I'm sweating through my scrubs, standing next to Dr. Felix who is seated on a tiny round stool in a room the size of my bed in St. Louis. A 15-year old female is sitting on the "patient bed" (a table with a rug and a sheet they don't change between visits). I'm holding her chart--a stack of 5-by-7 note cards with scribbles on them. Dr. Felix, is going over her lab results, he notes the result of her pregnancy test(positive) and her hematocrit of 26 (divide it by 3 to get hemoglobin, a measure of the oxygen binding capacity of the blood) Her hemoglobin is close to 9. The healthy range is 12-14. The insides of her eyelids are pale instead of pink--another indication that she is iron deficient.
He looks up and says, "M pti femme, ou se enceint" (literally: my little lady, you are pregnant (but pti is a term of endearment)).
She bites her lower lip and I notice her chest rise and fall faster than before. She won't look at either of us.
I catch bits of her internal dialogue by watching her face.
She asks herself some questions and swallows the acid of lonely fear.
Dr. Felix stands to examine her abdomen when, a Haitian woman walks into the room (She didn't knock, she just moved the curtain aside and entered. This happens regularly during patient visits here)
"Doctor," she said, "give me a prescription for the inhaler for my mother"
Dr. Felix moves his eyebrows together and says, "I wrote it yesterday. You have to go to the pharmacy to purchase it."
"I did," she said, "I need another one."
He looks at her the way you look at a kid who did something naughty but funny. "What did you do with the inhaler you got for her yesterday."
"It's all done."
He exhales, "what???" and says, "What, did you do drink it? I said take 2-3 pushes anytime there is an attack. It should have lasted a long time." His eyes are laughing.
She looks at him blankly.
As he starts scribbling on a piece of paper, she says, "It wasn't enough. We used it and it's gone."
He does what all the haitian doctors I have observed do with illiterate or poorly educated patients. He pantomimes the administration of the medicine as he explains in simple language how to use it. Then he has her repeat what he had done. The first time, she can't. She says "Give some when you need it" and she didn't gesture at all.
He went through it again and she was able to reproduce it.
Then she walked out, "Meci Docte" (thank you doctor)
Meanwhile, the anemic, pregnant patient was laying on the table, sorting things out. Because it was such a contrast to his voice during the interruption, his tender tone with her struck me. He told her how he was going to prescribe her Iron, Folate, and Amoxicilin (she also had vaginitis which is common in Haitian women who come into the clinic).
She whispered meci, accepted the paper he handed her, and slipped out.
