to a 4 week long hospitalization for a serious lower GI tract bleed that required multiple transfusions.  The records of this hospitalization are basically my only information source for her medical and social background.

Post-hospitalization she was put in an adult family home, but her husband and his family did not give her any of her critical documents (identification cards, immigration papers, etc).  A few months later she moved in with her sisters who appear to be understandably overwhelmed but taking good care of her.

You can see why sometimes a 15 minute appointment is laughably inappropriate.

So where does this leave me?  Grateful for the hospital records.  Concerned about this patient who is no longer taking any medication (these things got lost in the shuffle of moving) and has not seen a medical provider since her hospitalization over a year ago.

She was seeing me for abdominal pain, which after reviewing her records seems to be more chronic than acute.  The many tests I did were all negative.  I did uncover, though, that she is in bad need of her long lost thyroid medication, as well as a cardiology consult.  When I put my stethoscope on her chest I heard:  WHOOOOOOOOOSH.......................WHOOOOOOOOOOSH at a rate of about 45 beats per minute. The EKG confirmed her cardiac craziness and she is now awaiting a cardiology visit thanks to charity care.

She left in good spirits, amenable to trying the medication I suggested for her stomach pain (it is always helpful/frightening when a patient or caretaker brings someone else's pill bottle of medication that they have been "trying" for themselves.  Thankfully it was prilosec, and not lorazepam or vicodin).

And then it was on to the next task, next patient, next chart to complete.  Though even after being immersed back into the bustle, I am still marveling at the life stories that fall into my lap.