"Why did you come to the clinic today?" As the interpreter repeated the question in Russian, I admired the patient's hat. It was a White Sox Baseball cap. I'm not into baseball myself, but it warms my heart to see him adopting the local sports teams. I wondered if it was a Christmas gift from a new chicagoan friend.
"He has pain in his . . . uhhhhhh . . . in his . . . " the interpreter trailed off, stumped. English is her fourth language, and sometimes she struggles for the right word. My pen was poised over the chart, waiting. "Pain in his . . . ass!" she said triumphantly. "His ass." They looked at me expectantly.
I set my pen down. That wasn't going in the chart, not even in quotation marks. Was the pain in his buttocks? Perianal area? Rectum? Perineum? "Could you be more specific?" I asked.
Eventually, with some pointed questioning, I uncovered a story of what sounded like hemorrhoids.
I will not detail the digital rectal exam, but suffice it to say that positioning the patient was even more challenging than getting patient to disrobe for her complete physical. I did manage to confirm the diagnosis.
After explaining the cause and management of the problem, I and my attendings offered him some Anusol HC rectal suppositories from our cupboard and explained their use. As the interpreter passed on the information, I finished my notes, flipped the chart closed and stood up.
"He's wondering, should these be kept in the refrigerator?" the interpreter asked me.
"No. They don't need to be refrigerated."
A long conversation with the patient followed. "Can they go in the fridge?" she asked me again.
"They don't need to be refrigerated. They can be kept at room temperature," I repeated.
Further discussions in Russian ensued. I glanced at the clock on computer screen, eyeing the number of patients in our virtual waiting room. I was glad I hadn't asked about the hat; we couldn't have afforded the pleasantries. The patient's voice became urgent.
"He wants to keep them in the fridge." The interpreter was exasperated.
"Why?"
"His cupboards are very warm. He's worried the suppositories might melt, and then it would be too difficult to insert in his as-"
I cut her off before she could use that decidedly unmedical word again. "Alright. He can keep them in the fridge if he prefers."
As I followed them out to the waiting room, I thought how quirky and exhausting and oddly delightful the encounter had been, and how unremarkable the same visit would have been in a regular walk-in clinic.
