What’s a “Risin”?

In three weeks mom will graduate from Va Tech with a Master’s degree. She accomplished this while working full time, and as an “older student”. For a final assignment mom wrote an essay about her experiences in medicine in rural North Carolina. I thought this essay was very entertaining and well-written and asked her if I could post it on my blog. She said yes, and here it is!

What’s a “Risin”?
A Short Essay on Health Literacy In Rural N.C. 1961-2000

In late August of 1961, a young physician just out of the Air Force, his nurse-wife, three young children, and an old Chevrolet car came to rural North Carolina to set up a family practice in medicine.  The young “doc” just wanted to be the country doctor in the south that took care of his patients from the “cradle to the grave.”  His first office was in an old store building and was financed with a personal loan from the local bank.  The loan was for five thousand dollars and was secured with a handshake and a promise to work hard and repay the loan as soon as possible. The doors opened on the first Monday after Labor Day and this was the beginning of an odyssey that lasted for forty years. In that time, the doctor and his wife learned the most valuable lessons of their entire lives.

Lesson number one – you may live in America, but do you speak the language? The office had only been open for a few days when a young man came in complaining of a risin in his grind.  The doctor looked in amazement; medical school never mentioned a risin and where was the grind? After several moments, some sign language, and a request to “Please, can you show me where the problem is on your body?” the young man pulled down his trousers and underwear to expose his groin area and a large carbuncle.  The problem started with a single furuncle (boil) and the infection had spread to the entire groin area.  Fortunately, penicillin was available, warm soaks were applied, and soon he was well again. The doctor was medically educated and a every good physician, but that day he became aware of a language barrier that he had not been taught existed.

Lesson number two – assume nothing and be sure the patient understands what you are saying.  Several months after opening his practice, the new doctor was doing better financially and was able to hire a nurse to work beside him while his wife did the business of office administrator, bill collector, signing in patients and all other business aspects of the practice.  One early fall morning, a very pregnant young lady came into the office with the announcement, “I think I’m stagnant, can I see the doctor?” It took a few moments for the nurse to realize the patient meant she was pregnant, had not seen a doctor and wanted to be sure that if she went into labor the doctor would deliver her baby. When all logistics were settled, the nurse took the patient to one of the examining rooms to prepare the patient for the doctor to examine her.  The patient was told that sheets were at the foot of the examining table and that she should take off all her clothes and get on the table.  The doctor would arrive shortly to check her. The physician received the shock of his life when he opened the door to the examining room and found an eight-month pregnant, seventeen year old standing completely nude on top of the table. She had done as the nurse requested, taken off her clothes and gotten up on the table. She didn’t know what the sheets were for, so she left them at the foot of the table.

Lesson three – if the patient reads his chart be sure to be there to explain the medical jargon. After several more years, the doctor had matured and so had his practice.  He now felt comfortable with the language barriers and understood that fittin meant fighting; a pone was not cornbread but a swelling on a particular area of the body, and it was acceptable to tell patients that bathing helped to prevent skin problems.  One thing he had not learned at this point was that the patient might not understand medical jargon and the context in which it is used. At the time of this disaster in the making, a female came to the office where a history and physical was done. One of the questions asked concerned pregnancy.  Gravid meant times pregnant, para meant number of babies delivered, and abortion meant loss of a child during pregnancy, whether medically induced or spontaneous.  To the lay public, at this time, abortion meant criminal abortion, since all abortions were illegal.

The lady’s chart was left on the desk beside her while she awaited the arrival of the physician.  As most patients will do, she began to read her chart.  When the doctor arrived and opened the door he was met by a very angry lady.  In loud tones, she announced, “I have never had an abortion and I will not have that on my chart!” The doctor told her that yes, she had experienced an abortion in the past.  Once again she announced that she had never had an abortion and resented the fact that he was writing false information in her medical record.  It was at this time, the physician realized that to this patient she was speaking of a criminal abortion.  He every quietly and calmly set her down and explained to her it was a miscarriage and to the medical community an abortion and a miscarriage were the same thing. He knew she was innocent of wrongdoing and remembered the pain she had felt on losing her baby.  Once the patient understood the medical jargon and was soothed, she left feeling much better and remained a loyal patient for many years.  She knew the doctor cared about her and had time to explain and correct problems if and when they arose.

Lesson number four – if the patient is unknown to you but has a chart, study the medical record before you assume you know everything. Several years later, the nurse-wife became a nurse practitioner and took care of the doctor’s practice when he was at a meeting or out of town.  She felt very smart and thought she could take care of patients as good as any one.  One day, she had a rude awakening.  One of the doctor’s regular patients came in for a check-up.  The nurse practitioner went into the room and began her examination. She did not check on the past history of the patient and knew nothing about him.  While talking with the patient she learned he was a famous “fiddle” player. Now, she was really feeling that she was good at what she was doing.  While examining the patient she noticed he did not have a complete thumb on his right hand.  Showing empathy and a concern for the patient and his loss of the digit, she began to question how he could continue to play the ” fiddle” when he didn’t have all his fingers .The patient looked at her very soulfully and explained that he could not play as good as he once had.  When she asked him when and how he had lost the thumb, he stated that he lost it at age eight playing games at home.

All the anecdotes the author has used are real and did happen.  They are related as close to fact as can be remembered. In forty years, one of the greatest lessons learned is that low- literate may be applied to the patient, but perhaps it should be applied to the caregiver, too.  As caregivers, we may not understand the language, the culture, the gestures, the body language, or many other things that make each patient unique.  This week we had a patient in our rehabilitation unit that was thought to be mentally handicapped.  Once it was ascertained that she was very hard of hearing, and sound magnifiers were applied, the staff learned she was very bright. Every day it is a challenge to cross the barriers before us in order to deliver the best care possible to each individual.