| a nicer word for all this is empathy, or maybe compassion, which is what i hope this stuff is. but it's also a clue. if you notice five minutes after you walk in the room that you're really nervous and you cant really figure out why, maybe your patient is nervous and you sort of caught it.
so this lady had me climbing the walls. it was a yeast infection. that's the worst part on so many levels. it's so cafeteria hot plate family practice. a friend of mine used to call out "the bat signal!" for stuff like that-- ingrown toenail, impacted ear wax, peanut up the nose-- recognizable, common, fixable, good old home-fried family practice. but it was driving her crazy and pretty soon me too.
and i was in the swing of things. it was midway through a standard urgent care day-- full to boiling over with people who ran out of their meds months ago and are coming in out of desperation with something that's finally driven them out of their very last mind. i call 'em feral. at some point they had a doctor, but that was one job, six months, and three ER's ago and now they can't remember any of the myriad things that are wrong with them and when i ask them what medicine they're on they look at me like i'm stupid-- don't you know? (they live, apparently, in a fantasy world in which hospitals and pharmacies and clinics and ERs communicate with one another electronically-- which is a great idea, and i sigh wishing it were true every single time before laughing bitterly and writing "unknown 'heart medicines'")
i gave her the gyn blue plate special-- speculum exam, samples of everything for everything-- and wrote her for first line therapy for yeast infections. at this point she starts crying and refuses to leave the clinic. she's had these before and once the cream didn't work and once the pill didn't work and this has been going on for three days and the tears are running down her face. she's begging me for something better.
like i'm holding out on her.
like i've got something in the back that will cure her if she only begs me for it.
because i like to see people cry for some reason.
again we're in the fantasy world, where all hospitals and ERs and pharmacies are interconnected and where i have a cure for everything in a cupboard somewhere like a fairy tale witch who likes to see patients cry cry cry.
but i don't have a cupboard. and the creams and the pills are all i have. really. there is no special cure i'm keeping from you. you're getting the only one there is. it is the treatment for what you have which is why i am giving it to you.
but she doesn't buy it.
so i unleash the secret from the cupboard.
yes, i have been holding out on you.
there are a couple of explanations for why you're having these yeast infections.
you could have diabetes, but you don't-- i checked.
you could have a special type of fungus, but i'm treating you for that, too.
or you could have HIV.
<...>
(it hits her hard, like it was supposed to.)
which is why i want you to get your blood drawn this time.
(strangely, the crying stops.)
and i was going to do it anyway, because i test everyone, because you're supposed to. and i was going to do it anyway, because she was having kind of a lot of yeast infections and it's one of the things you have to think about when you've got a woman at risk who keeps coming down with something.
(strangely, she focuses.)
but lets face it, i could have slid it past, like a routine test, like just for the sake of thoroughness, just to be sure. but i slapped her across the face with it because i knew it would work.
(she picks up her prescription and follows the nurse docilely toward the door)
because, in the end, she had it part-way right. there was a little something in the cupboard. |
