Saturday, November 29, 2014

Thanks Dr. Juan

The work in the clinic is exhausting, and demanding, and absolutely thrilling. Six hours of work shouldn't wear a person out, especially college students, but at 4:30 my scrubs were soaked with sweat, and I was liable to fall asleep inside one of the pharmacy storage boxes. Dead tired, but jubilant. The clinic was everything I wanted it to be; my mind had to stretch and speculate to fit together the puzzle pieces of each patient's symptoms, only to figure out that my diagnosis was completely wrong. These are the three cases that stumped, surprised, and educated me:
            The first patient was an eight-year-old boy who came with one complaint, small white spots on his face. I had seen the same spots as a kid and my parents said that it was a skin pigment malfunction from tanning too often. The only information the boys mom gave us was that the spots had been growing, and he spent most of his time in the sun. "It must be the spots. They're harmless, we can just send him home." I thought. I'm glad I wasn't in charge because when Dr. Juan came around, he diagnosed the boy with tinea versicolor, a fungus that grows from excessive sunlight. Dr. Juan diagnosed him with some antifungal cream, and I got a healthy dose of humility.
            After lunch, a fifty seven-year-old woman came to us with complaints of back pain. We asked her the typical questions, but were stumped. She eventually complained of vaginal pain, but no pain while peeing. Unfortunately we didn't put these systems together. So we called Dr. Juan again for help. He asked her a series of questions I never even considered: presence of vaginal discharge, martial status, and contraception. He diagnosed her with chlamydia, and she was married! But how did she get it in the first place? Either her or her husband both in their upper fifties, were seeing someone outside of their marriage. A scandal had formed with the diagnosis, and I wondered whether the woman was quietly contemplating the murder of her husband or drowning under waves of guilt. Dr. Juan didn't seem to give the implications a passing thought, and professionally prescribed her and the husband treatment.
            The last case of the day was a nine-year-old girl, with red splotchy skin. She had developed a rash two days earlier on the small of her back, and the night before it had spread to the rest of her body. It was obviously an allergic reaction, but we had no idea what had caused it. I felt hopelessness rise up in me. How are we supposed to fight an unknown allergic reaction? What if the reaction came back and closed her windpipe? I was anxious and wanted Dr. Juan to help. He recognized that we didn't know what cause the reaction, but recommended a slew of substances to avoid, and prescribed antihistamines and an allergen test.
            The clinic was the most rewarding experience of my semester in Nicaragua. I learned to be attentive, speculative, and humble in the clinic. Most importantly, it made me more passionate about medicine​

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