Word: wrists
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...Rosa was a Medicaid mother of three with a painful wrist. In her early twenties, with no husband, on child-support, she was a typical patient from "the neighborhood". Rosa was pretty saucy though; she let you know she didn't like waiting, she was snappy during her interview, she made sure I wrote her out prescriptions for all the medication I recommended, even the over-the-counter ones. This way they would all be paid-for. She spoke no English, and she even poked fun at my clinic Spanish. I made a note of it in her chart...
...better?" she accused with a twinkle. Now we got into it: Any better? You've been living in my country all this time and you haven't learned any English? A lively debate on the merits of a bilingual society gave way to a cortisone shot for the same wrist pain. I had our therapists make her a splint and said 'adios'. I liked Rosa...
...Moving ahead about five years, I was now clinic Attending - in other words, the boss. "We found your old note on this patient. I think she has DeQuervains (the same wrist problem) again. And could you look at the patient in the next room with me too? I think she has the same thing" The resident was a good one. His report on their histories and physical exams was perfect. He was thinking about operating on both women...
...gotten a job. She spoke English decently. She had gotten her kids into a Catholic school. Some magic combination of seeking out a 'better life for my kids' and Welfare reform had helped her make it - though barely. I tried to show off some improved Spanish while explaining the wrist problem. "Give it up doc" was her response. "Just tell me what is the problem and what...
...DeQuervains is the most common cause of pain on the thumb-side of the wrist. It's a tendon irritation caused by friction. If it continues to be a problem despite pills, therapy, splints and shots there is a small and simple surgical procedure that cures it. I do the operation under local anesthesia, and because there's a tourniquet with a timer on during the case I can tell you how long it takes: about ten minutes. She understood the explanation and opted for the surgery. Then we went next door...