Every time I visit the hospital, the overseeing preceptor discusses the importance of taking a patient history. If done correctly, a complete history can get one close to a diagnosis, confirmed by the appropriate physical examinations and laboratory investigations.
I find it intriguing that each preceptor has his or her own story about working with a patient that answers "No" when asked if they have preexisting conditions or are taking any medications, only to find out passively later on that they do have chronic conditions and treatments. At this point in the story, the preceptor always makes a point about the importance of digging deeper into following the symptoms, even if the facts are not lining up. Each time we talk about this it brings me back to one of my most meaningful experiences in medicine, which also is a time where I felt absolutely helpless and mournful.
Following my first term of medical school, I was able to travel to Kenya to work in the Kibera settlement of Nairobi. I was able to work with some amazing people and it was joy learning at the hands of such kindhearted and knowledgeable physicians. After a week of working in the clinic, a team of nurses from another medical school joined us. We were able to hold a medical camp in a different slum near Kisumu, Kenya on the banks of Lake Victoria.
It was at this camp that I met a young patient who had a profound impact on me. She was 14 years old and came in with her mother and aunt complaining of fever and malaise. Both of these conditions are not uncommon in the settlements due to poor living conditions: dirt floors, no running water, and a lack of flushable toilets. However, people get along with life and are still able to find joy.
As she sat down I noticed a somber mood almost immediately. I always greet people with love and smiles because I love people, but for some reason she just was not having it. She never once looked up and she never smiled. It was like there was something hurting deep in her heart but she was afraid to say it.
My initial thought was "Okay, she is 14 and living in a settlement, so there is a good chance she is sexually active and possibly pregnant. She probably does not want her mom and aunt to find out due to the negative repercussions." So I switched gears and called over one of the female nurses to make the patient more comfortable and proceeded to asking about her sexual history. I asked the typical questions. Are you sexually active? Have you ever had sex? Is there a possibility of being pregnant? To each question, I received "No" as an answer. I learned that she was a typical 14 year old girl who liked to hang out with her friends and had no interest in sex.
The depth of her sadness was just too much and it pervaded our entire interview. I felt something more was going on and I called over my overseeing doctor and asked him to join me. After questioning her, he reached all the same dead ends. At this point we decided to proceed with a pregnancy and HIV test conducted onsite. At this point I withdrew from the patient encounter so she could be appropriately cared for by my overseeing doctor.
Later on, I witnessed the girl sobbing with her mother as they walked back to the settlement. I found out that she answered all the questions honestly. She never had sex and was not sexually active. However, she had been raped, her virginity stolen, and was now HIV positive. I cried a lot thinking about that girl and how when I first met her I had the biggest smile on my face, wanting to chat with her, and in her heart she had been violated to the core and had to live with that for the rest of her life. I should have been more observant and tried to match her mood. I should have been more compassionate towards her obvious distress.
I learned so many lessons that day. As future physicians, we have the opportunity to heal, which is tremendous because our patients present to us in their darkest hours and we are given the chance to change their lives. It is such a beautiful gift to see people through these hours and to do so in a manner that is respectful and honoring to them and to our chosen field.
I pray for healing for that sweet girl and I know in my heart that I will see many more like her. I will not fail them. I will meet them in their darkest place and do my very best, using everything I have learned in life and at school, to bring them out of that darkness and into the light.