Page 65 of The Devil You Know
“Oh,” I say quietly. It isn’t an uncommon request in my younger patients. “Any STD in particular that you’re concerned about?”
Mr. Powell takes a deep breath. He’s so thin that he’s scrawny, although I can’t imagine he was that way when he first went off to war. He keeps shifting on the examining table, unable to make eye contact. I’m convinced he’s got another psych diagnosis beyond PTSD. I’m no psychiatrist, but I know paranoid psychosis when I see it.
“So here’s the thing,” he says. “I was in this public bathroom, you know? Like at a rest station. And they had no toilet paper. But I had to wipe myself. So I found this newspaper on the floor of the bathroom and I used that to wipe.” He runs a shaky hand through his short hair. “I think I might have gotten some disease from the newspaper. So I want to be tested. For everything. Chlamydia, gonorrhea, AIDS—everything.”
“Mr. Powell,” I say as gently as I can. “You can’t get an STD from a newspaper.”
“You’re wrong.” His fists clench. “I think I did. And I want to be tested.”
“Okay…” If he wants to be tested, I’m not going to deny him that. Maybe this is all a story so that he doesn’t have to tell me about a recent orgy. Although I genuinely think he’s telling me the truth. “I can test you right now, if you’d like.”
He shakes his head firmly. “No, not here. Give me the test and I’ll do it at home.”
I’ve never heard of a full STD panel that can be run in the comfort of a patient’s own home. “I’m sorry, but I can’t do that. The tests have to be done in the office and also a blood test in the lab.”
“No.” He grits his teeth. “I can’t do that.” His voice raises a few notches. “I want to do it at home.”
I look at my patient, wondering if I need to be worried for my safety. Probably not. But wouldn’t that be a perfect end to my day? To get strangled by a crazy guy who wants a home gonorrhea kit.
“How about this,” I say to Mr. Powell. “I’ll do a physical exam and if it looks like you have any signs of a sexually transmitted disease, then we’ll run the panel. Otherwise, I don’t think you need to worry. Okay?”
That seems to placate my patient. His shoulders relax slightly and he lets me examine him. And there’s no discharge or suspicious lesions that would make me think that his encounter with the newspaper was anything otherthan benign. So I send him home with a clean bill of health.
Just as Mr. Powell goes on his way, I get a page from Ultrasound, which has never happened to me before during my short tour of duty at the VA. When I call the number, a breathless voice answers: “Dr. McGill?”
“Yes, this is Dr. McGill,” I say. Wow, they were actually waiting by the phone. Half the time when I return my pages around here, the person calling has taken off by the time I dial the number, probably having gone home for the day.
“This is Liz—an ultrasound tech,” an unfamiliar voice informs me. “I have a patient of yours down here. His named is Ray Chambers.”
“Yes.” I saw Ray Chambers early this morning. He presented with right leg pain and I noticed his calf was warm and tender. So I booked him for an ultrasound, thinking that the last thing I’d want to miss was a blood clot in his leg. He’d been reluctant, but finally agreed to get the test.
“So he’s got clots in both his right femoral and popliteal veins,” Liz tells me. “They’re pretty extensive clots, going all the way up to the pelvis.”
“Geez,” I breathe. Good thing I convinced the guy to get the study. A blood clot in the leg, also known as a deep venous thrombosis, is potentially fatal. The clot could travel up to the lungs, resulting in a pulmonary embolus,which could easily be fatal. He needs to be treated with a blood thinner, and my first choice would be to send him to the emergency room.
“The problem,” Liz tells me, “is that Mr. Chambers is not excited to stick around the hospital—I definitely can’t convince him to go to the ER. He keeps saying he wants to go home, and he’s obviously competent to do so. We’ve convinced him to stay though, just to talk to you, and I’m going to have someone wheel him up to your clinic as soon as we have an orderly available. It will probably be in the next ten to fifteen minutes.”
“Great, thank you!” I say. “That’s awesome. Thank you so much.”
“It’s no problem at all.” Liz seems befuddled by my rush of gratitude. It just amazes me lately when the staff at the VA actually does something to help me. I’m genuinely shocked they’re not making me come down there to retrieve Mr. Chambers myself. “Just have someone waiting there, because he’s a flight risk.”
The problem with that is I’ve got a heavily booked schedule for the day. I don’t have time to be waiting around at the entrance to Primary Care C for Mr. Chambers to arrive. This is one that I’m going to have to count on Barbara to do.
I sprint over to the waiting area, where Barbara is in the middle of putting a final coat of fire engine red on her nails. There are two patients sitting on chairs, and I thinkboth of them are mine—I’m really behind. But I need to make sure Mr. Chambers is safe.
“Barbara,” I say.
Barbara finishes two more of her nails before she speaks to me. “Hang on.”
She dips her brush back in the bottle of polish and finishes up the rest of the nails on that hand. I wait patiently, assuming she’s going to look up and talk to me after that, but instead she starts blowing on her nails.
“Barbara!” I say, more sharply this time.
Finally, she looks up. “Yes?”
I glance at the two patients in the room. “I need to talk to you about a patient. Can we go outside?”
Barbara sighs heavily, but reluctantly traverses the two yards to just outside the door. I lower my voice so that nobody can overhear. “There’s a patient named Ray Chambers who has a large blood clot in his leg,” I tell her. “Ultrasound is sending him up here in maybe ten or fifteen minutes, and I need you to pull me out of the examining room as soon as he arrives, okay?”
