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The Art of Medicine

You never know when the plague will strike

Maurer, Brian T. PA-C

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doi: 10.1097/01.JAA.0000830188.88179.79
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FU1-14
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A man can't cure and know at the same time. So let's cure as quickly as we can. That's the more urgent job.—Camus, The Plague

From the moment I step into the examination room, I sense that she's upset.

Usually this mother greets me with a smile. There is no smile today. Her eye contact is fleeting; her sentences clipped and short—a marked difference from the office visit yesterday, when she came in with her sick daughter.

“Now your son is sick,” I say.

“Can you tell me his temperature?” she says. “Your medical assistant seems to think that's confidential information.”

Immediately, I show her the encounter form and point out the number. “We clocked him at 99.6, a degree above normal—a low-grade fever.”

“Thank you.” The words are cold. There is no inflection in her voice.

“How is your daughter doing today?” I ask.

“Her fever's gone up. This morning it was 102.6.”

“It will take a couple of days for the medicine to kick in. When did your son get sick?”

“Just this morning. I had him to his asthma doctor to get his prescriptions renewed. He thought he was probably coming down with the same thing as my daughter.”

I examine the boy. Unlike his mother, he has a ready smile. I detect a few scattered wheezes in his lung fields.

“It looks like he's following in his sister's footsteps,” I say. “I'll give him a prescription for the Tamiflu. He needs to start taking his inhalers as well. How is he set for them?”

“His asthma doctor renewed them this morning.” She shows me the handwritten prescriptions.

I copy the names of the medications, the strengths, and the dosages into his medical record.

“Good,” I say. “Now we're all on the same page.”

“I brought along copies of his treatment plan and the results of his most recent allergy testing.” She hands me the paperwork. “This is the second time I've given it to your office. For some reason they didn't make it into his record last time. The same thing happened with my daughter's records. I brought along another copy of hers as well.”

“Thanks for doing that. I don't understand what happened the first time round. This time I'll put them into the children's records myself.”

“I know you will. You're always attentive to me and my kids when we come in. The problem,” she says, taking a deep breath, “is with your staff.”

This is news to me. “How so?”

“It's not everybody, just a few—but it's the same folks every time. I can tell—it's always the same. They never smile. They always act like they're doing us a favor. It's just little things, but I can tell. My kids feel it too.

“I admit, I made some mistakes. I had them when I was 17—a single Black woman with two kids. Yes, I've had to go on state assistance, but I've been working hard. I'll be graduating college this spring, hopefully getting a good job, so I can get ahead.

“I don't expect special treatment when I come here with my kids; I just want to be treated like everybody else—you know what I mean?”

Slowly, I nod my head. “I didn't realize—”

“Oh, it's not you. That's why I always schedule appointments with you. Like I said, it's a couple of people on your staff....”

“Perhaps we need to have an office meeting to put the issue out on the table. I'll talk with my supervising physician—”

“I already had this conversation with him 6 months ago. He said if we weren't happy here, we could find another practice. But to me, that doesn't address the issue.”

The words sting. Nothing was ever said to me.

“Let me see what I can do.”

“I appreciate it.” They rise to go, this mother and her teenage son. The boy hasn't said a word; he actually looks a bit embarrassed.

“Hey,” I tell him, offering my hand, “you can be proud of your mother for standing up for herself, and for you too.”

He smiles.

I give his mother a hug and a kiss on the cheek. Her anger has melted away.

Implicit racial bias still smolders beneath the veneer of our professional culture. Like Camus' plague, you never know when it will raise its head and surface in the city.

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