Routine Office Visit
“I have good news for you,” my resident exclaimed as she walked into the exam room. She was holding the patient’s most recent vitals handed to her by a nurse practitioner.
“I have good news for you,” my resident exclaimed as she walked into the exam room. She was holding the patient’s most recent vitals handed to her by a nurse practitioner.
My first patient with Alzheimer’s, Sheryll, led me on a journey of questions and self-growth which I had never expected. Until meeting her, I hadn’t thought extensively about how our biology may dictate cognition and free will. While my thoughts on the matter continue to develop as I broaden my clinical experience, these considerations continue to frame my understanding of my patients, myself and the world around me.
It was obvious that something was off. His mood was not what I would expect from a patient who had received a transplant, which for many patients represents a second chance at normalcy and freedom from the restrictions of dialysis. As we started our trek out of the SICU, my attending continued to tell me Mr. W’s story.
Huh? Just like that, my confidence took a nosedive. Jeff could have spoken to me in Mandarin, and I would have been no better off in understanding what he had just said. Suddenly, I felt very small in my new white coat. Rhinorrhea sounded pretty severe. How dumb would I sound if I asked Jeff how long the patient had to live? I thought.
I learned English out of necessity — not only for myself but also for my family. I grew up in Mexico and moved to a small Northern California town at the age of eight. When we moved to the United States, I was placed in an English-speaking classroom with no one who spoke Spanish. Necessity forced me to learn English quickly and, as a result, I became my family’s unofficial interpreter, including at their medical appointments.
For current third-year students across the country, the pandemic hit at a notably unstable moment in our lives. Mere months after many of us began medical school in new localities amongst new communities, all was suddenly fragmented.
On Monday morning, a medical assistant finds me with a nasal swab in hand. I scribble my signature and temperature on the form he hands me. “Ready, Maria?” he asks, and then laughs when I groan in response. I tilt my head, close my eyes and wait for the worst part to be over. After 15 minutes of waiting in the student workroom, he tells me I am COVID-19 negative and set for the week.
We often find inspiration in our ability as humans to create anew. I too fall prey to the promises of New Year resolutions and birthday candles, beckoning to us with the allure that our future rests in our hands.
It is Wednesday afternoon and I have one last annual visit for the day. As I enter the room, a slender 27-year-old woman wearing a white t-shirt and baggy blue jeans sits in the chair across from me.
In the pediatric ICU, a call was received from another hospital to give sign out for a patient already en route. The child being transferred had experienced a traumatic brain injury. The child was intubated after receiving every sort of therapeutic management imaginable in a desperate attempt to salvage any remaining brain function, but the prognosis was dire.
“What about my sugars?” she asked. In all honesty, since she was not hypoglycemic, I had not examined her specific blood glucose level or hemoglobin A1c too closely. Scrolling through the extensive list of her lab results, I spotted them and felt a knot form in my stomach.
Freud supposedly understood himself as a surgeon of the mind, dissecting his patients’ mental anatomy through the process of psychoanalysis. I found this comparison appealing, so when I started the psychiatry clerkship in my third year of medical school, I approached the interview in psychiatry as analogous to a surgical procedure — efficient, scripted, precise.