“You Don’t Know Me!”

Maria had seen my partner for a few years before switching to me last year. I was struck by her unusual accent and her ability to figure things out. 

On our second visit she told me in broken English that she was sure her blood pressure medication was making her sick. She had even been to the emergency room once with severe swelling of her tongue.

Maria didn’t know the word for what she had – angioedema caused by the enalapril she had been taking for many years – but she knew she had to stop the medication.

It took us a few visits to find a suitable alternative. I was hopeful I had finally got it right.

As I entered her exam room for today’s follow-up she smiled at me and said hello. I asked how she was doing as I sat down across from her with her chart in my lap. Her eyes turned dark and her smile dissolved.

“You don’t know me”, she said sternly.

Taken aback at first, I checked her facial expression again; it was serious, but not angry.

“I only know what you have told me and what’s in here”, I said, pointing to her chart.

She scoffed: “Other doctors’ words about me.”

“I’ll tell you something about me. I had five children, many have problems. My son is in prison, one daughter is on drugs, another won’t let me see my grandchildren and my husband is long gone”, she blurted out as she leaned forward in her chair.

“My mother had nine children, me the oldest”, she continued. “I only got five years of school. My mother, she needed me to take care of the babies, then I worked in a shoe factory. I teach myself English watching TV.”

I sat quietly as she spoke.

“My father was a drunk and my husband too. They both beat me. I always worked hard and my life was always hard. I say that’s why I have high blood pressure.”

In the silence that followed, her eyes met mine and they brightened a little again. I put her chart aside unopened and placed the blood pressure cuff around her arm.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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