I Am Stress

Last week, I talked about “Chief Complaint” and gave an example of a list of complaints from a Vietnamese woman. As it so happens, I had a patient this week from Guatemala who presented me with a similar list of complaints.

After introducing myself, I asked her why she was there. She then talked for at least ten minutes without mentioning a single medical symptom. Instead, she went on and on about her husband losing his job, how they lost their apartment because the landlord raised the rent, how her son was in trouble with the law and how worried she was about her daughter who was now also homeless.

To help you understand how difficult it is for me to listen to long stories like this, I have to take you back to what was going on just before I walked into her room. For hours, I have been constantly going over my dominion, scheming on what I need to do next in order to keep things moving along. Check this lab, go see how that patient is feeling, look at an x-ray that has just been taken, check to see if an ultrasound or CT scan has been done, go see if a patient in pain has gotten his pain medicine and if it worked to relieve his pain. Constant hustle. Constant search for efficiency. Constant effort to get patients feeling better and either admitted or sent home.

As I look at the computer and review what is going on with the patients in my fourteen beds, I judge that the next most appropriate thing to do is to rush into Room 5 and check on a fifty-four-year-old woman listed as having “abdominal pain.” I check the results of lab tests that were done when she arrived, look at her vital signs, and check the computer for her past history. I hustle into the room and introduce myself.

So, here I am, listening to that patient go on and on about the problems of her life. She told a very sad story that had nothing directly to do with her medical condition or her visit to the emergency department. The need I see to show empathy in my body language and speech is exactly at odds with the feeling I have inside: an emergency physician zooming to provide everyone with the best care possible and get everyone either discharged home or admitted as quickly as possible. My adrenalin is up. I’m on “Go!” mode inside. But, right away, I recognize that I need to keep all of that completely hidden as I listen to this poor lady. I sit down. I cross my legs. I fold my arms in my lap. I take a deep breath and look at her.

As I said, about ten minutes went by with me wondering when she was going to get around to her medical complaint. I finally couldn’t stand it any more and took the opportunity to repeat my initial question. “I am so sorry. So, why did you come to the emergency department tonight?”

At this point, she pulls out a paper, listing her complaints. I reproduce it here:

I am stress.

I am nerves.

Anxiety

Pain back of my head

No eating well

Pain in my stomack

Short breath

Dise (dizzy)

I can’t sleep.

I got bone cancer.

I got crams.

I can’t walk.

My mouth dry I can’t talk.

I am homeless.

The list didn’t have everything on it as she came up with several other complaints as we talked. For example, for the last year, the middle toe on her left foot has felt like the bones were crunching, causing severe pain.

I carefully examined her then I reviewed the results of the x-rays and blood tests that had been done and were all normal. I empathized with her then explained that I would give her some medicines for pain and anxiety and refer her to medical and psychiatric clinics. Hopefully, someone would be able to address all of her problems that we were not going to be able to fix in the emergency department that night.

I ask her if she has any questions and then I rush off to see my next patient.