“I feel like I am going to die … I was in a major car accident last week because of blurry vision that came out of nowhere.” Becky was one of thirty or so patients I saw at the family medicine practice on a hot day in Houston. She came in because of worsening headaches for the last six months. “Can you describe your headaches for me?” “Well, they cover my entire head. No particular spot where it’s worse.” “Do you sometimes feel dizzy, or feel a sense of falling when standing?” “I do. From time to time, I would feel that the entire room is spinning. And if I didn’t grab hold of a ledge, a countertop, or anything to keep me standing, I would fall. I fell a few times because of this.” “I’m sorry to hear that, Becky. Did something happen six months ago when you started getting these headaches?” “Not really, no. They just started around that time. I work as an accountant and also have nephews I look after. These headaches are starting to affect me both at work and at home, and I am getting really worried…” Catherine placed her arm around Becky. “I know this must be hard on you, Becky. I can come back in a few minutes if you would like.” “No, it’s OK T.J., but thank you so much. I’m OK.” “Thank you, Becky. With these headaches, do you sometimes feel a sort of ringing in your ears?” “I do! Every day actually … it’s like some sort of buzzing sound worse on my right ear.” “Do you feel that your sense of hearing has changed in the past six months?” “Yes! Either my two nephews are too loud, or I am actually losing my hearing.” After completing the history and the physical exam, I thought Becky may have Meniere’s Disease. Outside the room, I looked up its common causes, which include stress, anxiety, medication side effects, alcohol use, migraines, recent illness … Then, I read the word “trauma.” Asking Becky about head injuries or traumatic events never crossed my mind, and I knew this was a question that I didn’t ask. I closed my laptop and knocked on the room door. “Hi again, Becky. Is it OK if I ask you a few more questions?” “Of course.” “Thank you so much. In the past, did you have any injuries to the head?” “I … well, yes …“ Her eyes immediately shifted to the ground, then we both made eye contact. “I was married to my ex for two years and was physically abused by him. I remember he grabbed me by the throat, and throw me. He would either hit my head with his hands or with whatever object was nearby … When I said halfway through our marriage that I wanted to end it, things got worse. I no longer loved him.” “After the divorce was finalized, I started seeing Catherine. I’ve never felt so much love from one person, and although I still have my fights with depression, things are better now. I am no longer afraid of him because he is locked away.” I placed my right hand on top of hers. “I am truly sorry that you went through this, Becky. I will say this: When I walked in and saw how you and Catherine look at each other, I could tell you both care for one another.” “That’s very sweet of you to say. Becky’s not too shabby,” Catherine said playfully. “One last question. Have you seen a neurologist or had any head imaging done in the past?” “No to both, but I certainly want as much help as I can get to find answers.” “Certainly. OK, I have a good idea of the next steps. Will be back in a minute with Dr. Wesley.” “Hey T.J., how is Ms. Gonzalez doing?” said Dr. Wesley. I presented Becky to him, and he nodded after every sentence. “That is just horrible. Has she seen doctors in the past? What do you think we should do for her today?” “I don’t believe so, I think we should refer Ms. Gonzalez to both a neurologist and to have brain imaging done. Also to a psychiatrist.” “Good plan, T.J. Let’s visit her.” “Hi, again, Becky, Catherine. This is Dr. Wesley.” “Great to meet you, Dr. Wesley,” said Becky. “The pleasure is mine. So, T.J. told me what you both talked about. I am very sorry that you been through tough times these past two years. Have you had any contact of any sort with your ex-husband, letters, feelings of people stalking you?” “None that I can think of. I feel very safe now, and I am with Catherine and my family every day.” “That is wonderful. It’s good that you have a strong and loving support system. Our plan for today is to refer you to Dr. Patrick, a neurologist colleague who will help you find the answers you are looking for. Also, will refer you to Dr. Miller who specializes in psychiatry in case you want to see someone.” “Yes, yes … thank you both so much for taking the time to listen to me. I’ve never been someone to ask for help, but it’s very comforting to know that there is help when I need it.” “Always here for you, Ms. Gonzales. Any questions you or Catherine have for us?” “No questions. Thank you both so much.” Dr. Wesley and I left the room, and it was on to the next patient. Even to this day, Becky’s story has left a deep impression on me in regards to how I approach every patient interaction. You should always take the time to build rapport with every patient because it makes asking the hard questions a bit easier when you need to ask them. Always be genuine, feel for how the conversation is going, and remember that no matter how tough their past is, there is always a plan of action to help. All names and events have been altered to protect confidentiality. Ton La, Jr. is a medical student and can be reached on LinkedIn. Source
