This morning I was with Dr. C again. I got there fifteen minutes early, just to prove that I can, if I know when she wants me. That was the most correct thing I managed to do all morning. Besides transgender, Dr. C specializes in geriatrics. She doesn’t just have a lot of elderly patients, she researches and writes articles about it, and is punctilious in her approach. Thus, my problem.Given that people above 60 are rapidly becoming a larger and larger percentage of the American population, and of course need more medical care than the younger segment, the other doctors in this practice also see a majority of geriatric patients. However, their approach to an elderly patient is not much different than their approach to younger ones. They talk about physical symptoms, medication lists, and depression or anxiety if it seems warranted. For Dr. C, however, the social history is the major component of geriatric care (and rightfully so). So she expects, when I report, to hear not just about current symptoms, but about where the person is living, how safe the house is, how well they do at washing and dressing and ambulating, how they eat, whether they go out at all, and what family or friends check on them. (It doesn’t help that after my purposely abbreviated history of our patient last Friday, she believes I wouldn’t know a social history if it jumped in my lap.)
Well, it was a miserable morning, partly because I was continually disappointing Dr. C with my inadequate histories, and partly because I was mad at myself. I would pick up the chart, see a list of conditions a mile long (eg osteoporosis, COPD, CHF, GERD, hx falls, depression, widowed), think of a dozen useful questions to ask (taking calcium? able to walk around house? safety rails by toilets, showers? energy, sleep, getting out of house? social activities? friends/family in area?), and promptly forget it all the minute I walked into the room. I love the elderly patients. They usually have a great sense of humor, and mostly they don’t mind spending time explaining their medicines to someone who looks like their granddaughter or greatgranddaughter. So of course I forget to ask them how long it took to put on the beautiful blouse and trouser set, and do their makeup and jewelry before coming in.
By the end of the morning, I did manage to get a fairly complete history, with the result that by the time the patient got away from me and the doctor, the lab had closed, and she couldn’t get blood work. Which left me pushing the wheelchair and trying to explain that checking her INR (measure of coagulation speed in people on warfarin) was really important, worth a whole ‘nother trip out of the house, including dressing up and finding a driver.
In the afternoon I was looking forward to working with the nice Catholic doctor, but he was out, presumably sick again. So I attached myself carefully to someone-who-was-not-Dr. C. She tends to have a little more exciting line of patients; it was with her that I saw the guy with chicken-pox pneumonia a while back. One of the patients was a really sad story, even harder for me because she reminded me of my psychotherapy patient, whom I also could do nothing to help. She has a couple medical conditions, not too bad; but her children’s marriages are falling apart, and one daughter and one son-in-law are in very poor health. Plus, her husband is verbally abusive, finding fault with everything she does, and sometimes physically pushes her around. I saw him in the waiting room, you wouldn’t think it to look at him. So she was crying with the doctor and me, saying she has no one to talk to, and her husband won’t allow her to get out of the house to talk to a counselor. And the whole time she was crying about her children, she was desperately trying to dry her eyes, so he wouldn’t see she’d been crying and get mad at her again. I wanted to go and punch him in the waiting room, but it wouldn’t have done any good. What is her son doing, not to help her at all? Stupid kids. How sharper than a serpent’s tooth, and so on.
It hardly cheered me up that I succeeded in getting a good history from her, or that I induced her to cry all on my own (which would have pleased that psychiatry chief resident who always said, Go for the affect.) Bother.
God, don’t ever let me behave like that to my mother.