Sitting in my office at the Family Medicine Center and checking my desktop is something that I try to do before clinic really gets busy. I always preach to my Medical Family Therapy students that they have got to be visible to be used by primary care providers. This day was different. Being in my office was the trick. One of the doctors who uses our service on occasion raced into my office at 8 a.m. and closed the door behind him, even before my purse hit the floor.
“I need your help with this patient, Betty. She is in bad shape.”
As he spoke, I immediately recognized this patient from a clinical case presentation done the previous week.
“She is going to hear this morning that at the age of 25 and with 3 children that she was being diagnosed with HIV/AIDS. We would like for you to see her.”
She was a very sick woman being cared for by a newly turned senior resident and fresh from orientation intern. Everyone was worried because they were not sure how she would handle the news. Her affect had reportedly been pretty flat since her admission. Her hesitancy to get the HIV test to begin with marked for her team a presence of awareness and denial. I sat back in my chair thinking about who was really my patient here and then it dawned on me, the entire system was my patient. So, I started rapid fire paging and checked in with the senior (who was dealing with the recent death of a loved one), the intern and the medical student who had done a great deal of the interviewing up to this point. I also paged the Infectious Disease (ID) resident who gave her the news and who admitted to not sticking around long after giving it to her. I wanted to know what she had been told, how the team was managing this very complicated case, and how each person thought I could be helpful to her and/or to them.
I waited a few hours after the ID resident spoke to her so as to eliminate the “pounce effect.” Prior to my visitation, I stopped to check in with her nurse, who remarked that Betty’s affect remained flat but who commented that her Family Medicine service had been exceptional. She was impressed with how our Family Medicine team was caring for her. Noting things such as: taking time to answer her questions, not racing out of the room, touching her hand, and functioning as a team.
Upon approaching Betty, she laid still, enveloped by her white hospital cotton blanket and staring blankly at a monitor. I introduced myself again, having been introduced to her the day prior by one of her team physicians. She said she did not want to talk that day because she was getting a painful IV treatment for an infection so I agreed to return the next day. She initially did not want to talk this day either, but kept responding to brief joining questions. I felt the ambivalence and when asked again if I could stay with her for just a few minutes, she said yes.
With no chairs close by, I squatted close enough to make eye contact. Standing just did not feel respectful. We spoke about her kids, her understanding that this was a chronic illness if she followed her treatment, and her support system. She noted the support of her pastor and offered a past history of depression that she knew was at risk of returning, especially with this news. She noted that ironically she came to the hospital with belly pain and flu-like symptoms and now would be leaving with a powerful label and a chronic illness.
She talked about how she would tell her mother and her mother’s probable response (one of strength and love). She was not sure yet how she would tell her children and began to withdraw slowly at that point. She disappeared emotionally when thinking about talking with her partner of 2 years. It was suspected by the ID residents that she contracted the virus 1-2 years ago. She ended our session with an admission of anger, still remaining blunted in her affect. She would not go into detail about her anger but in many ways she did not need to as it appeared the anger was directed toward herself at that moment.
I entered the room a professional wanting to offer my assistance and left the room a mother painfully aware of the precious moments in life. I could see where my team needed support. They saw what I saw in this patient, themselves. Most of them are young, some are parents, one grieving the loss of a loved one herself, and all recognizing how Betty’s life had changed dramatically that day when she heard the news of her chronic illness.
Tomorrow, after a long weekend, I will return to see her again. I will also check in on the Family Medicine team who is providing her care. The amazing thing to me about Family Medicine providers is that they are often criticized for not being specialized enough in one aspect of medicine but actually they are….they are masters of systems and are skilled at diagnosing, treating, and referring to specialists when needed. They have a genuine interest in incorporating me as a Medical Family Therapist because I too share a similar approach to care. In this job I am vulnerable to the same highs and lows that my fellow primary care providers experience each day. This case is reflective of just another day in the life of this Medical Family Therapist. I look forward to sharing more and hearing back from you about cases that left their mark on you as well.
++ All identifying information has been changed to protect the confidentiality of this patient and the providers who cared for her.
