A couple of days ago I had the opportunity to participate in an event put on by a student club of which I'm a part. The Humanitarian Service Organization (HSO) puts on a Health Fair out in the community of Grenada each semester. It's a relatively new club, so this semester's fair was only the second. A group of 20 to 30 students from the School of Medicine (SOM) and Masters in Public Health (MPH) programs set out on a bus around 1230 pm, a little late already because we had to wait for some students to get their coffee fix. On! On!
We were setting up outside a grocery store called, aptly enough, Foodland. The store manager had been nice enough to put up about five outdoor tents in a row on one side of the parking lot. There was a hodgepodge of chairs and a few tables. The Type A's immediately grabbed tables and the rest of us made do with chairs and benches. After some initial set up, we got to work. We were taking histories, blood pressures and blood glucose readings. We had a couple certified nutritionists set up ready to give counsel, as well as a few clinical tutors who've actually graduated medical school.
My first patient was a woman in her 40s. She was slightly overweight and refused to make eye contact for longer than a few seconds. She told me she just wanted to check herself because she has high blood pressure and diabetes. She was taking insulin and had done so that morning. By this time it was nearly 130. She had skipped lunch and told me that she felt weak. Her head was drooping and she looked ill. She knew her sugar was probably low, so I decided to skip the page-long detailed history, and get to the testing. Since we only had four glucometers I had to go track one down from where it was hiding on a student's table (no longer in the central location designated for the glucometer home). I gathered my supplies and tested her - her blood glucose was in the 40s mg/dl. If that number doesn't mean much to you, suffice it to say that she was about to pass out on me and go into hypoglycemic shock possibly. I saw the number and definitely failed my first test of keeping a straight face when something was going wrong. I rushed to the clinical tutors to ask them where I could get something sugary for this lady to eat. After ten minutes and way too much discussion, she was handed a juice box to get her through. I retested again another ten minutes later and it had significantly risen, about 65mg/dl, which meant she was almost in the normal fasting range beginning at 70mg/dl. I quickly moved her through the system so she could go home and get something to eat.
Foodland surprised us again when they took orders and made all the students and clinical tutors a sandwich. Around 230 I was getting hungry, but we had a stack of patients waiting in the heat to be seen. I didn't even consider eating. Unfortunately, some of my classmates did. While patients were waiting a large group of our understaffed health fair took their sandwiches and went to the other side of the parking lot, in the shade, to eat their lunch and talk. Every patient waiting saw their student-doctors taking a break to eat lunch. Many of the patients hadn't eaten lunch themselves because they came to the fair! It will be a shock for many of these same students when they are required to work 12 hours or more and get laughed at when they say "but I haven't eaten lunch yet!"
Almost everyone I saw that day either had hypertension and/or diabetes themselves, or had a family history of it. I saw one patient who believed she could control her hypertension with a cup of hot tea. I tried, and failed, to convince her that she really should be taking her medication, since her BP was now 145/100. I saw one man who was 85 and had been failed by his regular doctors. He described excruciating burning upon urination that had been happening for some time with no improvement. According to him his doctors hadn't done anything for him. He felt it was useless to talk about it anymore since nothing would be done. I saw one girl, nine years old, whose mother wanted her BP and blood glucose checked. I asked if there was any reason she suspected something wrong, but no, just wanted it checked. The BP was uneventful (I did get to utilize my "variety pack" of BP cuffs for the first time). When it came time for the blood glucose check it was another story... the way we were testing blood glucose requires a small needle prick at the end of a finger and one drop of blood. It is a small needle, but still it is a needle. The girl didn't want it done and basically refused. I said that was okay we didn't have to do it, we would just have to tell her mother that she decided not to do it. At the thought of that she decided to just do it. I realize now that this is the moment I failed my patient. She didn't want to do the test, and it wasn't medically necessary. She didn't look like she had Type 1 diabetes, and she didn't complain of any key symptoms. The mother wanted it done because it was free and available, and why not? Turns out the mother was also under the impression that I was going to blood type her as well. I could have explained the test better and when the girl refused, I could have gone to talk to the mother instead of making her do it...in the end we did the test and she barely flinched.
The Health Fair itself was a success; we saw many more people than they did last semester. I learned a lot about myself and about how I could do better when I interact with patients. This is a learning process. I somehow expected that I wouldn't mess anything up because I was trying to be so self-vigilant. Looking back I do see things I could have done differently. Hopefully these lessons will stick with me as I move forward.
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