Sketches from a Rainy Clinic Morning
Just a little more sleep
It was still very dark out when Babyboy woke up this morning. He usually sleeps like a champ, so it was odd that he cried out just before dawn. I lay in bed and listened to him whimper and rustle and kick for a few minutes. I knew it was almost dawn because I heard a few cars drive by: early morning commuters, the trickle before the morning rush. I knew it was raining from the swoosh of the car tires. I knew it was cold because both cats were curled up against my legs. Babyboy quieted; he fell back asleep. The cats, however, had started stretching out and yawning. I figured I had about fifteen minutes before they started their feed-me meaows, which would then progress into kneading at our pillows, and then knocking things off the bedside tables. I hunkered down for those last fifteen minutes.
I had a new patient this morning, a middle-aged woman, well-dressed, anxious, sitting very straight up in the chair. I introduced myself, and we started chatting. She told me she was new in town, that she had just moved here from out of state. I asked her what brought her to the area.
“Well, I had to start over,” she said. “I finally got myself out of a bad relationship.”
“Oh, an unhealthy relationship?” I asked.
Her voice went very low. “Abusive. Real abusive.”
“Physically abusive?” I asked.
She paused and looked down at her hands, then up at me. “Yes.”
“Are you safe now?” I asked.
“I think so,” she nodded. “I’m staying with a friend he doesn’t know about. I changed my name.”
We talked for quite a while. She hadn’t seen a doctor in years, except for the emergency room. She had suffered a jaw fracture, nasal fractures, dislocated fingers. She had nightmares. She was forgetful, she felt depressed.
“I wonder if I have that thing that football players get,” she asked, “when they get so many concussions?”
“How many concussions did you suffer?” I asked.
She thought for a moment. “Maybe thirty? Something like that. He knocked me out all the time. That and the near-strangling episodes, maybe another thirty of those. Do those count?”
I didn’t know what to say. “It’s a lot of trauma,” I offered. “Physical and emotional. It’s hard to say what the long-term effects may be.”
I continued. “But you know, I think that what you’ve been through, there’s going to be a lot of healing. I think it’s wise to create a support network, with me, and a domestic violence organization, and neurology, to help us with the question of the head trauma, and psychiatry. You’ve been through a lot, and I think we should assemble a team for you, to help you through the recovery process.”
She nodded. “Yes, I think that’s all very good,” she agreed.
I wasn’t sure, but I thought maybe she relaxed back into the chair, just a tiny bit.
Mrs. L is an eighty-three year old lady who was booked for a physical exam. I looked through the chart and realized I hadn’t seen her since last winter, when she had been in the hospital for pneumonia. It was a soft call to bring her in then, but better safe than sorry with a lady over eighty. She got better, and apparently went on her merry way. Today she jumped up and hugged me when I came in the room.
“Long time no see!” I thought she looked younger somehow; she was smiling fit to burst.
“No offense, doctor, but I’m so glad it’s been awhile; I’m enjoying my good health.” She told me how she and her husband had been traveling almost the whole year– traveling all over the country to visit with their children and grandchildren and great-grandchildren; to meet up with old friends; to see places they wanted to see.
“Wow, you’ve certainly been active!” I was truly impressed.
“Well, that bout with pneumonia scared us. We realized that we’re old, and one of us could go at any moment.”
“But you’re a very healthy-“ I started to protest.
“No,” she said, cutting me off, “it’s life, and it’s true.” She smiled. “We’re so lucky! We’ve been married over sixty years, we have a beautiful family! How many people can say that? We decided we shouldn’t waste the time we have left sitting in front of the TV, like damn old fools.”
We laughed, and I thought, That is so damn awesome.
My last patient of the morning was a young man who usually sees another doctor in the practice. The reason for visit was listed as “STD Testing”. I figured this would be either I’ve-just-started-dating-someone, or I’ve-just-broken-up-with-someone. When I walked in he was already in a blue gown, sitting on the exam table, and the exam table was covered in extra paper sheets. I must have looked perplexed because he said, “Um, I’m pretty sure I’ve got crabs.” He looked so incredibly pained.
“Oh!” I said. “Well, we can cure that,” I reassured him.
He told me that he’d had a fling with a guy two months before, and the itching had started only two weeks ago. He hadn’t thought much of the itching at first because the contact had been so long ago. He hadn’t known that the eggs can take awhile to hatch, and then cause symptoms weeks later. The itching got worse, and worse, and now was so bad he couldn’t sleep.
“And then I saw them moving around down there.” He hung his head and mumbled, “It’s just so disgusting, I can’t stand it.”
“Okay,” I said, “Let’s see.” I did need to make the diagnosis. The poor guy turned eleven shades of red as a quick exam under the light confirmed Pediculosis Pubis, and a healthy infestation, at that.
He had read about it already. “I really want these things dead and off of me,” he said. “Throw the book at me, give me all the treatments there are.”
I’ve seen crabs before, but it’s been awhile; I had to look it up. He dressed quietly and eyed me working at the computer. I sensed he was losing faith in me, because I didn’t remember off the bat what all the treatments were. I was getting self-conscious as I scrolled through the online textbook. Finally, I recommended shaving the hair and using Permethrin twice, plus a prescription for Ivermectin, with repeats of everything should any eggs survive. He agreed and took the prescriptions.
“I’m confident this will work for you, and let me know if you have any questions,” I said, in closing.
“And shouldn’t I get tested for other things too?” he asked.
Now I was kicking myself. I had gotten so preoccupied with looking up the treatments for lice, I forgot the common sense to order a full STD panel for him. Of course, duh. I felt myself blushing.
“That’s a very good idea, good for you for wanting to be complete,” I conceded, and sent him off for a battery of tests.
I don’t know who was more embarrassed.
I spent the evening with Babyboy. He polished off his sweet peas and turkey puree with smacking lips and many “mmms”; he rolled around on the floor and giggled, trying to catch the cat’s tail; he babbled through his bath and then got warm and cuddly in his pajamas. It was almost milkie bottle time. I put him in his bouncy chair and sat down at the computer to do a few things. He bounced and talked to his stuffed monkey for awhile, while I worked. Then, I realized he was very quiet. I turned to look, and he was motionless, just watching me, his eyes both puzzled and sad.
“Oh, I’m sorry!” and I leaned down to make eye contact. I smiled big and tickled him. “I’m here, here I am! I see you!”
Immediately his face lit up with a gift of a smile, and he was all afrenzy, laughing and bouncing and pounding his monkey.
I pulled him up out of the chair and held him close, tickling and bouncing and giggling, as I walked away from the computer.
4 thoughts on “Sketches from a Rainy Clinic Morning”
Nice site.. Love your writings.. Thanks 4 sharing with us your medical expiriences..
Fantastic, mango puree! You remind me what I missed about clinic. So glad I still get to do FNA’s – but it is much more limited in terms of human experience. You make it sound amazing – your patients are lucky.