What Changed?

I knelt down in front of my patient and gently felt for a radial pulse. "Hello, what's your name?" After introductions I asked her what was going on that day. She said that she was having "severe fatigue."

In just that short amount of time it was painfully obvious that she had some psychiatric problems. Her father said that she wasn't really able to take care of herself but wasn't bad enough that she was on a conservatorship. He had given her a cell phone in case she got lost while walking around the city but now she used it to call 911. Dad didn't seem too happy about that.

Severe fatigue, not just tired. Fair enough. Also generic enough to have all sorts of causes. My next set of questions changed my thought process. I asked how long she had been experiencing this severe fatigue. She stared at me blankly. I asked again, this time giving her the choices of minutes, hours, days, weeks, months or years (don't know why I stopped there, I should have thrown decades in as well). She thought for a minute and then said that it had been going on for months.

At this point I'm starting to see where this is going but I persist. I asked what made her call today, after months of severe fatigue? What had changed to make her call? Her answer....she had severe fatigue. That was about as far as that conversation went.

At this point I decided to backtrack a little. I asked her if she knew where she was (trying to determine if she was altered or not). She rattled off her complete address, zip code included. I then asked her what day it was. She immediately opened her cell phone, check the date and day, and repeated them back to me. I looked at my engineer and we both laughed. If she's knows enough to check her phone for the day and date I think I'll let it slide. I could tell you those things without doing the exact same thing.

Finally the ambulance showed up. We walked her over to the gurney and sent her on her way. What do you want to bet that we'll be back?