Mysterious abdominal pain


We don’t have to come to a truce.

Sure, I’ll write the excuse.

            But the frequent refrain        

            Of abdominal pain

Shows a survivor of kiddy abuse.

The patient’s left-sided abdominal pain radiated into the suprapubic area and sometimes into the back. I did the basic history, and I went to enter the diagnosis in the Electronic Medical Record.  I found the same diagnosis five times. 

Worry played the patient’s face during the request for a work excuse. I found all the info I needed about previous work- up.

A couple of CT scans, showed a cyst that progressed to resolution.  The patient had seen a surgeon, the right inguinal hernia had been fixed, but the pain essentially hadn’t gotten better.  Colonoscopy and EGD had been inconclusive.  Persistent hematuria had been investigated by the urologist.  Other specialists had been involved.  Everything abnormal had gone away or couldn’t explain the situation.

Today I found blood in the urine.  Again.  I made arrangements for a non-contrast CT scan to rule out a kidney stone.

Then I looked away from the screen and made eye contact with the patient.  I shut the laptop as a statement: now we are talking, your problem is important to me. 

In Spanish I reviewed the work up and I said, “Sometimes, when someone has a pain in the stomach that doesn’t go away it’s a sign that they survived sexual abuse during childhood.”

The expression fell from the patient’s face like infrastructure falls in a building implosion.  I offered Kleenex and one was taken.  Many such survivors clutch the tissue and don’t cry.  This patient was no exception. 

And the patient didn’t speak.

I said, “We must discuss this in depth.  But first we must make sure you don’t have a kidney stone.  Can you come back next week?  We’ll schedule a half-hour visit.  There’s a lot we have to talk about.”

In a perfect world I would arrange for counseling, but in Sioux City we don’t have enough people who speak Spanish who do counseling.  Actually, it’s mostly me.  Most patients need more counseling services than I can provide.  I still have to work on the patients with abdominal pain.

I attended two other patients with abdominal pain this morning, both with blood in the urine.

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