Today’s first patient was a prime example of what happens when you talk over a patient’s head:
He came into the office for a social security/disability evaluation. After bouncing around from job to job, he had decided that “It would be easier for everyone if I just didn’t work anymore.” My preceptor was well into his background information when he told her that he had been diagnosed with tuberous sclerosis in addition to his well-controlled epilepsy.
“Do you know what that is?” he asked.
“Yes, I’m familiar with tuberous sclerosis.” Slight eye-rolling from my preceptor here.
“Yeah, but do you know how you get it?”
“Yes, it’s a genetic disorder—autosomal dominant, you get it from your family.” She answered.
“No, but do you know how you really get it?”
“I’m not understanding you sir—what are you asking?”
“Well, I was diagnosed by Dr. X years back and he told me that the reason that I have tuberous sclerosis is that somewhere, back generations ago, one of my relatives had sex with sheep.”
At this point, my preceptor turns and gives me her signature deadpan look over the top of her glasses, and I try hard not to laugh.
“I’ve never heard that.” I add.
“I’ve never heard that, either.” she says with a snort.
His neuro exam was completely normal, in case you were wondering. Good strength, reflexes, fully able to walk (ambulate, for you high-brow types), and all that jazz. We filled out the disability paperwork, but are confident that they will reject his claim.
I came home and Googled “tuberous sclerosis sheep sex” tonight and do you know what I got? Something about sex cells from sheep may help researchers better understand tuberous sclerosis! My theory is that someone gave this poor guy a long-winded sermon on research and what he extrapolated was that some relative of his was poking sheep and is to blame for all of his skin lesions. Funny, but bizarre.
Our second patient today was an elderly Amish woman who has been having problems with her memory. It was interesting listening to my preceptor make slight adaptations to her mental status exam. For example, she had to ask her if she ever gets lost at the produce auction rather than in the grocery store. Or if she had stopped driving the horse and buggy by herself. The woman was in her 80’s and it was just interesting to think about how she’s lived her life cloistered on a farm, with so much going on outside of her community. No internet, no television, no radio… only newspapers.
Today was just weird, and this is one of the things I love about medicine; you encounter all different types of people, and you never know who is going to show up in the office/hospital.