[This poem was written by Duncan Maru, co-founder and President of Nyaya Health.]
You have come to me for a busted toe,
an accident, you say.
Dressed in your loose black shirt
with a large Christian cross on it,
grey sagging sweat pants.
Your face, round, youthful, inquisitive,
You speak respectfully, calmly.
I could be lulled into thinking
that the busted toe is all that ails you.
But then you rattle off your medication list
like state capitols.
This awakes me from my
“musculoskeletal chief complaint”
slumber where most problems resolve.
I now see in your chart where you have been,
raped, hit, punched, kicked, abandoned.
Etiology of your condition is not “mechanical trauma”
While you were suffering a lifetime of abuse,
I was in medical school
learning about tendons
and now here’s your lifetime of chronic diseases:
Metformin, amlodipine: for adult-type diabetes and hypertension
Risperidone: for psychosis
Celexa: for depression
Trazodone: for sleep
Truvada: for prophylaxis against a deadly virus since you were raped
again, this month.
How I wish I could prescribe better laws, better communities,
better protections, better families.
But back to the purpose of our 15-minute visit:
you stubbed your toe.
I don’t think it is broken but owing to clinical prediction rules
and perhaps my own cognitive and emotional needs
you need an X-Ray.
So I order that, and give you the usual advice for
mild musculoskeletal injuries.
You smile graciously and move on.
Duncan Maru, MD, PhD is a co-founder and President of Nyaya Health. He is currently a resident in the Internal Medicine – Pediatrics program and fellow in Global Health Equity at Brigham and Women’s Hospital and Children’s Hospital of Boston.