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“Are you sure you’re OK, Mr. Crew?” Abi asked her clinic patient.
His eyes drifted towards her slowly shifting hands. Under his gaze, she became acutely aware that she was picking the cuticles of her nails, as she often did. She quickly dropped her hands to her sides.
“Uh…” he glanced at his wife, who sat in a chair across the room. “Yes. Fine.”
“Ok,” Abi replied hesitantly as she continued to examine him. She was working as a medical assistant at an urgent care clinic located in a small town in Utah, set amidst the slate-gray peaks and forested canyons that made up the surrounding Rocky Mountains. She worked two shifts a week checking patients in and out, taking care of billing, drawing blood, and running drug tests. She loved her job, perfect for a student interested in medicine.
She decided to go into medicine when she was 9 years old, after her younger brother was diagnosed with brain cancer. This wasn’t the first time she would spend days on end in a hospital: a genetic mutation had led to cancer diagnoses in many members of her family. Her young mind was filled with memories of doctors explaining imaging scans, lengthy names of medications, and the oh-so-stylish hospital robes that changed ever-so-slightly depending on the hospital. To her, doctors were geniuses: superheroes in white coats. Despite all the loss she experienced, she felt very much at peace in the hospital. Over time, she sought out experiences that would bring her a few steps closer to her dream of becoming a physician, such as working in the clinic.
Since it was cash-pay, the clinic was often filled with patients without healthcare insurance. Many companies in the surrounding areas required work physicals for their employees to be done through this clinic, which was what brought Mr. Crew in with his wife that day. He was a tan, sturdy man with large arms, a baritone voice, and dirty-blonde hair shaved into a buzz cut. His new job as a trucker started in a week, and he was required to get a physical and general sight exam for his commercial driving license. He looked faint as he sat in the clinic chair.
“You look like you might be dizzy, Mr. Crew.” Abi started again, cautiously.
The patient’s wife made a snorting sound from her corner of the room. “He’s not dizzy,” she said under her breath.
Abi proceeded to take Mr. Crew’s vital signs, noting a slight fever and mildly fast heart rate. Her kind eyes, sometimes blue and sometimes green depending on when you looked, were laden with concern. “Are you in pain? Your heart rate is a bit–”
“I’m fineeee,” He interrupted her, more quietly this time.
Moving to the general sight portion of the exam, she asked him to stand and identify a row of letters from a card she held up a few feet away. As he attempted to get up from his seat, the color immediately drained from his face. His knees buckled, and he nearly fell.
“Ughhhh okay, honey!” his wife exclaimed in a disgusted tone as Abi rushed to help the patient up. “You might as well just tell her at this point. You really don’t look too good.” The two of them cut eyes at each other before she excused herself from the room.
Once they were alone, Abi started again. “Mr. Crew, I will NOT continue this exam until you tell me how you’re feeling and what’s wrong. I know you want to pass, but if you’re not feeling well, we can always do this later after we help you get better…”
He sighed loudly before pulling up the right leg of his Levi’s, revealing a large, jagged shard of glass firmly embedded into his calf. The skin around the glass was red, swollen, and covered in crusted blood.
Abi hid a gasp behind her hand, and then placed the vision cards on the table before speaking. “OK, sir,” she started slowly, “I’m going to bring Dr. Ramirez in here to check this out.” He nodded, resigned, and hung his head.
Once the doctor entered, the patient began to explain. “Marilyn and I,” he referred to his wife with a look of exasperation, “have been having… issues.” He squinted in pain as the doctor examined the wound. “Ya know… arguing about things. She’s been naggin’ at me… wants me to drink less, spend more time at home, all that stuff.” He sighed. “Anyway I was out late yesterday drinking at a bar. Got a little wasted. Must have jammed my leg into a broken bottle at the bar or something, or maybe in the cab? I dunno. It didn’t really hurt at first, so I didn’t look at it.”
Abi and Dr. Ramirez looked at him expectantly when he stopped talking. He met their gaze for a moment, then hung his head and continued to talk. “I got home around 3 somethin’. Marilyn was up waitin’, and she was pissed. She yelled at me, and I just kept tellin’ her to quiet down, ya know? She was hurting my head. My leg started to hurt and we noticed what happened, but she told me to be a man. Like if I was such a man to stay out as late as I want, I should be a man and push through the pain. Told me to leave the glass in there… that if I took it out, she’d leave me.”
Dr. Ramirez determined that the glass had not injured a major vessel. Abi assisted him as he injected lidocaine to numb the skin in the area, carefully removed the shard of glass, irrigated the wound with saline, and then stitched the skin back together again.
Mr. Crew fidgeted in his seat. “I love Marilyn, even though she’s a little crazy. But I guess I keep breaking her heart, metaphorically speaking. I deserve a little pain.”
“If you want some resources,” Abi mentioned softly as Dr. Ramirez finished the stitches, “We can give you a number to someone you and your wife could talk to… if you’re interested.”
“Nah,” Mr Crew replied quickly. “Can I finish my exam now?”
Abi helped the patient finish his exam, and watched him as he left the clinic, his wife speaking sternly as she trailed him to the car. Abi was surprised… she had known something was wrong with her patient and that he was hiding something, but to find out that he was hiding an injury?? Abi felt sad for her patient and his wife, who seemed to be absolutely miserable.
At the same time, she felt oddly… hopeful. She was on the brink of entering a career in which she would learn to screen for all types of family (and other) problems. She would have resources to help. Medicine was about so much more than just disease… it was about everything that affected the health of a person, both physically and emotionally.
And maybe, in the future, she’d be able to help fix someone’s heart… literally and metaphorically speaking.
Written by Dr. Oye, adapted from an interview with Abi
Until next time,
Abi is a second year medical student in Utah. She is passionate about offering advice and resources to help students on their pre-medical journey. Connect with her on Instagram at @abisanatomy, where you can learn more about the ins and outs in the life of a medical student! At her website, https://www.abisanatomy.com/, she also offers her famous compilation of medical school reviews written by medical students around the country, professional essay editing, resume creation, personalized application assistance services, free MCAT resources, and advice on writing personal statements!