A Home Visit

I know that chart. It's the thick one that screams of too many years and problems at the clinic. It has numerous papers falling out because the holes are torn from use. I already know the name that is written on the front cover in large block letters; Mrs. Aranja is back, and my afternoon will be spent fighting over her symptoms and medications.

If I recall, she was just here last Wednesday. She had wanted more pain medication because her headaches had become unbearable. They were the throbbing kind that never seemed to go away. She awoke with them and lived with them throughout the day. She had tried a number of remedies including aspirin, Motrin, Tylenol, and Percocet, but she only liked to take Tylenol 3, the infamous Tylenol with codeine. So, each month I found myself filling in a prescription for Tylenol 3.

The first time I met her, she seemed pleasant. She was seated on a chair in my examination room and wanted to see a doctor because she was having back pain. Easy enough, I thought, and proceeded to enter the room. She seemed similar to many of my patients—fifty-ish, pudgy cheeks, short dark hair. She giggled nervously when I asked her why she had come. “I have back pain, doctor.”

At first, I didn't know why she had back pain, because the chart was lost somewhere in the records department. So, I began to ask the battery of questions that I always ask patients with back pain. Did she injure herself? Did she have weakness? Could she keep her urine? No, she did not injure herself. No, she had no weakness. No, she did not have any loss of urine. It seemed like a simple problem to solve—probably a muscle strain or arthritis.

“So, …