The Hardest Lesson to Learn
Posted by Kurt Palumbo, PA-S2Comment

“Can you tell me more about your past medical history?” the resident asked.

The patient looked away in silence.  I looked at the resident, and the resident looked at me. We were both dumbfounded.

“Miss, have you ever been to the hospital before for a psychiatric complaint?” I asked.

Again, the patient looked away, this time even more annoyed.

I stood in silence, not sure what to do. This patient clearly did not want me to be there – she didn’t want the resident there either.

“Miss, can you talk to me?  Can you please say something to me?” the resident pleaded.

“Why do you care?” she said.

She spoke! I felt a sense of relief even though I barely had said a single word the entire interview.PAsConnect_KP

“What do you mean why do I care? I care because I am your doctor, I want to help make you better,” the resident said in a surprised tone.

“Why do you care? You don’t care about me.”

I was baffled. I kept thinking to myself, “Why would she say such a thing? Why would she think we don’t care about her?” I suppose it was in that moment I realized the disparity between the patient and the provider. It was a disparity I had always wondered about, but never faced head on until I met this patient.

She was on a 302 by her mother for psychotic behavior and profuse vaginal bleeding. She appeared catatonic and selectively mute to all of the healthcare professionals that tried to gather her history. It was my third week of my psychiatry rotation, and by that point, I had just started consulting throughout the hospital. I was struggling to gather confidence and this patient did not help my situation at all. How did the resident and myself expect to care for this patient when she wouldn’t even speak to us?

I think her lack of communication was due in part to her psychosis. We as a psychiatry team believed her psychosis was due to a rare encephalitis called anti-NMDA receptor encephalitis. This rare type of encephalopathy is caused when antibodies target the N-Methyl-D-Aspartate receptors in the brain, internalize the receptors, and lead to clinical psychosis. She left AMA before we could confirm her disease, but I think her lack of communication was also related to something else.

Minorities have always had a difficult time in this country. I wonder if the patient I saw was a victim of years of discrimination. Did she think I was trying to take care of her to satisfy my own desires of being a good practitioner? It could it have been her Haitian roots differed from my German-Italian roots and she assumed I would not be able to help her at all. Either way, when I said, “Je peux parler français, si tu veux,” she just replied, “no.”

We all come from somewhere and wherever that may be; the experiences from those places are what define us as human beings. I wish I could have connected with her more and helped her in whatever way she needed. I thought by speaking in French a small part of her would be open to speaking to me, but I was left with nothing. As I have continued on with my rotations, I’ve learned that sometimes a patient’s previous experiences influence their thoughts and feelings so strongly that your actions cannot undo a lifetime of discrimination. I’ve also learned that you cannot let that define you as a practitioner. That is a hard lesson to learn. It is one that the classroom did not prepare me for.

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