So you think you have a stressful life?
I walked into Room 14 and introduced myself to my next patient--a peroxide-blonde, twenty-something female anxiously sitting in her cot, her tattoos peeking out from both the collar area and the short-sleeves of her hospital gown.
"Hello, Marissa," I said, "I'm Dr. Jim and I'll be taking care of you today. What happened that brought you to our ER?"
Her answer was brief and, quite honestly, unexpected. "My boyfriend and my husband are both being jerks to me." It turned out that she had been "completely stressed out lately" from the shabby treatment from the men in her life. As a result, she was having episodes of heart palpitations, episodic runs of shallow, rapid breathing, and being "jittery all the time."
"In fact," she said, interrupting my history-taking, "I need a cigarette real bad. Like, right now."
I shook my head "no" to her request, explaining that my ER patients are not allowed to leave our department to go outside and smoke. "If you really need to, though," I said, "you are free to sign out against medical advice, go out and smoke all you want, and then sign back in to be seen. Unfortunately, you might be waiting a while."
As I expected, she decided not to sign out AMA and go have a smoke, but not before rolling her eyes at me. That's okay, though. Little did Marissa know, but I got an A+ in "Rebuffing Eye Rolls, 101." Hell, I could teach that class, even.
We continued on with our discussion. "I think I might be having a heart-attack from the stress," she said, sincerely trying to explain the full scope of her symptoms. "I never was like this until my husband threatened to leave me, and now I am stressing-out all the time. Even my boyfriend notices it." There was no flicker of self-awareness, although I was expecting at any time for her to jump up and down and recognize the root of her problems. Without my help. I was hopeful that saying the words out loud might make the obvious evident to her.
No such luck. Marissa needed to hear her it spelled out from her friendly ER doctor.
"Well, Marissa," I asked, "do you think that maybe you are creating a lot of your stress by trying to have a relationship with two men at the same time? Emotionally, that is a lot of energy you are giving away." My shoulders shuddered as I had a sudden thought of just how much physical energy Marissa might be giving away, too.
"Um," she said, "I don't think so. I think most of the stress is coming from trying to get pregnant." She looked at me to gauge my response.
I took the bait. "You're trying to get pregnant?" I asked, trying to mask my surprise. "By which guy--your husband or your boyfriend?"
"Well," Marissa said, "that's part of the problem. I don't know who I want to have a baby with yet. My husband is good-looking, but my boyfriend is a little smarter, I think." She took a slight pause before continuing. "Do you think I should go for some good-looking kids or some smart ones?"
I looked around her treatment room closely, straining my eyes to find the hidden camera that was obviously recording my reaction for one of those candid camera shows. I couldn't find a little peep hole, though. Unfortunately, this was a real patient-physician encounter.
"And," Marissa continued, "it's not just who should I have a baby with that is stressing me out. My boss just increased my hours to thirty-five a week. I used to do twenty-five hours before. I don't know if I can handle ten more hours a week."
Again, I took the bait. "What do you do that is so stressful, Marissa?" "I'm a bartender," she said, puffing out her chest with pride. "Do you have any idea how stressful a job that is?" I assured her that I didn't. "Yeah, well, it's not only about mixing and serving drinks. I have to listen to people go on and on and on about all their problems. Like their problems are more important than mine. Most of the time, I just smile and nod my head while I'm tuning them out."
I smiled at Marissa and nodded my head.
I had had enough of Marissa's complaining for this visit. It was time to move on to her physical exam and testing. And, hopefully, figure out what we could do to help her.
"Marissa," I said, after completing a stone-cold normal exam and reviewing her normal EKG, "I have several worries about you, the most important being that you are carrying on relationships with two men. I worry for your safety right there. Are you protecting yourself?" She looked at me funny. "Are you sexually active with both of them?" I asked her more plainly. "Well, yeah," she said, like the answer should have been obvious to me. I, however, didn't want to assume anything.
"Then you need to make sure you take care of yourself and protect yourself, okay?" She nodded yes. "Otherwise, I'm afraid, your symptoms all seem to be related to stress. The treatment for that," I continued, "is simple--reduce the stress. I don't know how you are going to go about this, but you need to simplify your life, make some decisions about work and your relationships, and start carrying those decisions through."
"But," she said, "I don't know if I should stick with my husband or my boyfriend. What would you do?" I looked at her, at the sincere plea from her confused eyes, and realized that she was not going to be able to make the decision on her own.
In my mind, I knew exactly what I would do. First and foremost, I would have Marissa throw out her cigarettes. Then, I would have her avoid both men for a month and see where that would leave her. Finally, I would have her immerse herself in her work, since her pride was quite evident when she spoke about her bartending work. Unless, of course, the bartending environment was contributing to her problems (which, I suspect, it probably was).
As gently as I could, I shared some of my thoughts with her. I explained to her that she was exhibiting "psychosomatic symptoms," where her body was physically exhibiting symptoms from her mental stress. Pure, unadulterated anxiety. Marissa, I thought, could benefit from a professional counselor to guide her through some of her decisions. And by staying in close contact with her family doctor, too.
"I'll tell you what, Marissa," I said, "I'm going to have one of our case managers come talk to you. They'll review your counseling options with you and, hopefully, a counselor will be able to help you make some decisions that will be in your best interests. Does that sound okay?"
She nodded her head "yes." "And," she added, "can I have something to help with my nerves over the next few days?" It was my turn to nod my head "yes." What I was providing was, really, only a band-aid to her problems, though. With her unique complaints, she needed to sort her head out.
I wonder if Marissa ever pursued counseling or not. Part of me suspects that she probably blew it off, thinking her time was more valuable than driving somewhere for an hour appointment. But a small part of me still wants to keep the faith in her...that, with a little guidance, she would begin to make more responsible decisions.
Sometimes, the stories and complaints we hear in the medical field are nothing short of mind-boggling. We only wish we were making some of this stuff up. Imagine, being torn between having a baby with your husband or your boyfriend. Makes me wonder if the baby turned out cute or smart.
In the meantime, I'll just keep things low-stress on my end, plugging away as a father, as a husband, and as an ER doc...how about you?
As always, big thanks for reading. I hope you all had a great holiday weekend. See you on Friday, June 4. Until then...