The patients that stood out to me today were:
55 year old woman with no way to get into Parkland and 1) uncontrolled insulin-resistant diabetes, maxed on all the oral hypoglycemics we can give (metformin, glipizide, pioglitazone); 2) bipolar disorder controlled on olanzapine and fluoxetine; 3) hypertension managed with lisinopril; 4) hyperlipidemia marginally controlled on simvastatin; 5) OA, for which she takes ibuprofen; 6) and she’s also taking aspirin and multivitamins.
6 year old girl c/o 2 week history of red eyes with exudate and dry skin on her hand. As the encounter unfolded, she said she was crying every day, had headaches, and insomnia. Her father is in jail since February and it’s unclear when he may be reunited with his family. Photo: Nora and me
21 year old woman in NAD from Burma (Karen) c/o cough and feeling warm at night. The first thing I noticed was head lice, then a normal exam until her lungs, where I auscultated rhonchi in all fields – what!? Renee listened and found the same thing. So she walked in with a cough and out with pediculosis and community-acquired pneumonia, probably mycoplasma. I started her on a challenging regimen of clarithromycin, prednisone, albuterol, ibuprofen. Also permethrin for the pediculosis.
Mary saw a woman I’d seen 3 weeks ago. At the time she was in respiratory distress and I called 911. They declined to transport her to a hospital because she didn’t have any symptoms other than SOB (lungs clear, no fever, etc.). Nora took her to the Baylor ER, where she was admitted (for >week) with a pneumothorax.
We ask all patients, have you ever been physically or sexually abused? It’s not an uncommon question, but we take care in how we ask it, trying to create a space where people can say yes vs. just tossing it out and then on to the next question. And here I was in exam room 2, with Nora and a 32 year old woman who answered, “Yes.” She was raped when she was 18 and this was the first time she’s said anything about it. And so there we were and after I worked her up, left so that Nora could sit with her, listening, the woman crying, Nora talking in the soft connecting way she has. Paroxetine, regular visits, “You came to the right place.”
How long, how long must we sing this song, how long, how long?