Thursday morning I got out of bed at five AM and made myself a cup of tea. It was still pitch black, but I had to try and convince myself that I was feeling bright and chipper for my final med long case exam. With the time change, I had persuaded the college to give me the latest possible time-slot and this was the rewards I would reap: A 550 AM long case instead of 4. Small victories folks. I’ll be honest that although I felt underprepared, I really wasn’t worried. Oral examinations are my forte, your boy can yap and yap till he gets muzzled by force and not a moment sooner. If anything I was only bolstered in my confidence by having ten weeks more real experience than any of my peers. Could I tell you the Glasgow-Imrie criteria for pancreatitis? Hell no, but if you needed someone to talk about how to properly identify a snake or what kind of worms make your bumhole itch, I was your man. Firing up my computer, I put on my button-up shirt that I had worn only once for Jack’ birthday six weeks prior—the time my Jupiter was in retrograde—and logged on to Microsoft Teams. I took an extra second to clear my my desk of any stray geckos, which had a tendency to hand around my computer because of the warmth produced by the aging battery. Finally on my computer I saw the first two faces, an administrator and an actress, who would be serving as my mock patient. We began with troubleshooting some internet issues, I had to hotspot the company phone for a little more stability, and it looked like things had finally settled. That is until the first tropical shower two minutes into my pre-case registration.
Thankfully, the admin worker and actress took sympathy on me, and they immediately garnered an interest in the strange surroundings they saw on camera: the Australian hat hanging off a rusty nail on the back wall and the mosquito net that draped over the background. We spent a while talking about Panama as we waited for the adjudicators to enter the meeting. Finally they did, it was a hematologist and another fella who didn’t even introduce himself. The hematologist did all the talking, and read questions off a piece of paper. It was a multiple sclerosis case—an autoimmune disorder that damages the nerves, which is common in white people in colder climates but hardly seen anywhere else—possibly the most Irish disease ever outside of cystic fibrosis or alcohol induced dementia. The patient was having an exacerbation most likely, although the cases are designed to be somewhat ambiguous. When I asked her about her disease she knew all the details, and gave clear answers about the exact medications and dosages she was on. My pseudo-patient probably knew more about MS than I did, go figure. She basically did all the work for me.
If only the two patients I saw at base clinic a few hours later were anything similar.
It was a lady in her mid-twenties, her husband, and her daughter. The daughter was a little over two years old, and had not much going on with her, other than a lack of diapers. At one point while I was talking to her, the daughter stood up and started urinating all over the chair where she was standing.
The parents were having some shared genital symptomology, her more-so than him. She had abdominal pain as her first complaint, but then confessed to having discharge from down below after a really weird back and forth where she just stopped answering my questions when I spoke to her. She also told me this had been going on for the last six months. I spent nearly an hour pulling teeth trying to get her to give me more details about her symptoms, she was really closed off.
A urinalysis showed not much in her urine, and a genital examination showed she had some discharge and a raw cervix. I found out roughly an hour after seeing her that she had already been seen and treated by us six months ago, and given a prescription for some vaginal candida cream and suppositories. She wasn’t even the one that told me, it was her partner that did when I was taking his history separately after hers. I had asked her explicitly and she didn’t mention it at all. Going back through her previous notes that I had quickly scanned before attending her, I found a small barely-legible footnote three charts ago right at the very bottom. This was really important information that I only wound up getting by chance second hand. I imagine that if I just gave her the same treatment again, she probably still wouldn’t have said anything. It just goes to show the contrast between medical school patients and the real deal. Things will seldom be as clear as you want them to be. People are strange, they are scared, they don’t know what’s going on, and sometimes they do but they don’t want to share. Communication is meant to be a two way street, and yet sometimes traffic only moves in one direction, no matter how hard you try. The best you can do is your best, and the last thing you should do is get upset. I treated her for pelvic inflammatory disease and him the same.
The next day, Friday, marked my last as an active member of Floating Doctors. It started like any usual day would, with a text on the groupchat from Cristobal that he had found a boa constrictor on the base outside Chrystian’s room, caught it with his bare hands, and put it into an empty cardboard box that had once been used to deliver condoms. The rest of the team had left early to go into Almirante for state distributed covid vaccinations, leaving me and the serpent together to become acquainted throughout the morning. He was a chipper young fella with a sharp tongue.
A surprise patient turned up at base, and I saw her. She had something odd going on but not too serious, and had been tolerating some crampy pain in the left lower quadrant of the abdomen for three years, which had now gotten worse. She didn’t have anything noteworthy on history or exam, I think she might have had an ovarian cyst and gave her a letter for an ultrasound in Bocas town. Right as she was leaving I got a text, it was from an unknown number.
‘Hola Juan, it’s me, the girl from Ensenada. You told me to call when I got credit on my phone.’
Finally. I had tried to reach her several times over the last three weeks since we lost contact. I typed a message back.
‘Yes, of course! How are you doing? What happened?’ I said.
‘I am in the hospital Juan’
‘I had surgery’
