The Patient Story: Unpacking Mrs.A’s Case
Part III of the Narrative Medicine Case Competition 2024 Recap
On the morning of the first day, the groups were introduced to Mrs. A, a 33-year-old woman who is fresh out of open-heart surgery and has been suffering from post-surgical acute pain; she is prescribed opioids for pain relief. On top of this, she is also a new mom and has an 11-month-old baby whom she is breastfeeding. Upon visiting her family doctor, it was discovered that she had a breast abscess needing antibiotic treatment. Mrs. A has left the clinic worried about her pain as the referral to a rehabilitation program is a 6-month waitlist. She has many concerns about her baby’s health as she continues to breastfeed while taking opioids.
Mrs. A surely has a lot going on! However, as the participants would discover the complexities of the case study don’t end there, this was just the tip of the iceberg for Mrs.A. During the first ideation phase of the event, the groups start to tackle the case study, trying to identify which problems they wanted to tackle.
With only five questions to ask about the case, the participants were curious about the location of the case, where they found that she was receiving her cardiac care at St. Paul’s Hospital. Her Family Doctor’s clinic is also located in the downtown Vancouver area. A few groups were also curious about her sociodemographic status, and they discovered that Mrs. A went to cosmetology school and opened up her salon two years ago. As she is recovering, the salon is temporarily closed, which causes her a lot of pressure with just having given birth and having surgery. This means that she has no significant source of income until she can handle going back to work again. Mrs. A is also Vietnamese.
Groups were curious about her support system, and who was helping her get through this difficult time. Mrs. A lives with her baby and her husband. After her recovery, her husband has been supporting the family a lot both financially and mentally. However, her husband is only able to take two weeks off from work until he would have to go back. This means that Mrs. A would be alone at home with her baby while she is still recovering.
She cannot afford to have a babysitter to help with the baby. She is still not able to carry her baby by herself as her sternal incision is still healing. Mrs. A also has a sister who checks up on her now and then, however, since she is across the country she is not able to physically help her. It was revealed that she was part of a postpartum group which was helpful for her postpartum anxiety, but due to the many limitations that her surgery is causing she has not been able to go for months.
Only one group asked about Mrs. A’s childhood history. They found out that she was raised by her mom and dad who immigrated from Vietnam. Her dad was a construction worker while her mom worked at a restaurant as a cook but passed away 10 years ago from a heart attack. Growing up, she witnessed her mom be a victim of domestic abuse by her father. After her mom passed, she visited her father once a year but did not keep in contact otherwise. Due to witnessing her dad abusing her mom, she had trauma from this growing up. However, she was never officially diagnosed with a mental illness.
Another rich finding was her experience with the healthcare system, which has not always been positive. Other than a couple of providers (i.e. nurses from the hospital) who have provided her phenomenal care, she does not have complete trust in the healthcare system. Most of the doctors that she has seen in the past have been dismissive about her pain and symptoms. Often she felt that her providers lacked empathy and overlooked the severity of her symptoms. Mrs. A also had perceived discrimination from her mom’s healthcare providers. She felt mistreated and prejudiced because of the lack of her mom’s English proficiency. The hospital had a lack of Vietnamese interpreters, therefore, Mrs. A always had to be with her mom for her appointments.
These were just some aspects of our case study. All of the teams focused on different aspects of the case study and knew different types of information. Every bit of information that the groups discovered was incorporated into their final projects. Everyone used their narrative medicine lenses and critically assessed how they could improve Mrs.A’s life and those around her. Participants acknowledged that every patient has a story and Mrs. A was definitely not an exception.
Read about the rest of the NMCC here.
– Andrea Enriquez (NMCC Chair)
