written by Magdalena Kertscher, Mercer PA student and Nicaragua Mission team member
When I found out that Megan and I were going on a house call I was ecstatic. We were taking silly pictures together and joked around about trying to look "cool" while giggling like school girls. We were thrilled to asses another UTI or pneumonia or maybe an interesting looking ulcer. The truth of the matter is we were not equipped for What we saw! Not in the slightest.
We walk into a shack. Step over a ledge and enter a room. There was no flooring, only clay. In one corner a hammock with a young male in it snoring comfortably. On the other side a dark area with a table and a free-standing fridge that couldn't have been more than 40 yrs old. There were people all around and I wish I remembered them too but my focus was elsewhere.
We walked over to the next room; small, dark and eery. Musky smell lived there full-time. On the left side of the room was a bed fashioned out of mismatched pieces of wood covered with old sheets. Suspended above was a hammock-looking thing jerry rigged out of pieces of tarp and foil patched together; "this is probably where the kids sleep" I thought to myself. The walls made of pieces of wood with inch thick gaps in between. I heard the rain cut through air and land on wooden planks inside the room with a deafening sound of extreme poverty. Those planks were covered with scraps of cardboard. On top of it laid a man in his 80s. Extremely cachectic and not moving. He weighed maybe 75lbs soaking wet. His chest hardly lifted as air entered his frail lungs. Sofia, our translator introduced a young female named Maria Clara who could only have been his daughter...except she wasn't. She was his wife and the man was not 80, he was 38.
Leonardo Antonio had been brought down from the mountains due to illness he succumbed to several days earlier. He lost his appetite and strength. He was vomiting blood and soiling himself. I leaned down to listen to his heart and I got nothing. The excruciating sound of silence rang louder and louder as I moved my stethoscope around his prominent ribs. He was barely breathing. I've seen plenty of dead people. Cut into their flesh to explore my passion for learning. Never have I seen a soul itching to get out of one. And for that I will never be the same again. A part of my innocence died today.
His children, 12 yr old son Lorenzo Antonio and an 11 yo daughter whose name I fail to recall were gathered around looking at us. What stroke me the most was that there was no hope in their eyes, but a calm look of certainty. They weren't hoping we were going to help, they knew we would.
There was not much hope in our eyes. Megan and I looked at each other and only we knew the panic behind our confident collected demeanors. Our professor was at another house so until she arrived it was just the two of us with 7 months of classroom babble behind our belts. We ran through the differential diagnosis at least 4 times searching for any glimpse of salvation. Maybe we were missing something! Doubtful, each differential landed us in one of two bottomless pits, AIDS complications or cancer.
How will I stomach looking into this little boy's eyes knowing that the father he knows has a price on his head. His family didn't have the money to take him to the hospital...it was going to be $50 to take him there and run tests. I started chatting the boy up and making him laugh. Perhaps not to make him feel better but for myself. Knowing that after today he was not going to laugh for a while. He was going to become the man of the house. He is only 12 and after this is over he will never be 12 again.
In PA school we learn how to write SOAP notes. A visit summary that becomes part of that patient's chart.
S in SOAP stands for "subjective" Information that is given by the patient.
O is "objective" findings from that visit.
A stands for assessment or the diagnosis we want to give and treat; and P is the plan - what will be done to make that patient better.
Since Megan and I did S, O and A in the shack I decided to finish my soap note tonight. I owed Leonardo this much...it was the shortest plan I've ever done...
Patient visit, 38yo Hispanic male...
...so pray we did.
As much as professor Mattingly made fun of her fake anointing oil made of EVOO in this case it was as real as it gets. For Leonardo and his family this was an inescapable reality, a part of their story forever...And all we could do was pray.
I felt helpless, puny and crippled by my limitations; Unworthy of the stethoscope wrapped around my neck. I felt like a foe. Leonardo's family believed in us; they believed that we were going to help and heal...and EVERYTHING that we could do was pray...and I pray that it meant EVERYTHING to them.