Monday, May 21, 2012

I drink my medication and it goes away...

We had a delightfully curcuitous patient during my Family Medicine rotation. She came in with a legitimate history of migraines and had recently had what was believed to be a TIA (totally legitimate). The office manager saw her name on the schedule and I swear her face turned green. (PS, that's never a good sign). She told me they actually used to work together and that in a nutshell she and her mother are nucking futs.

 The doctor had me see her on my own before coming in to wrap things up (now I know why). Legitimate issues aside (which were indeed discussed, in depth and I know have been followed-up on) she is a bit...quirky.

Patient Quirk No. 1 -- she speaks fluent English, but English is not her first language. The giveaway? "I drink my medication." The Spanish equivalent for "drink" is tomar, but it is a bit more flexible in meaning than in English, and can mean "to drink/to take." You hear it a lot in Spanish speakers, it's one of those idiosyncrasies they frequently cannot shake. Like Germans and "w vs. v" it just never clicks.

Patient Quirk No. 2 -- she's a drama queen. I need not elaborate on that as we all know what drama queens are. And no, I'm not referring to her patient complaints. I'm referring to the Joan Crawford-style renditions of her history.

Patient Quirk No. 3 -- she's slightly repetitive

Q: Can you tell me what you were sent to the ER for?
A: "Yes, doctor (people call me "Doctor" at their own peril. Some of them get quite crotchety when I have to tell them that no, I instead of the real doctor cannot write them their hydrocodone). It started when I was at home trying to do some school work. I was trying to do some school work (pregnant pause) when I started to feel funny. I thought it was my eyes because I was trying to do some school work and when I do a lot of school work my eyes can hurt because I'm doing a lot of school work. Sometimes when I do a lot of school work and my eyes hurt(pregnant pause) I drink my medication and then I can keep doing my school work. But this time(pregnant pause) when I was trying to do my school work it was different. I couldn't talk." She goes on to say a few more things that I won't repeat because they are personal details about her treatment. Suffice it to say she did indeed have a real reason to be admitted to the hospital.

Q: How often do you get migraines?
A: Doctor (pregnant pause), I get migraines several times a week when I get migraines. I've been getting them since I was 21. I've gotten to where I can feel it (pregnant pause), and I drink my medication (pregnant pause) and it goes away. So they can't figure out what's wrong with me (pregnant pause) because normally when I feel it coming I drink my medication and it goes away.

Q: There are a couple of different medications listed here for migraines. Do you take them all?
A: No doctor (again she calls me doctor at her own peril), I only drink one of them. The other doctor she told me to drink Medication A, but it made me really sick (pregnant pause), and when I drink it I am allergic to it. So I don't drink that medication anymore. Because I'm allergic to it (pregnant pause), I don't drink that medication anymore. I now drink Medication B. When I feel a migraine coming I drink it (pregnant pause), and my headache goes away. I had one on night one in the hospital, and night two. I drink the medication (pregnant pause) and it goes away. But they still can't figure out what's wrong with me doctor. I drink my medication (pregnant pause) and it usually goes away. I'm a medical mess and they cannot figure out what's wrong with me. this point I'm half-wishing she spoke Spanish so I could only half-understand her. But alas, no. I'm also starting to wonder if I'm going to get a migraine myself. I'm legitimately concerned about her (and also wondering why she isn't seeing a neurologist), but I'm also having visions of the scene from Aladdin where Iago is chased by the Sultan on a flying carpet...and then sees forty-six Sultans spinning around his head. No I am not including a lot of the details of her treatment because they are real issues, and personal to her.

After about twenty minutes of this, the REAL doctor (the one who can give the narcos what they want) has finished with her other patients, and comes to play.

Lather. Rinse. Repeat. No matter what is being asked of her she retells the whole bloody thing from beginning to end. Thirty more minutes of the patient saying the same thing about how she drinks her medication, telling us at least five times what has happened at the hospital (never mind that we have the report, and wrote down in detail what she has said), and how they don't know what happened to her. In addition, she provided many other details that would lead me, as well, to conclude that she is indeed...nucking futs.

...I need a drink (pregnant pause)...of not medicine.

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