The time my patient had the munchies

6 minute read –

CRUNCH! Monique popped another chip into her mouth, biting down loudly before she responded to our question. I must have worn my annoyance on my face; she gave me an apologetic look as she swallowed. Only midway through my third year in medical school, I was still working on the ability to control my facial expressions (like the one time a patient offered to sex my attending up… yepppp she said “I wanna sex you up” to him before licking her lips… deffff had to look away).

Dr. Patel had just asked the patient if she drank alcohol, smoked cigarettes, or did any illicit drugs. Monique formed a small smile and dropped her gaze, simultaneously amused and ashamed. “Real talk,” she chuckled softly. “Since you’re the doctor and alladat. I smoke a bit of weed from time to time.” She was a good-humored twenty-year-old with deep mahogany skin and a quintessential New York accent that made it obvious where she spent her childhood. Large hoop earrings hung from her ears, and her jet black hair was slicked into a high ponytail atop her head. She had taken time from her college sociology course that morning to come in for a well- visit. Although this was an Adolescent Medicine clinic, we were using the pediatric clinic space, complete with its colorful plastic chairs and metallic fish decals strategically placed on the walls.

The attending (Dr. Patel) was a kind-spirited Indian woman with almond skin, sporting a bindi on her central forehead. Her bun was wound so tightly that you couldn’t possibly tell that her hair reached her waist. “OK, well, it’s not as dangerous as some of the other drugs, but you never know what it’s laced with. Plus, it makes it harder to succeed in school when you’re high. Just a few things to think about.”

Monique retorted, “I won’t front… It makes me feel closer to God though.” She dissolved into laughter, reaching for another one of her snacks.

Dr. Patel smiled at her as she rose from her seat, motioning for me to join her. “OK, Monique. You’re generally doing well, but we have to watch your weight like we discussed earlier. We’ll see you back in six months!” The three of us exchanged pleasantries before Dr. Patel and I left the room.

“OH! I think I left something in there, I’ll meet you in your office,” I said to Dr. Patel after we walked a few steps.

“No problem, there are a few minutes before the next patient,” she replied.

It was the best lie I could think of to get back into the room. Though I couldn’t put my finger on it, something felt off. We had discussed Monique’s dramatic weight gain earlier in the visit, but didn’t dwell on it. She had gained 30 pounds earlier in the year, and even more since the last appointment. I wondered if more was going on than we had been able to ask about in the brief 10 minute encounter. As a medical student, I felt uncomfortable pushing the issue while Dr. Patel was in the room, but I had a few more questions.

“Hey Monique,” I started, shutting the room door behind me. “Is it OK if I show you something?”

“Uhhhh, cool I guess?” She looked annoyed. “I thought I was all set to go.”

“Just about! I just wanted to talk about something I saw in your medical record.” I sat in front of the computer, turning the monitor so she could see. I pulled up her weights in pounds over the last 7 visits, charted as dots on a line. Her weight had been strikingly consistent until 6 months ago, when it shot up suddenly.

“Dead-ass, I’mma be tight if you just came back in here to fat shame me,” Monique said, chewing on another chip as she stood up to leave.

“OH, no!” My cheeks got hot. “I just wanted to ask about what happened in your life around this point,” I pointed to the dot on the graph from 6 months ago. “Maybe it’s nothing, but just checking.”

She inspected the graph, and I watched as her eyes widened, and then glazed over. She was silent for a long spell before mumbling, “Nothing. Can I go?”

Contemplating her behavior for a moment, I responded, “You’re free to go, ofcourse. But if there’s something going on that you didn’t want to tell Dr. Patel because she’s older, I just wanted to let you know I’m here.”

Monique wore the expression of a store mannequin: completely blank. We were both silent for an uncomfortable amount of time, and I felt I had struck some chord within her. Crap, I’m about to get in trouble, aren’t I? She’s PISSED. Why did I meddle?

She plopped back down, the squeak of the plastic seat finally breaking the silence. Her demeanor was akin to the angriest of clouds before a rain-storm, so I reached behind me to grab a box of tissues in anticipation. As if on cue, she began to cry.

Not knowing what else to do, I pulled my chair closer to hers and gently placed my hand on her knee, hoping it was more comforting than creepy. She bawled for what seemed like an eternity before I spoke again.

“What happened, Monique?”

“I been trying to ignore it! I swear I been trying to ignore it, but ya’ll not letting me move on!” Her shoulders shook as she sobbed.

“I’m here,” I said softly.

“Around then… that’s when my mom came to visit me on campus.” She stopped to blow her nose. “I was happy to see her, you know? It had been a long time cause I was busy with school stuff. Anyway, she uhhm… she… she asked me if I was ready to go to therapy for some shit — sorry, stuff — I had gone through. But I hadn’t thought about all that in years. So after she made me think about it, I started smoking to calm down. I was smoking mad weed and eating mad food. Not gonna lie, the weed makes me hungry as hell. Sorry, as heck.” She blew her nose again.

“No, express yourself however you want.” Should I press her to figure out what she’s talking about? Or am I just being nosy… “Why did she think you needed therapy?” I found myself asking.

She looked at me with the saddest eyes I had seen in awhile. “I… I ruined everything. Some time ago, when I was a freshman in highschool, I came home from school, and no one was home but my dad’s brother who was visiting from out of town. He hadn’t seen me since I was a little girl, and he told me I had grown up to be such a beautiful woman. I didn’t think nothin’ of it. We watched TV together for awhile, and a scene came on the screen where the couple was having sex. I noticed his hand on my thigh after a minute… and then noticed him moving towards me,  but I didn’t expect… I didn’t… expect,” she started to cry uncontrollably again. We were both startled by a loud knock at the door.

“JUST A MINUTE,” I yelled, as Dr. Patel peeked her head in. I rushed to the door and whispered to her that I would need a few more minutes with Monique. Dr. Patel’s eyebrows were furrowed with concern, but she said she would go see the next patient alone and come back in a few minutes.

Monique went on to tell me the horrifying story of how she was raped by her uncle when she was fourteen years old. He had his way with her in the living room of her childhood home while her parents were still at work, and then made her promise not to say anything. A week later, she woke up to find him naked in her bed. The day after that, she told her mom what had happened, who immediately called her dad and demanded that the uncle be kicked out of the house. Monique’s dad sided with his brother, who vehemently denied the accusations. She described how horrible she felt when her dad refused to believe her, his only daughter, stating that his brother would never do such a thing. The situation eventually  broke up her parents’ marriage, as well as ruined her relationship with her father’s side of the family, all of whom considered her a lying teenager desperate for attention. She started sobbing again when she told me she hadn’t spoken to her father in years.

Later that day I reflected on the situation. Dr. Patel and I were able to get Monique connected with a clinical psychologist that worked with victims of sexual assault. We decided on even closer follow up in three months instead of six to make sure she was doing well. 

I learned a lot of huge lessons that day. First, I learned to trust my gut. Something felt off because something was off. Second, I learned that something simple could be a clue that leads you to something much more complicated (ie we thought weight-gain was her biggest issue, but it was really just a symptom of her growing dependence on weed and food due to the trauma she had sustained). Third and most important, I was reminded to listen with empathy to my patients, because I could never truly know what it is like to go through the world in their skin. I couldn’t believe all the pain Monique was hiding behind her “unbothered” New-Yorker vibe.

I still think of Monique from time to time, hoping she found peace and healing from her past. One thing is for sure… I became a better (future) doctor that day, thanks to her.

Until next time, 

Dr. Oye