The old saw goes: "If you listen to the patient long enough, she will tell you what the problem is." This could be a mantra for seeing patients. Recently, I saw a tired, sad-looking 56 year old woman for a rash on her face. It was the kind of rash associated with stress -- so I asked her to tell me what was going on in her life.
1) Her ex-husband had sexually abused her 14 yo daughter for 3 years. He's in jail now. Her daughter has been in and out of relationships since -- back home now, she is smoking and drinking. The patient's 18 yo son dropped out of high school last year and does nothing.
2) When husband was arrested for molestation, her kids were taken away by child welfare and it was 18 months before she got them back. She feels guilty about that.
3) She says that they don't have enough money for food or rent. All she gets from welfare is $700/month and it is all she and her kids have to live on.
4) She herself was abducted from a bus stop coming home from school at age 17. The guy took her to his apartment, got her drunk, sexually abused her and dropped her off in a.m. at the school bus stop where she was picked up by the police. He was never found.
5) After high school, she became an exotic dancer and worked at that for 20 years to make money to raise her kids. She has not picked good partners. She has no savings.
Her dream as an 18 year-old was to become an artist. She still draws a bit.
I listened in amazement as this story unfolded. How can one address all of this in a dermatologic appointment? One can only honor the story by listening. I am sure there is much more for her to relate. There is always hope, but assisting this woman seems a herculean task.
