I have a family I have been taking care of since 2001. They are from Iraq and I have seen them through so much. They were basically brand new refugees that came through Jordan when I first started seeing them. There are six in the family, including a child who was a newborn in 2001. The mother had *severe* PTSD, to the point of mental status changes and total incapacity. I had never seen real, acute post traumatic stress outside of psych rotations in med school and it was scary seeing it on my own. At my current practice, DSHS wasn't able to provide an interpreter and, although the community mental health system exists as a theoretical safety net, in practice it was just impossible to get her in. Multiple times, through the father and son who spoke a little English, I told them outright that they needed to get into a community health clinic, that I didn't think I had the resources I needed to treat them. I even called and made appointments, printed out information on refugee support services, but they kept coming back to me. For some reason, wisely or unwisely, they decided I was their best chance at getting help.
So I basically shot from the hip and did what I thought was best, started SSRIs and alpha blockers, treated insomnia, saw them frequently for longer visits and talked to them about their experiences. Treated the childhood illnesses, diagnosed an appy, helped the dad through a herniated disk, got the mother some surgery to repair a chronic eardrum rupture.
Now, slowly, over eight years, everyone is doing great. PTSD is totally in control on sertraline. Two of the kids are over 18 and lost medicaid coverage and so I've just been treating them on the side whenever I could for minor things. The mother who spoke no English and had a GAF of 20 eight years ago, now speaks near perfect English and seems totally normal to anyone she meets.
Every time I see them, their eyes brighten, they grab my hand warmly, and they are so grateful. This was a family I was so sad about having to say goodbye to after leaving this practice.
Today, my last day seeing patients here, they just came in for a scheduled visit. They are going back to Iraq for a visit for the first time and needed prescriptions refilled and a travel medicine consult.
The first thing they said to me when I walked in the room was "We heard you are leaving. We're coming with you. Tell us where you'll be and how we can go there." It turns out the father works at a barber shop not far from the community health center I'll be working at and it's actually totally convenient for them. Because they are listed as Arabic speakers in the DSHS system they will automatically have an interpreter show up for their visits (not that they need it anymore). They will get to see the mental health workers at the clinic. They will get much needed dental care for the first time. *And* I will get to see the two uninsured kids.
After the visit, they congratulated me profusely on the coming birth of my son and insisted on taking pictures of me to take back to Iraq to show the family there.
Wow. I swear to god, this is why I got into medicine.