Another day at the office

Today was my second subspecialty clinic at CareFree, a clinic for indigent patients and families; all comers accepted irregardless of ability to pay. It is not quite clear yet, whether contributions to CareFree constitute donations to a charitable organization; not all the paperwork has been filed I believe. Much of the professional staff however, is voluntary. Therefore, there is a certain degree of disorganization inherent in such a system, who is coming, who is going, who is on first.

As an illustration of the above, my first pediatric patient two weeks ago was a 57 year old women seeking Social Security Disability coverage for a cornicopia of complaints. As coincidence would have it, she had my MOTHER as a teacher. "Oh Dr. Honicky, I once had a teacher by that name." "Where were you living at the time?" "Cleveland, Ohio." "What part of Cleveland?" "The East side." "Where abouts on the East side?" "Moreland Hills." She taught me and my twin sister, I think in the 8th grade." Wholely moley, she was right on: 8th grade History at Orange Middle School. This women's life had been a bumpy one, homeless, vagabond, abused, and now living in the Lansing area near her daughters on food stamps and welfare. The CareFree clinic wanted me to evaluate her for asthma as she had difficulty breathing several weeks before when she was lying down reading to her grand children, and, oh by the way, she now is morbidly obese. I evaluated her and sent her a copy of my dictation outlining my diagnosis, acid reflux, coming up the esophogus, spilling into the airway and causing laryngeal spasm; hence, abrupt onset of difficulty in breathing. She appeared at the clinic today and told me that I was the only doctor to have sent her a clinic dictation for which she was grateful, only, she wanted to correct a few errors: she has 3 daughters and not 2.

Today's new patient was a 12 year old who must have followed Leah as she drove back from Columbus Ohio last week; entwined as he was in Child Protective Custody. In the room was the child, his mother, and a social worker. My first step was to interview the child about his asthma, what did asthma mean to him, how does it feel, what makes it better, worse, when was the last time he felt bad, queried whether he took his medicines, whether he could feel his asthma getting worse, etc,etc,etc. As we talked together, his mother kept interjecting, trying to answer for him, but he persisted; he listen, read my handouts, asked questions, made eye-to-eye contact, came up with unique answers to questions that I posed. I asked him what made his asthma the very worst: cigarette smoke; do you smoke cigarettes? No? does anybody in your family smoke cigarettes? His mother immediately interjects that she only smokes outside and a pack of cigarettes (20) lasts 3 weeks. The look on the child's face of incredulity was a picture to behold. He learned from me that Jerome Bettis, who played running back for the Pittsburg Steelers has asthma. I showed the child a picture of untreated asthma and a healthy lung. I asked the child what did Jerome Bettis's lungs look like, the child pointed to the asthmatic lungs. I told him that Jerome Bettis could not run as he did unless his lungs looked normal. I asked the child, what made the difference between his own lungs and those of the football player. "He took his asthma medicines". That's right. During the interview, during the review of systems I asked about injuries and he showed me his finger. "I got 5 stitches in it." "How did you get injured?" "I got cut by a broken beer bottle that I was shooting at. Where is the gun now? I asked. "My step father bought it for me, but he keeps it." His mother adds that he was staying at a cousin's house, the cousin is now in jail for molesting children. Mom continues, he tells me that he wasn't molested, but you can ask him again as you examine him when we leave the room as he is shy and doesn't like me to see him without his shirt on.

There are two more patients for next week's clinic. I will begin at 9 AM and work to my usual 1 PM.