A Priceless Smile

Yesterday was a really busy day.  Since Matt Kappen (my buddy from med school) and I are the only family docs here right now, there's a lot for us to do each day.  There was a lady in labor, two admissions to the hospital in the first couple hours of the day, hospitalized patients to see, stuff going on in the ER, I had a full outpatient clinic scheduled, and Matt and I were hanging out in the endoscopy suite for much of the morning as Matt works on honing his endoscopy skills. 

Amidst all the craziness, I saw a lady in my clinic who was 75 years old and about 4 foot 3.  The nurses got a kick out of seeing us walk side by side because of our height difference.  Many of the indigenous folks are pretty short, yet they still like to call me "Doctorcito", which means little doctor.  She came into my office and her granddaughter translated for her.  The elderly woman did speak a little bit of Spanish, but she was much more comfortable with her native indigenous language.

The ladies were very stoic during the interview, as is the custom of many of the folks from deep in the jungle.  They told me about how she was suffering from worsening pain in both knees, her right hip, and her right shoulder.  Her knees bothered her more than anything.  You could tell by looking that those little joints had done more than their share of manual labor during 75 years of hard life in the rain forest.  An exam confirmed that she had horrific osteoarthritis, with not much more than bone-on-bone in her knees.  Those little knees sounded like a bowl of Rice Krispies when she bent them.

We talked about treatment options, and she decided to have her knees injected yesterday, and to bring home some Ibuprofen to be used as needed.  I got everything ready and she bought the injectable steroids ($2.00).  After the injections, the stoic lady from deep in the jungle came down off the exam table.  Since an immediate effect is provided by the Lidocaine in the injection, you could tell that she already felt a huge relief.  I explained to her that it would take a couple of days for the steroids to kick in, but you could see a huge smile creep across her weathered face.  It's not a perfect treatment, but it will give her many days, and hopefully months, of relief from her pain.  As they left, I told them, "God bless you".  The ladies were so happy at this point that they were practically laughing.  "Yes," they answered, "we do trust in the goodness of God!"