An Interesting Patient

By Jennifer R. Gastelum

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Jennifer R. Gastelum 

Jennifer Gastelum.png
 

Year in Medical School: 2nd 

Place of birth:
Long Beach, California

Where you grew up:
Southern California (Imperial Valley and San Diego mostly) 

College: UCLA

Major(s) in College:
Physiological Science and Women's Studies
 

Goals (medical school and beyond): 
I plan to serve the underserved and help improve the access and quality of medical care for everyone. 

Personal Philosophy on life and/or medicine: One day I hope to look back on my life and say that I improved the world for the better; no matter how small or big that impact was. 

Favorite Quote: Never forget your roots and be very proud of them. - My mentor, Dr. Calles

 
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I saw a 20 year old Latino male patient on my second rotation in my community practice experience course. He came to the clinic with his Mom (who didn't speak English) and his little brother (might have been his nephew.) The patient spoke English.

He was being seen for some suprapubic discomfort that has lasted about 3 years. The pain comes and goes and felt like a knot in his abdomen. Nothing made it better and sitting in certain positions made it worse. He had seen doctors before for this with no explanation as to what was wrong.  However, it had gotten worse recently and he was getting really concerned that something may be wrong. He had no other signs or symptoms. The doctor did the physical exam and thought the pain could be attributed to cystitis (inflammation of the bladder) that may be caused by eating acidic foods (which the patient denied) and decided to try a medication to relax his bladder and see him again for follow-up to see if there was any improvement.  If there were no improvement at the next visit then he would refer him to a radiologist for an ultrasound.  The patient wanted the referral now because he was really worried.

Before the doctor and I headed out of the exam room, the mom turned to her son and said "Les vas a decir o no?" (are you going to tell them or not?) and her son responded with "No." She then said "Si no les dices yo les voy a decir." (If you don't tell them, then I will.) Her son just looked down at the floor.

His mother turned to me and asked "Hablas espanol?" I told her I did and she started telling me with tears in her eyes that she thought her son needed to be seen by a psychologist because she just found out a couple of days ago that her son had been sexually abused when he was 14 years old back home (Mexico). Her son was looking down at the floor the entire time she was telling me this.  She went on to say as she tried to control her voice and fight back the urge to cry that her daughter told her about this abuse and that she felt that she had always known, but was never able to bring up with her son until a few days ago. She was worried about her son now because he was telling her that he feels "different." He had told her that he is really confused.  It turns out he has had girlfriends in the past, but is now confused as to who he likes. She wanted him to see a psychologist to talk to someone about what happened to him years ago and to help him figure out who he likes so that he isn't confused anymore. She did not care what he chose or decided on because she loved her son no matter what, but she just wanted him to get help to sort out through what happened to him. She felt really guilty at not being there for him and not finding out about what happened to him until years later.

I explained to the doctor what she had told me and he went on to ask the patient about his sexual history.  So far no sexual contact with men (only women), just experiencing feelings of confusion.

Bottom line... we told him we'd be happy to give him the referral to see a psychologist.

After the doctor and I stepped out of the room I asked if I could go back to talk to the family a little bit more because I can understand what they're going through, so I went back.

I wanted them to know that they weren't alone and that there are many Latino families that are experiencing having a family member who is LGBT. I told them I knew exactly what they were going through because I have a sister who is lesbian.

I wanted the patient to understand that what happened to him did not "make" him gay, and that if he later learns that he is attracted to men OR women OR both, that it is not caused by his abuse and that it does not make him any less of a man for liking men (if that's what he later finds out). The mom was completely supportive and apparently his brothers and sisters are aware that he is feeling confused. It seems as though his family overall is very supportive, which makes him very lucky. After discussing everything, the patient seemed more relaxed that this was brought up and brought out to the open, even though this is going to be an ongoing issue.

It made me very happy to see this case. I sympathize with the patient for what he went through when he was younger, but I am so happy to see that there are supportive families and especially supportive parents out there.   It makes me very proud to see this in another Latino family.

As a doctor in training I think it is important to develop a level of comfort when dealing with extremely sensitive subjects like sexual abuse, sexual orientation, and domestic violence.  I know that all doctors will be confronted with these issues at some point in their career. Although one might never become completely comfortable to discuss these issues openly with a patient, perhaps the best support that we can provide for them is an open mind and a sympathetic ear.

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Last Updated: 01-13-2011
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