Today I have a practical exam; that means doctors are shadowing me. It’s my turn to talk with patients about their diagnoses, and I’ve been looking forward to that part of medicine.
It’s my second patient; she’s here for vaginal discharge. I go in, introduce myself and explain my role. I’m still mediocre at documentation, but I’m good at putting patients at ease, so we make small talk. She just moved here from Chicago — a fresh start after a tough breakup. She’s a manager at a luxury apartment.
You can tell she’s had years of working people from all walks of life. Her manner is polished. If she weren’t sitting on the exam table in a paper robe, you’d assume she was the doctor and I the patient. We’re close in age. We talk about how cold Seattle is and how difficult apartment management sounds. I joke that I quit social work (my former career) to avoid dealing with difficult customers. We have that in common. We’re close in age. Under different circumstances, we might have been friends.
But that’s not why she’s here. She’s having discharge and complaining about the smell. She figures it’s a yeast infection — she’s prone to those — and maybe some antibiotics will help. I complete the exam and get samples. She gets dressed while I go to the lab and run through the differential diagnoses. My patient has trichomonas vaginalis, which is sexually transmitted. Strange, she said she had no new partners. Maybe there was a one-night stand she didn’t want to talk about. It’s not a big deal; patients skimp on details. They lie. They forget.
The other, more plausible reason for her diagnosis doesn’t cross my mind until I re-enter the room. I thank her for waiting. She smiles and says it’s no problem at all. Then I deliver the bad news. The happiness, the excitement, and hope of her fresh start drains from her eyes. All the polish, the finesse — it’s gone.
“Yeah, he wasn’t faithful,” she says. “That’s why I left him.”
We talk about all the treatment options, but by the end of the appointment, it’s clear she’s going to need a full testing for sexually transmitted diseases. Her manner is different now, shocked and sad. The paper robe is in the trash, and she’s back in business casual. But her previous confidence is gone. Then I realize she still has it; it’s keeping her from crying, from losing whatever cool she has left.
She hangs on while I take her to the lab. HIV test, syphilis, gonorrhea, and chlamydia — they’re all on the agenda now. You can tell she’ll have a long afternoon — a trip to the pharmacy, some angry phone calls. She sits down with disbelief and chips at the rhinestones on her phone case.
I want to fix this; I’m supposed to be the doctor, right? But I’m up against a problem beyond medicine: loss of hope. In a matter of seconds, her optimistic anticipation turned to empty shock. I try to find a sticker for her, the kind we give to little kids when they cry from shots. Dora the Explorer? Care Bears? But I realize a sticker won’t help.
Instead, I put my hand on her shoulder. I start to say, “It’s going to be OK,” but I stop short, realizing we don’t know if that’s true. Instead, I say, “Hang in there. I hope your day gets better, and I’m here for you.” She buries her face in her hands. What else can I do?
C. J. Hua is a medical student.
Image credit: Shutterstock.com
