Saturday, July 6, 2013

Who are we without our memories?

I MET HER three days ago, the patient who had no recollection of the past. I took on the reins of the interview after the resident, in her frustration, decided that I could probably extract bits and pieces of information from her. Her husband was nowhere in sight, and her companion, the brother she had not seen for years, was just as clueless as she was.

Wheelchair-bound, she was sweating profusely, her extremities cold, her breathing labored. Her heart rate went through the roof. She looked 40 instead of 30, which was the age written in her chart. She was wispy and pale. Her voice was so soft I had to lean my head towards her. 

"Nakakaintindi ka ba ng Tagalog?" I asked. I thought the problem was with language. She hailed from an island province in Southern Luzon. Surely she must understand a bit of Tagalog, but she looked as if she did not get me at all, the way medical students often do when asked about mechanisms of drug action.

Seconds later she replied, "Opo." So I scratched my language hypothesis off.

We were making progress—or so, I thought.

Her brother handed me the result of a thyroid work-up, including a neck ultrasound, done two years ago. Why she had consulted with a doctor at that time could finally settle whether she had a thyroid problem to begin with.

"Bakit ka nagpakonsulta sa doktor noong 2011?" 

She gave me the confused look.

I continued: "Kasi po, may ipinagawang test sa inyo noon. May dahilan ang bawat test. Ako po, nagpapakonsulta sa doktor kasi may lagnat ako. Ang iba naman, nagpapakonsulta kasi masakit ang tiyan nila or buntis sila. Kayo po—ano ang naramdaman niyo noong 2011 na siyang nagtulak sa inyo para magkonsulta sa isang doktor?"

The confused look again. 

I decided to feed her questions easily answerable by yes and no—generally a poor technique in taking clinical histories, I know, but if I could elicit something from my train of questioning, maybe I could use that as a jumping point.

"May nakapa ka bang bukol sa leeg?"

"Wala po."

"Para bang kumakabog ang dibdib mo?"

"Hindi po."

"Hirap ka bang lumunok?"


Dysphagia!, I thought. "Kelan niyo po unang naramdaman ang hirap sa paglunok?"

The quizzical, confused look. Again.

"So nahirapan po kayong lumunok noon?"

"Hindi po."

This went on for 20 or so minutes—probably the most un-productive history taking session I had with a patient.

Finally I said, in the mellow Ilonggo tone I employ when consoling patients, "Huwag ho kayong mahiya sa akin. Okey lang po na sabihin niyo na hindi niyo na po naaalala ang mga nangyari sa inyo."

"Hindi na nga po."

"Sino po kaya ang pwede naming kausapin tungkol sa mga naramdaman ninyo? Marahil isang tao po na mas nakakaalam kung ano ang naramdaman ninyo noong mga panahong iyon."

"Ang asawa ko po."

Ah, true love.

"Nasaan na po ang asawa niyo ngayon?" 

"Wala po dito."

I said I'd leave her for the moment. I told her to take her time and think things through. My tour of duty ended with many questions left hanging in the air. Did she really have a thyroid problem? Did she really have difficulty swallowing? What was she feeling then that led her to consult a doctor?

I was surprised to see her again in the morning. 

"Hi, Ate. Kamusta ka?"

She was no longer sweating, her vitals were within normal limits, and she looked better clinically. 

"Ako po ang nag-interview sa inyo kagabi. Naalala niyo pa po ba ako?"

"Hindi po."

Labels: ,


Blogger Unknown said...

Tragic. :(

Sun Jul 07, 02:44:00 PM GMT+8  

Post a Comment

<< Home