24

What a day.  Only 5 patients this morning, and it was all I could do. 2 OB’s needing NST/AFI’s. One of course presented at 39 weeks without any prenatal care from our group, with pre-existing hypertension on medications, and without any prenatal records. She’d like to be induced Friday, please, but she’s not sure when her due date is.

Next another patient with severe back/left belly pain. It’s not her pelvic organs, or her gallbladder; those were removed a while back.  It may be something around her kidney, like the liquid she had removed twice with a needle several years ago, now that she thinks of it.  I’m not sure, as I talk to her, that it isn’t actually from her heart. But I am sure that something is wrong with her. She can’t smile, or really move her face at all. Tears come early. She’s anxious, can’t sleep. Nothing is fun anymore. She’s guilty about everything. Energy is gone. She can’t concentrate.

She has lost 30 pounds over the past several months.

She thinks about driving off a cliff nearly every day.

She hasn’t seen a doctor in 7 years. I guess I’m it, then.

We do an EKG, and I examine her. I grab the therapist from her office to see if she can stop by. She does. We make a plan, and order labs and a follow-up appointment. Then she’s gone.

Later I stop by the therapist’s office to ask how the discussion went.  “She sure is depressed. Also, guess what she’s drinking every day?”

I brace myself for the inevitable unearthed alcoholism that the patient had denied previously. I’m wrong.

“24 cans of Pepsi. A day. 24 cans. I asked her three times to be sure.”

What?

Leafy stops by after clinic to catch me staring blankly at the 30 charts on my desk. We talk about the drama currently happening among the staff.

As we leave the building I tell her about the Pepsi. She acknowledges sometimes you just don’t know what to do. Today, her patient complained of being run over by a Studebaker. Which crushed his penis. And now he wants to have an erection.

“But I don’t even know what even will work?”

“Well, can I just have some Viagra?”

“Sure.”