And I wish I could tell you a story about fancy heroics - about an exploratory laparatomy, a chest thoracostomy, or a patient that coded and I was the last person to perform the chest compressions that brought them back to life. But I can’t. But I can tell you that I saved a life.
She was 16 years old, and moved here four years ago from El Salvador. This was her follow-up appointment for an otitis media. It was her second time visiting a doctor in the United States. She was seen just three weeks ago and was prescribed amoxicillin for her ear. The doctor her told to follow-up in 2 weeks. It’s been three weeks, and she is now coming in to the clinic. She missed her last appointment because her mother couldn’t find the time to bring her to the doctor.
I take a look at her chart before entering the room, and I noticed that she’s in the 3rd percentile for her weight and 50th percentile for her height. Odd proportions, if you ask me, and I decide that I am going to dig a little deeper than ‘how’s your ear’…
I open the door to see a bright, cheerful young girl dressed in a paper gown. She takes one look at me, and immediately blushes and wraps the gown tighter around her frail body. I immediately try to make her feel comfortable by making a joke or two, but I can’t seem to connect. She’s avoiding eye contact. She seems self-conscious, maybe? I introduce myself to her and her mother. Her mother speaks only Spanish, and she speaks English. I ask her mother if it’s acceptable that I interview her in English. She obliges.
"I understand this is your second time here, so I just want to learn a little more about you, if that’s ok with you…"
I begin to ask questions about her ear, about the antibiotic regimen, her hearing, associated symptoms. She answers the questions, but she still seems too timid to make eye contact. I still can’t connect.
She has absolutely no past medical history, no past surgeries, no medications, no allergies - I am flying through this history. I begin my physical examination, and other than some mild tachycardia, she appears perfectly normal. Even her tympanic membranes are normal. Her ear infection has been cured.
And just as I am ready to wrap up the interview, I take one glance and notice four small scars on her wrist under her bracelets. And in that moment, I remembered that she was in the 3rd percentile for her weight - I think. I walk over to the chart, and confirm my thought.
I take a careful diet history, and I find out that she doesn’t eat much.
"I am just never hungry," she admits.
And I find it odd that a growing 16 year old girl isn’t hungry. I tell her that I want to ask her more personal questions, and I ask if she would rather that I ask her mother to leave the room. She says that her mother can stay. And I gauge that she’s comfortable with that because her mother doesn’t understand English. I look at her mother, and she doesn’t look at me - almost oblivious to the interview, almost negligent of her child’s health. I mean, what parent doesn’t want to pay attention to what their child has to say, even if its in a different language?
I ask her about her menstrual period, and I find out that she hasn’t had a period in 2 months.
“Is there any chance that you might be pregnant?”
After a very long five seconds, she answers, “No.”
I knew she wasn’t too sure of her answer, and I decided to take that as an opportunity to dig even deeper. To investigate. To get to the bottom of her lack of eye contact, miss periods, and odd scars under her bracelets.
I learn that she recently lost her virginity to her boyfriend, and he broke up with her a short time later.
“Fucking asshole,” I think. But I can’t let it show. I find it devastating how one person’s actions can take such a toll on another person, with the offender being absolutely unmindful of the damaged they have caused.
I learn that she recently started throwing up her food after she eats, mostly because she feels fat.
“I have a big belly,” she says.
I learn that she was hospitalized two months ago because she fainted in a store.
I ask her mother about this in Spanish. “It’s because she didn’t have breakfast,” she says.
I ask about the scars on her wrist, and I lose eye contact. I walk up to her, place my hand on her hand, look in her eyes, and tell her what I know.
“I know that some people cut themselves whenever they feel angry or sad. Do you know anyone who does that?”
She nods, hesitantly.
“Do you have any friends that have done that?”
She shakes her head, slowly.
“Have you done that?”
She looks me in the eyes, and doesn’t say one word. And I know.
I ask her if she’s ever told anyone about any of this before – about the vomiting, the cutting. She puts her head down, and shakes her head.
I ask her if she has friends, relatives, or a parent that she feels comfortable talking to. She keeps her head down, and shakes her head, ever so slowly.
I ask her if she has ever thought about killing herself. She looks me in the eyes, and doesn’t say one word. And I know.
And just then, it occurs to me that this is a girl crying for help. A girl who is broken behind that big, beautiful smile. A girl who needs someone to talk to, someone to confide in, someone to listen. A girl who might do something destructive to herself if she doesn’t get help soon. A girl who was waiting for someone to ask the right questions.
I leave the room to consult with my attending, and we decide the best course of action is to call the ambulance to take her to the emergency room. And she leaves.
And just then, I realize that she came in for an ear infection.
Today, I saved a life.
Read it. Read it all, and see what we mean when we say that medicine is an art form.