Wide eyed, I graduate my pediatric residency and sign up for my first ‘big girl’ job in El Paso Texas. My employer reminds me “you are the first female pediatrician for the clinic – we have never had a pediatrician before”. I am told parents would bring their kiddos for “Bread and butter pediatrics” – Wait what? This included – ear infections, sore throat, lice (yes lots of lice seen royally weaving their way in and out of their hair) and so on. Walked in to a full clinic of ‘walk-ins’ waiting for me on Day 1. Deep breath! I can do this. Remember “Its Bread and Butter”.
Here we go. First patient with poor appetite and not gaining weight referred by a Physician Assistant. Weight so low that it cannot be plotted on the growth chart. Parent speaking rapidly in Spanish that I am unable to comprehend. Using an interpreter, I diagnose failure to thrive, detailed history of feeding, order labs and therapies but the mom is worried about the “COUGH” and that she got a dose of ampicillina in Mexico. I scream in my head “Nooo” – Priorities! Priorities! Takes about 45 minutes. 10 more patients walk in. Second patient 10 year old boy for a sports physical. Almost at the end of the exam – “I need to check your private parts” Kid goes into a hysterical cry “No no no” They never did that to me ever. Where was your previous sports physical? In Juarez – Mexico. After 15 minutes of explaining I find undescended testes in a 10 year old!? Ultrasound ordered and moving on to the third patient “I have something to show you” Takes a plastic box and asks me to open. Excitedly open ( skipping like a little girl in the hallway in my mind – are those colorful beads from Juarez) boom there is a round worm which the parent states came out of the toddler’s butt hole. This is a joke right!? Nope, move on moving on after prescribing anti-parasite medicines. Next patient needs a referral to a specialist in Austin to get a jaw surgery so he can speak. He is 6 years old with absolutely no speech and unbelievable temper tantrums. Mom says he is “chiple” which my interpreter translates to “spoiled brat”. He cries and bites and hits mom while taking vital signs holding on to 6 cars. They are all of the same kind with 2 blacks, 2 blues and 2 reds. Interesting! I know where this is going but does the mom know? He hardly calms down when he enters my room, throws himself on the floor and starts arranging the cars. He is a new patient “just for referral” mom states. More history, more questions, have you heard of autism, no he is lazy, he does not want to talk. No – it is autism, more questions, therapies, introducing autism to a mom who has never been to school. Mom is crying, I shed a few tears wishing she had received help earlier. But it is NEVER too late. How was this missed? They have been in Juarez for the last 3 years only seen a doctor if he falls sick. Where is my “Bread and Butter” that I was promised? Next patient with “blood in stools or hematochezia to make me sound smart”. More questioning it is just red stools but no blood. On examination, I find red stain on the finger tips. He has been eating takis – spicy hot chips very popular in El Paso, spicier than Red hot flaming Cheetos. So he has takichezia. Next patient with “refill on purple pill”. He says he cannot eat chile and hot sauce anymore. Well, you should not be eating those anyway I smile at him. He looks at me sheepishly, how about I take the pill when I want to eat chile? Extensive review of records show me that it is “THE NEXIUM”. More dietary counselling. I tell myself – “It is still my first day and I have survived so far but that is a lot of interesting pathology in this border town.” Next patient I am told is a “difficult patient”. I am already running behind on patients. 13 year old with multiple complaints, pains, dizziness, you name it she has it. I ask the parent to step out and speak to her. Mother insists that she knows everything going with the patient and they have a great relationship and she needs CT scan for her head ache. I speak to the child alone and she says she has attempted suicide a couple of times. Does your mom know? She says she is afraid to say anything. This is more pediatric psychiatry today and not Bread and butter I chuckle. More time spent about suicide risk and talking to mom. My son is “muy flaquito” but he is at 89 th percentile for weight which means he is overweight. More patients and it is almost time to go home when I realize it is 730 pm and it is still sunny. Days go by and it has been several months that I have been in the sun city and catching up on Spanish and trying out Chico’s Tacos when I see the autistic spectrum disorder patient again after several missed follow ups.. I wonder if she will have more questions or if she even went for therapy. She hugs me so tight that I can hardly breathe. She tells me - I have been a mother for a while but you made me a “mommy” today! Her son said his first word after 5 years – “mommy”. I don’t need Bread and Butter. I love my patients on the border!!