Patient Encounter

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A senior couple came in escorting their elderly mother with chief complaints of uncharacteristic lethargy and recent unwillingness to ambulate or leave the house. Although she appeared disengaged with the world, the meek and non talkative patient her standard of self respect and posture as she frequently readjusted her repeatedly slipping hijab as she sat quietly as her family spoke on her behalf. The son-in-law was on the side of my attending physician, always nodding in agreement and countering his wife’s arguments when she disagreed with the physician’s diagnosis of depression — depression in general is fairly prevalent, the elderly are especially susceptible when and if they lose their physical or mental independence they once enjoyed. The visit ended with the daughter in denial that her vibrant mother could ever be depressed, despite all the evidence to the contrary, and ultimately refused having a counselor coming to meet her mother. But, denial is the first step that hopefully eventually follows acceptance.

After each patient visit the attending and I have a quick de-briefing where I can ask questions, offer up an amateur differential, and learn more about the patients. My question for the physician this day was about the social history of the son-in-law. The husband seemed unusually knowledgable, and malleable to medical opinions. The doctor then responded:

“The person I’m worried about actually is him. He used to be a doctor in his country, so he understand what I’m talking about because of his training. But, he’s actually the one who really needs counseling, he’s seen a lot of traumatizing things. He used to complain of having nightmares of seeing corpses strewn about on the streets as wild dogs gnawed at their bodies”

The husband was a physician, an Ophthalmologist, in his country during a time of civil war. Often, the rebels would come into the clinics with a wounded comrade and demand their friend be saved. For the rebels, being an Ophthalmologist this wasn’t an adequate excuse for not knowing how to pull out shrapnel or mend a lacerated femoral artery from a gunshot. Doctors who refused or hesitated were executed on the spot, as was this person’s colleagues — though, on other war fronts the aggressors in this story just could of easily have been the political regime.

Eventually, he doctor fled with his family to the United States and has never returned. Despite earning a scholarship to train in Italy where he completed his clerkship and later returned to his country to gainfully practice medicine the post traumatic stress drove him away from medicine.

I couldn’t help but reflect on the gentleman throughout the day, as I still do now. I wonder what other horrible things he may have seen, seen other doctors be forced to do, or worse become accustomed to doing. I am fortunate to be in a position where people share their experiences with me, sometimes it seems it’s the only chance they get to.




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