back in business

It’s been difficult to keep updates going when I haven’t had much to say, much to talk about. But I saw – and treated – my first cases today.

Rather than try to keep this as a sort of entertainment for potential readers that may or may not exist, I thought it might be nice to keep a portfolio for myself of the cases I’ve seen and the experiences I’ve had. If entertaining stories come up, great. If not, that’s fine too.
Yesterday was my first day actually seeing patients. I’m working at the Voluntary Health Services, down Old Mahabalipuram Road. It’s a dusty little place, with a few old buildings that look like old timey schoolhouses. It was frightening to sit at a desk with a patient seat in front of me. My first patient sat down, addressed me as ‘madam’ and proceeded to tell me her name. Remarkably, it was the same as mine. I thought that was kind of a cool little sign.
I saw 4 or 5 patients yesterday, all with colds and sinusitis. One woman had what I suspected to be a chronic bronchitis. She had diffuse wheeze and creps heard throughout the chest, with some bronchial breath sounds as well. She complained of 3 months duration of cough with copious sputum production. We interns all had various suggestions, such as bronchiectasis, bronchitis, even walking pneumonia. The medical officer suggested that these all may be zebras. Think simple, he said. Don’t suggest investigations you know your patients won’tundergo. So we prescribed amox for a mild LRI, cough syrup, and an aminophylline. And then we sent her home.
What a strange approach!
I wonder, what does she actually have? TB? COPD? Will she get better? Or will she keep taking short courses of antibiotics periodically prescribed by doctors who just want to get the patients to go home?
Another young woman came in and told me that she was diagnosed with “sugar”, meaning diabetes of course. She says she hasn’t taken medication for one month. Why, I ask. I had to work, she says. The problem is that for her, this is actually an answer. It is valid. If she takes time off of work to go pick up her medicines, she will lose a day’s salary. She doesn’t come to the clinic until she is too weak to work. I have pins and needles, she says. I am dizzy and weak. Fatigued. We ask her if she’s done her blood work. She tells us that she has just given blood and that the report won’t come until tomorrow. I prescribe her inj. B complex – for her satisfaction or for my own, I don’t know. I ask her to come back with her blood reports tomorrow.
I know I won’t see her again.

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