No Hablo Crazy

It was my first year in medical school, and I anxiously prepared for afternoon clinic. I nervously put on my white coat, new enough to still be free of coffee stains, carefully bundled my stethoscope into a figure of eight and loaded my pockets with pens, reflex hammer, palm pilot and hell even a flashlight for a neuro exam. The pockets strained at the seams, but I needed all the help I could get.

The first two years of medical school are pretty much brute force memorization of all the science stuff you need to learn how to apply in your last two years of medicine. When you aren’t in the classroom, you’re usually at a toga party with other med students.
One afternoon a week though is preceptor clinic, and the exception to the above rule.

They match you up with a real doctor and you work with them in clinic to try to begin to get a feel for how its all supposed to come together.

My preceptor is a family medicine doctor who works in a busy clinic in the south east part of the city. It’s a non profit clinic and takes care of the underserved with a large migrant population. I’d noted that I was fluent in Spanish on my preceptor request and that I’d like to work with the latino population. I was really excited to start.

Dr. Schwartz kindly showed me around the practice and then scanned his schedule.
“Here, why don’t you go see this new patient? He’s just here for a medication refill, but why don’t you practice getting a complete history, and then we can do the exam together.” He disappeared into the exam room next door to the one I was supposed to enter.

Faking an air of confidence and clutching my bulging white coat pockets for moral support, I opened the door and nobly sallied forth.

According to the medical assistant’s notes, Ricardo was a forty two year old laborer who needed his prescription refilled. Ricardo wore paint stained overalls and fingers colored by nicotine. His eyes were tired, but he had a sweet smile and was holding a Safeway bag of empty containers.

I introduced myself, and then asked “Prefiere hablar en ingles o espanol?’ He gave a sigh of relief and said “Oh espanol, porfavor.”

Ok, no problem. I used to be a Spanish translator at a clinic in college, I can totally do this without getting the clinic interpreter.

I try to remember the acronym I learned last week to remember the order of a proper clinical history. BADHITS? ADCVANDISMALS? Thank god for the Maxwells in my pocket. Chief complaint, that’s right.

“Pues senor, como podemos ayudarle?” What can we help you with today, sir? Somehow medical school seems to have erased all of my previously existing common sense.
In Spanish he begins to explain to me. This is what I understand.

That he has always been in very good health without any problems but two years ago, well maybe last month his stomach began to hurt. When the pain started he was driving a truck all night from Jalisco to Guadalajara, and the moon was very bright and the sky with stars. Suddenly a cat, an orange cat, ran across the road and he swerved. The window became the door. A woman all in blue appeared and motioned him towards a hill. He was very tired, but summoning all his fuerza he made it up to the hill where he found a well. He is not sick, but the water from that well helps him.

I listen and nod sympathetically, but am wondering what the hell happened to my Spanish! I used to be so fluent, and I really have no clue what this guy is telling me. What the hell else could well mean in Spanish? Antacids? An herbal tea? I better go get the interpreter because this is totally hopeless. Ricardo smiles cheerfully and hands me his empty prescription containers.
*********

“What the fuck does that mean?” Ivy explodes. A gaggle of girls have gathered to celebrate finishing our final exam of the semester. It’s a beautiful fall evening and we are laughing at the swimmers out in the bay. Sure, they may have only 2% body fat, but its much nicer in here. The embers from the fire reflect off the dark wood paneling, there’s soft cheese, sparkling wine and an adorably flamboyant waiter who keeps the wine and outrageous compliments flowing.

We’ve discussed health care policy, advanced calculus, the hidden symbolism of War and Peace, and now we’re onto updating each on other on our romantic relationships, or lack there of. Ok fine, we mainly just talked about boys and shopping.

Ramona has just finished telling us about the great guy she thought she was dating. They had been going out together for a couple of months, spending weekends in wine country, and getting along fabulously. She got jealous “Ooooohs” when she described the sweet voice mails he’d leave at night when they couldn’t be together. Not from me of course, I tried to not roll my eyes and signaled to the waiter for another drink. I knew there had to be a punch line.

Yeah. Yesterday, as they basked in the afterglow, wrapped only in the bedsheets he said, “You know Ramona, what I like best about you is that we don’t have to be in a relationship, we can just have fun. I’m just in such a selfish place right now….”

Ouch. Where the eff did that come from? We all have our own theories of male behavior, but few of us would have guessed that was coming. I did, but would have thought he’d have the common decency to not say it while naked.

I think that Francine managed to one up her however, and Ivy can barely contain herself.
“Is he gay?” she asks. “Does he have a girlfriend? Maybe an STD? Oooohh. Erectile dysfunction?” Ivy is also a gynecology resident, so she paused, thought for a second and then queried suspiciously, “Are you sure he isn’t really a woman?”

“Oh stop it Ivy, I think it’s kind of sweet. He just wants to take things slow,” Kat, the married friend interjects. Ramona nods in agreement and takes another slug of her mojito.

Francine sighs. “Yeah, that’s what I thought at first, but it’s been two months now. And I swear I’m so sick of just making out and it not going anywhere further. Besides, kissing him is not my favorite thing. He’s so great in so many ways, but he kisses me like his tongue is a fish gasping for oxygen on the bottom of a boat. Except it’s the back of my throat.” She forlornly swilled her wine and looked to the bottom of the glass for answers.

Ew. Good on paper, but not so bueno in the bedroom. Francine really needs to walk away from this, or hell simply run, but as a friend we’re required to tactfully filter the message with as much positive spin as possible.

“Well, it doesn’t sound like you’re really that into him anyways,” I say.

“No, not really, I guess, but I am starting to think its something about me!”, Francine responds. This elicits a chorus of “Oh honey, it’s not you!”

And it really probably isn’t. Francine is the complete package: brains, beauty and boobs.

“Well, that’s definitely NOT it, and if he doesn’t do it for you, just move on. Who knows what’s going on with him? Man-glish is impossible to translate.”
We all laugh and order another round.

**********

I leave the room exactly as Dr. Schwartz exits his.
“Wow”, he exclaimed, “You’re fast! Normally I can see three patients while the student sees one, but we finished at the same time. Why don’t you go ahead and present him to me.”

Embarrassed, I start off as Maxwell’s instructs.
“Ricardo is a 42 year old truck driver presenting today to establish care and get his medications refilled. He is generally in good health, as long as he takes his medicine every day.” I pause, unsure how to phrase the next part. “Um, his history is a little confusing, as he says he has nothing wrong with him, he just needs all these medicines refilled. Maybe I didn’t understand his Spanish as well as I thought?”

Dr. Schwartz has been busily sorting through the bag of empty containers and writing prescriptions as I talk. “Great, great!” he heartily replies. “So concise! And very professional too. I like your sensitivity to his disease. Of course he doesn’t think anything is wrong with him.”

Even more confused, and blushing like a debutante at the Folsolm street fair, I am still an experienced enough medical student one month in to know better than to ask questions that reveal my ignorance when I can just look them up myself.
I walk back into the room to give Ricardo his prescriptions for haloperidol, fluoxetine and lorazepam. After he leaves I stealthily turn on my Palm Pilot and check out the pharmacy manual.

“Haloperidol: an atypical antipsychotic useful in the management
of delusional szhizophrenics. Side effects include….”