I suppose it is a bit Greys Anatomy to want to put some of those memorable patients into paragraphs. I want to be able to remember them though; in the years that will follow I want to be able to tell my story of being a doctor with their stories, however brief the encounter was.
Currently I am based at a Community Health Centre in Bontheuwel, Cape Town. A primary health care facility which swarms with patients that queue for hours to access even the simplest of its services. One day I'll walk you through the process, but for now lets move to the heart of the facility - "the floor" as we call it. This is the central purpose of the clinic, the point where patients sit and sit and sit and sit some more, waiting to see a doctor. Mostly they are there for some kind of follow up; they have high blood pressure and/or diabetes and/or asthma/Chronic Obstructive Airway Disease (which is what happens when you smoke a packet of cigarettes a day for most of your adult life) and just for fun we usually throw in a bit of Gastro-oesophageal Reflux (aka heart burn) or osteoarthritis.
This week I've spent most days on "the floor". The patients tend to blur into one big bunch of similarity. They shuffle in and out, they complain about sore backs and knees and ankles, they promise they are taking their tablets and that they are not smoking as much as they used to. It has the potential to be mind numbing stuff... if it weren't for a few colourful characters along the way.
One particular dear old lady stands out in my mind from this week. When I picked her folder up off the top of the pile in big capitals across the front was scribbled 'DEAF'. I anticipated a protracted and painful consultation, as some of these patients are hard enough to talk to when they hear just fine. Surely, I think though, someone must have accompanied her and will be able to facilitate a speedier process... alas no.
After calling out her name about four times a little hand goes up and she seems to gesture, unsure if I am calling her or not. "Well", I think," if she could hear her name she can't be that deaf!" She shuffles after me into my little room and has a seat. Obviously used to the long wait she has come armed with a knitting project and I wait for her while she neatly folds away the grey chunky wool and the needles into her little shopping bag. What you must understand is that for some patients, a trip to the clinic really is a whole day affair and probably one of the few excursions they venture out on, and while it cannot be said for everyone, some of them make a special effort. Though I never thought about it until one of my patients mentioned the other day that she had specially had a bath the day before because she was coming to clinic, I now noticed that she is wearing what is probably one of her 'going out' dresses, because by primary health care standards it is designer. Made out of that soft, cheap chinese satin; a deep purple with little blue, white and grey flower prints, and matching buttons that go up to her neck, it is not faded or frayed which is what makes me think she probably wears this when she goes somewhere special... and it humbles me.Assuming now that 'DEAF' simply implies speak louder than normal, I do just that but she shakes her head and waves her arms and the only sound she makes is a little squeak! It's too gorgeous, but I have no idea how to communicate with her.
Perhaps if it had been a straight forward consultation I would have been a bad doctor and examined her, rewritten her prescription and despatched her to the next queue without having to say boo, but what complicates the process is that on her last visit the Doctor who saw her had diagnosed her with fast atrial fibrillation (google it) and refered her to Somerset Hospital for review. The whole point of her coming back to see the doctor today was obviously to follow up on what the Somerset doctors have decided would be the best management for her. Now you can see why communication was necessary. I'll admit I was stumped and was about to admit defeat and despatch her on her way to be some other doctors problem in a month... but my conscience got the better of me and I gave it another shot. Her squeaking and gesticulating seemed to indicate that she would be able to read, but since I can't speak Xhosa, reading and writing it certainly wasn't an option.
"What are the chances," I thought, "of this little deaf-mute 72 year old african lady being able to read and write English!!!!" Being out of options though... I took a piece of scrap paper and wrote in big, neat letters "ENGLISH?"
Amazement is too tiny a word. There were several small excited squeaks, vigourous head nodding and gesticulating for the pen and paper upon which she wrote in perfectly legible print "YES I CAN READ AND WRITE ENGLISH"
A silent and protracted consultation followed; she had been to Somerset, and had an appointment for the 9th of April, she was still getting palpitations although her pulse was reasonably slow and regular today. She wanted to show me a sore on her leg that was not getting better...I asked her how long it had been there for to which she replied since 2007! I was amazed...how did she have so much faith in the system that she comes back for her medicine every month, if no where in her folder it was evident that she could read and write English, or if she hadn't been able to tell someone about this ulcer on her leg since 2007!
I saw no other interesting, colourful patients this week and I spent 4 days on "the floor", but this little gem made up for all of that boredom. She was so beautiful...because she didn't look 72, because of her little purple satin dress, because of her chunky grey scarf/sleeve that she folded so carefully away, because her blood pressure was perfect, because she never seemed upset or frustrated with me because I didn't know how to be her doctor at first. I left our written consultation in her folder, I wrote a little note about communicating with her in my notes and put in big capital letters next to 'DEAF' on the outside of her folder 'BUT ABLE TO READ AND WRITE ENGLISH!'
Currently I am based at a Community Health Centre in Bontheuwel, Cape Town. A primary health care facility which swarms with patients that queue for hours to access even the simplest of its services. One day I'll walk you through the process, but for now lets move to the heart of the facility - "the floor" as we call it. This is the central purpose of the clinic, the point where patients sit and sit and sit and sit some more, waiting to see a doctor. Mostly they are there for some kind of follow up; they have high blood pressure and/or diabetes and/or asthma/Chronic Obstructive Airway Disease (which is what happens when you smoke a packet of cigarettes a day for most of your adult life) and just for fun we usually throw in a bit of Gastro-oesophageal Reflux (aka heart burn) or osteoarthritis.
This week I've spent most days on "the floor". The patients tend to blur into one big bunch of similarity. They shuffle in and out, they complain about sore backs and knees and ankles, they promise they are taking their tablets and that they are not smoking as much as they used to. It has the potential to be mind numbing stuff... if it weren't for a few colourful characters along the way.
One particular dear old lady stands out in my mind from this week. When I picked her folder up off the top of the pile in big capitals across the front was scribbled 'DEAF'. I anticipated a protracted and painful consultation, as some of these patients are hard enough to talk to when they hear just fine. Surely, I think though, someone must have accompanied her and will be able to facilitate a speedier process... alas no.
After calling out her name about four times a little hand goes up and she seems to gesture, unsure if I am calling her or not. "Well", I think," if she could hear her name she can't be that deaf!" She shuffles after me into my little room and has a seat. Obviously used to the long wait she has come armed with a knitting project and I wait for her while she neatly folds away the grey chunky wool and the needles into her little shopping bag. What you must understand is that for some patients, a trip to the clinic really is a whole day affair and probably one of the few excursions they venture out on, and while it cannot be said for everyone, some of them make a special effort. Though I never thought about it until one of my patients mentioned the other day that she had specially had a bath the day before because she was coming to clinic, I now noticed that she is wearing what is probably one of her 'going out' dresses, because by primary health care standards it is designer. Made out of that soft, cheap chinese satin; a deep purple with little blue, white and grey flower prints, and matching buttons that go up to her neck, it is not faded or frayed which is what makes me think she probably wears this when she goes somewhere special... and it humbles me.Assuming now that 'DEAF' simply implies speak louder than normal, I do just that but she shakes her head and waves her arms and the only sound she makes is a little squeak! It's too gorgeous, but I have no idea how to communicate with her.
Perhaps if it had been a straight forward consultation I would have been a bad doctor and examined her, rewritten her prescription and despatched her to the next queue without having to say boo, but what complicates the process is that on her last visit the Doctor who saw her had diagnosed her with fast atrial fibrillation (google it) and refered her to Somerset Hospital for review. The whole point of her coming back to see the doctor today was obviously to follow up on what the Somerset doctors have decided would be the best management for her. Now you can see why communication was necessary. I'll admit I was stumped and was about to admit defeat and despatch her on her way to be some other doctors problem in a month... but my conscience got the better of me and I gave it another shot. Her squeaking and gesticulating seemed to indicate that she would be able to read, but since I can't speak Xhosa, reading and writing it certainly wasn't an option.
"What are the chances," I thought, "of this little deaf-mute 72 year old african lady being able to read and write English!!!!" Being out of options though... I took a piece of scrap paper and wrote in big, neat letters "ENGLISH?"
Amazement is too tiny a word. There were several small excited squeaks, vigourous head nodding and gesticulating for the pen and paper upon which she wrote in perfectly legible print "YES I CAN READ AND WRITE ENGLISH"
A silent and protracted consultation followed; she had been to Somerset, and had an appointment for the 9th of April, she was still getting palpitations although her pulse was reasonably slow and regular today. She wanted to show me a sore on her leg that was not getting better...I asked her how long it had been there for to which she replied since 2007! I was amazed...how did she have so much faith in the system that she comes back for her medicine every month, if no where in her folder it was evident that she could read and write English, or if she hadn't been able to tell someone about this ulcer on her leg since 2007!
I saw no other interesting, colourful patients this week and I spent 4 days on "the floor", but this little gem made up for all of that boredom. She was so beautiful...because she didn't look 72, because of her little purple satin dress, because of her chunky grey scarf/sleeve that she folded so carefully away, because her blood pressure was perfect, because she never seemed upset or frustrated with me because I didn't know how to be her doctor at first. I left our written consultation in her folder, I wrote a little note about communicating with her in my notes and put in big capital letters next to 'DEAF' on the outside of her folder 'BUT ABLE TO READ AND WRITE ENGLISH!'
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