A 20-year-old female presents to a student health after-hours clinic with a sore throat, body aches, and a stuffy nose…
It sounds like a typical case—given age, gender, and a smattering of symptoms, diagnose, educate, treat…problem solved. However, what seems simple in the textbook may prove complicated in reality. This experience showed me first-hand how patients can affect outcomes of their own care.
That night in February 2012, I was feeling horrible. So horrible, in fact, that when the care provider told me to take some cold medication and not go to class the next morning, I—a student who’d rarely missed lecture even as a college senior—followed the advice without much protest.
A few days later, I developed a wheezy cough. I’d struggled with asthma as a kid, and although I’d stopped carrying an inhaler after middle school, my symptoms had returned during my sophomore year of college when I got “swine flu.” So this new development was an inconvenience more than a reason for alarm. A couple of weeks, a new inhaler, and a breathing treatment later, that distinctive wheeze disappeared, but my overall condition worsened—and my frustration intensified.
By that time in my undergraduate career, I’d fully immersed myself in the culture of the place, been indoctrinated into the gospel of putting work, grades, and other obligations above personal wellness. Even our conversations prioritized the same. “How are you?” was often met with a rundown of upcoming deadlines instead of an actual answer to the question. Sickness? No excuse, this gospel preached; keep doing as many activities as you can manage, only slowing down when you’re too fatigued to leave the dorm. But I can’t place all of the blame on the institution; even without that external pressure, I’ve always been the type of person who wants to follow through with every commitment I make, regardless of the consequences. Whether that stems from a sense of dedication to the activities I involve myself in or a fear of disappointing others is anyone’s guess.
In any case, even when intense chest pain and deep coughing made me feel my most miserable, I still went to dress rehearsals for a dance performance I’d signed up for the preceding semester; only after the final performance did I go back to the after-hours clinic. It was then that I was given antibiotics to, as the healthcare provider on call termed it, “treat symptoms of walking pneumonia.”
At first, I didn’t believe I actually had pneumonia. After all, I told myself, the healthcare provider on call never ordered a chest x-ray to confirm anything (clearly I knew nothing about lung crackles at the time). I still took the antibiotics in the hope that I’d bounce back from whatever was going on inside my body. Eventually, the deep cough went away, and my friends stopped joking that I had tuberculosis. However, my chest still hurt when I stretched or moved abruptly.
I went home for Spring Break and told my then-PCP about the issues I was having. She postulated that the harsh coughing that I’d done while I was ill before had caused an injury. She told me to put heat on the affected area, take pain medication, get plenty of sleep, and not exert myself. Under the watchful eye of my family, I complied. However, when my vacation was over, I once again succumbed to the desire to make the most of my final year in college.
One afternoon toward the end of March, I performed a spoken word piece at an outdoor rally. Before I began, I was feeling fine. But I wasn’t expecting to step up to the microphone and perform the piece as passionately as I did; I practically shouted the words over the noise of the passing cars, for all those gathered to hear. The moment I rejoined my friends in the crowd, my chest exploded with pain. Since my discomfort was so obvious, my friends urged me to go back to the clinic. Once again, I was told not to exert myself too much, and once again, I all but ignored the suggestion. Fortunately, the ache slowly started to subside for good; otherwise, my refusal to remove myself from more dance rehearsals and late-night outings in the following weeks might have left me even worse off than before.
In retrospect, it’s obvious how stubborn I’d been during the majority of the experience. I was well aware that I needed to take better care of myself; I complained about my ailments, told my peers and concerned parties that I understood the importance of taking it easy, yet pushed myself to function as if I weren't ill.
In medical school, we do our best to memorize the typical presentations of common diagnoses but are cautioned that the patient “doesn’t always read the textbook” when it comes to presenting symptoms. That caveat can also be applied to cases like this one, where prognosis relates to the patient’s level of compliance. On the wards, I’ve encountered numerous cases of patients who decided not to take important medications or chose to ignore a physician's strong suggestions to make life-preserving changes. I’ve often found myself unable to understand how they’d fail to comply in these situations. My response to my illness was no better than theirs; indeed, if I hadn’t been so set on keeping up "business as usual," I might not have spent an entire month suffering from chest pain. But as a result of my experience, I will likely be more willing to acknowledge the complex intersection between disease management and daily life—after all, I was once a patient who had to navigate it myself.
