A Different View

This vignette comes from a great primary care doc with us last week:

"After clinic today which ended at 3 PM I was called over to the ER to see a 16 yo girl with a fever--mute, delirious and, having been recently diagnosed with and treated for malaria, seemed to the folks handing her over to me to be suffering from cerebral malaria--a potentially deadly complication. My assessment suggested otherwise, even though she was febrile. It was a very hot day and she was so agitated that the stress alone could have caused a low grade fever. She was very tachycardic and hypervigilant, looking left and right, in an absolute panic. It was very scary and I wasn't sure what to do, with no ability to do lab tests, x rays or even a malaria test because our reagent ran out. I went with gut instinct and gave her Ativan, first under her tongue and then through an IV.

Through a Creole translator I determined from the neighbor who brought her in that the girl's friends, his children, thought she had been "mystified"--a voodoo belief that someone has been turned into a soulless zombie. Sure enough, with some hand-holding and gentle coaxing as the Ativan kicked in, the girl made a turn around and started talking for the first time in 5 days! I got the history that she went through a similar illness right after the quake lasing 10 days. She had seen several dead bodies and wouldn't speak or interact for almost two weeks.

She then said her first words to me, through the translator, "After the earthquake, all I could think about was my school (destroyed--all schools still closed even now). Today, the earthquake happened again. But this time I thought I was dead." Her cerebral malaria was in actuality PTSD. All medical assessments down here are made in the looming shadow of a recent severe disaster.

It's easy, coming from the States, to forget and view symptoms through a faulty lens that wants to "medicalize" everything and apply the old familiar thinking to a totally unique situation. This took me 8 days to fully appreciate and now I'll be leaving, passing torch to some fresh recruits to learn their own unique lessons."