“Samantha is your next patient,” my medical assistant informs me in my primary care clinic. Samantha is a Caucasian woman in her late 40s, and I typically find her in the room with well-groomed blond hair and a cheerful outfit, such as a pink blouse, a flowery skirt, and golden sandals. She has been my patient for over a year, and I know that her life is anything but cheerful. Because she is guarded and puts her best foot forward, I had to gently dig for her to open up to me, but now she trusts me, and we have a doctor-patient relationship that is quite special.
She is divorced and a single mom fighting to make ends meet. Her adolescent son, who means the world to her, began to act out recently via vehicle collisions, drugs, alcohol, verbally abusive language and questionable physical abuse towards her. She did not feel safe at home with him, so in desperation, she asked her ex-husband’s father, her son’s grandfather, to provide shelter and support to her son for a short while. Thankfully, he agreed.
Samantha had never had asthma until she got a steady job. She found a reliable income cleaning houses, but the job exposes her to strong chemicals. She now suffers from severe occupational asthma, which requires multiple inhalers and nebulizing treatments daily and has even led to pneumonia and hospitalization. A pulmonologist follows her and prescribes steroids for difficulty in breathing. Unfortunately, the mask I provided her made her feel claustrophobic and triggered an anxiety attack. We discussed the possibility of her changing professions, but she couldn’t because the salary pays her bills. When she’s not cleaning houses, she’s often at her friend’s cancer treatments as his health care proxy.
When I first started seeing her, she never cried and never shared. She has no time for friends, and she hates “getting in touch” with her emotions. However, she carries a heavy load. Due to the trust that we’ve built, she allows me to ask how things are going. When she shares, it comes out raw, and when it comes to her son, she always cries. Sleep evades her, and depression plagues her. She declines any help from counselors, psychiatrists or anti-depressant medications. However, she is willing to see me in the clinic frequently to address her medical issues, and I hope she has come to see it as a safe haven to offload some of her heavy burden and check-in about her stress and emotions in the midst of everything.
I recently received a message from her, “Need to speak to Dr. Hou about a personal matter.” When she came in, she told me she had a new onset of severe spasmodic torticollis. This rare, painful condition causes the neck muscles to involuntarily contract and twist. The neck either freezes in place or twists with tremors and causes severe arm pain. She was diagnosed by a neurologist who treated her with Botox injections that have been ineffective.
She tells me that she cannot work. A social worker suggested disability insurance but forewarned that it is not easy to obtain. She suggested that Samantha identify a medical provider who would be an advocate and put her case in the best light. She listed me.
Samantha told me, “I’ve refused disability in the past, and you know me, I will fight and find a way. But now, I don’t know what to do…” As her voice started to break, I told her that it was very reasonable to consider disability insurance during this difficult period and that we need to seriously consider other options for work. She exclaimed, “Thank you, Dr. Hou. I was right. I told the social worker that you may be the only one who might understand and advocate.”
I had felt powerless before when I was helping Samantha manage her severe asthma and knew it could be prevented if she changed professions though her life circumstances didn’t allow for it. It strikes me that after my long road of medical training, I am now deemed by the federal and state government as having the credentials to identify appropriate candidates for disability insurance. As her primary care doctor, I take on several roles: a listener, a counselor, an advocate, and one who diagnoses, treats and walks alongside patients. This is the special privilege of being a doctor — to be an insider in the lives of our patients and to use the power granted to us to advocate the best we can.
Amy T. Hou is an internal medicine resident who blogs at Primary Care Progress.
