Clinical, Featured, Health Policy, Internal Medicine
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What Brings You in Today?

Patient: 58-year-old AAF

Chief complaint: sinus congestion

Me: Good afternoon, ma’am. Wow, what a contagious smile you have. I hear that you are here because of a stuffy nose? They said that you tried Claritin and that did not help. You feel congested, and it’s hard to blow anything out? And no fevers, no cough, no difficulty breathing or any wheezing?

Patient: Hello, sweetheart. Yes, that’s right. I bet it’s just my allergies.

Me: Oh, are there new allergy triggers?

Patient: Yes, I just moved into my aunt’s house to help her because she had a stroke and she’s got so much dust in that house. It wasn’t like that back when she was raising us — guess now it’s my turn.

Me: I love that, it’s a testament to how she raised you. I agree with you, I’ll give you something to shake up that mucus so it doesn’t feel stuck, and some nasal spray to help you breathe easier. Watch for fevers and chills. Come back and see me if you don’t feel any better in a week or if anything gets worse.

Patient: Thank you, doctor! Look at you, I wouldn’t even believe you’re still in training with how quickly you took care of business.

Me: To be honest with you, the quicker I get at taking care of business, the less I feel like a doctor. We barely even got to talk, what is the fun in that?

Patient: We are about to talk. Listen to me now: learn to accept the compliment. You are an accomplished woman in a world that hasn’t been easy on you — I can see it in your eyes. Be proud of yourself. You are representing us all.

Me: What? Come on! I am not the one this world is hard on. Mom and Dad gave me everything.

Patient: Good. Acknowledge your privilege. But you aren’t doing anyone any favors if you don’t also own your own struggle.

Me: That is true.

I looked closer into her weary eyes — we were more alike than we were unlike.

Me: So, are you originally from East Texas?

Patient: Been here a long time, are you?

Me: Wow, after three years, you are the first person to ask me if I’m from here. I’m originally from South India. I’m just here for my training.

Patient: I would have never guessed that. I have friends who grew up in India.

Me: Okay, fine. I moved here when I was six. I mainly grew up in Dallas. Lately though, when people ask, I tell them where I come from. I don’t know why.

She sat back, looked at me, and nodded.

Patient: I’m sorry about the things they are saying about immigrants these days. It’s not right.

I had a lot that I wanted to say. I could sense her trying to welcome me into a safe space.

Me: That was cool of you. Dr. King said it, right?  “Our lives begin to end the day we start to stay quiet about the things that matter.” And it’s all around us. There is so much to talk about. And they keep telling me that it’s too early in my career to make noise. It can get you feeling caged up.

She sat back, looked at me for a while, and just smiled.

Patient: Yeah, obviously. You better keep your seat at the table. And then we need you to make room for the rest of us. You know what your problem is? You think you need to scream and shout about it. I am sick and I came to you to help heal my pain. You know why? I really trust that my life matters to you. I told you, I saw it in your eyes. Now, ask me what you’re supposed to ask your patients when you walk into a room.

I was confused for a moment, and then I understood what she meant and I smiled.

Me: Tell me what is bothering you today, and tell me how I can help.

Patient: My son is coming home next week. You know, he is in the Navy. And honestly, I am worried that it is more dangerous for him at home than for him to be out there. I keep thinking about the last time he came home. He was pulled over. I keep thinking about that. He told me it was because his turn signal wasn’t turned on and I really did think it was good they stopped him, what if they didn’t and he had gotten hit? I can’t lose him. I really did think that. I really tried to believe it.

Me: We gotta believe that, right? Hey, that’s so great, the Navy! Thank you for sending your son to do such noble work to protect us all. And thank him, too.

Patient: I will. And thank you, too. That’s a world I know nothing about — military, law enforcement, any of that, but he tells me that it’s a service, it’s purpose is to honor and it sounds like everyone there really wants to help people. I don’t know where things get lost in that.

Me: Hm. I think I know what you’re trying to say. I mean, I’ve never even seen a real gun before,  but I think mine is the only other profession that gives fallible people the license to preserve and potentially take lives. I don’t know, maybe the concept of lives mattering changes when you have that power? The ways of the world still confuse me.

Patient: I will pray that it’ll never make sense to you.

Srijna Nandivada, MD Srijna Nandivada, MD (4 Posts)

Resident Physician Contributing Writer

University of Texas Health Science Center at Tyler

Srijna is an internal medicine resident physician at UT Health Northeast.