Organ Recital

March 15, 2005

Over the years I have noticed that people often come to the doctor with a list of problems. One-stop shopping, I’m sure they are thinking; let’s get everything taken care of at once. I can relate to that.

The trouble is, human beings can’t give full attention to multiple things at once (no, not even doctors!) There is actually a concept in learning theory that explains why the brain can’t work that way (although I can’t remember the term right now!)

And of course, folks don’t always mention the most important or serious thing first, or at all, even if they know which is most serious. I once treated a lady who was having a heart attack, but all she cared about was her headache!

During the medical brigade, the patients could access only one service a day. They had to choose between medical, dental and optical. If they wanted another service,they had to come back another day and wait in line again with no guarantee of getting in. So they had to decide which was most important.

Most of them had one or more of about 10 symptoms:

1. Loss of appetite and abdominal pain – diagnosis, parasites
2. Headache – diagnosis, chronic low grade dehydration and heavy physical work, including carrying heavy loads on the head
3. Sore throat, coughs and cold symptoms – mostly viruses and allergies.
4. Pain in the bones – ditto heavy physical work
5. Dizziness – ditto dehydration
6. White blotches on the skin – superficial fungal infection – unsightly, but harmless
7. Skin ‘allergy’ – a non-specific rash that I had no clue about
8. Acid stomach
9. Exertional chest pain and shortness of breath walking up the mountain that Villa Nueva sits on – angina pectoris. Take these baby aspirins until they run out in 30 days and be sure to sit down and rest until the pain goes away. (!!!)
10. Asthma. There’s a lot of wood smoke from cooking in addition to considerable smog.

It was pretty routine to see a mom and a ‘passel’ of kids, and 'laundry lists' of symptoms were the norm. I always started with the baby and worked up to the mom in order to minimize the confusion in my brain. One day I saw a family of 7 – mom, 4 kids, and 2 nephews. Each of them had at least three complaints – some had more. It was late in the afternoon, I was already tired, and the almost-equatorial sun was beating in on us. Fortunately, none of them was really sick. Anti-parasitics, Tylenol and vitamins for all, and they were on their way. Meanwhile, I was toast – cross-eyed with mental fatigue.

So on the next to last day in the afternoon I had already worked through a lot of these families, and another one was in my cubicle. I’d finished with the two or three kids, and mom was giving me her list. Headache, pain in the bones, parasites, dizziness – maybe there was more; it’s all kind of a blur.

And oh! by the way, is there any chance of seeing the dentist? I lost a molar recently and I have a lot of pain, I can’t sleep at night. It just broke off, leaving the root behind.

Believe me, it’s all too easy to tune out towards the end of the list. By the grace of God, that last snapped me out of my fog. Have you had fever? I asked. Yes, she had. I looked in her mouth and winced. The socket was full of pus and the gums red and swollen. We had stopped giving out tickets for the dentists (they pulled hundreds of teeth; the record was 29 from one person), but I was worried about the retained tooth fragment – a wound can’t heal properly with a foreign body in it.

I stepped out to consult with Joe, one of the dentists. He immediately offered to come and look at her. “Oh, yes, that definitely needs attention. I wish she had come earlier in the week so we could load her up with antibiotics beforehand. Give her two grams of ampicillin today and something for pain and have her come back first thing in the morning.”

I was grateful that he was willing to add her to an already full caseload. I begged a dental ticket from Bob and gave her a big bag of horse pills. Shortly thereafter, we finished for the day and I went home and passed out.

The last day was just as busy and exhausting, but when we were done I thought about her again and tracked Joe down to find out what had happened.

Oh yes, he said, it was a good thing she had come, because it wasn’t just an abscess in the soft tissues, but osteomyelitis – infection actually in the bone, from where it can easily get into the bloodstream and cause a catastrophic infection. She could have been dead in two weeks without treatment, he said.

Ay, carumba! It´s a good (God) thing that my numb brain woke up to pay attention to what she was telling me! Those kids definitely did not need to be losing their mama at such a young age.