In my last post I mentioned that med school has taken me out of my comfort zone more than I ever have been before. I realized today that it is clearly doing the same for my classmates.
Example. One of the people in my interview group (for the sake of anonymity, lets make this person a girl named Prudence) was just totally blown away today. Prudence, you see, is a very christian, conservative girl who enjoys sex with her monogamous boyfriend of a couple years. She almost always uses condoms. She drinks at parties, but nothing too serious. This, by the way, is the box that I'm putting her in. It might not be entirely fair, but from what I can tell it's a pretty accurate representation. My point is that in her own little world, she's basically doing everything right, and things are good.
So. We were at the local public health clinic today doing the high risk interview (see the post below). Prudence and I had two patients- she interviewed the first, and I did the second. Her patient was a man who drinks 6 days a week, snorts coke 2-3 times a week, and has had over 100 male sexual partners in the last 3 months. He's HIV+, Hep C+, and who knows what else. My patient was a female sex worker who 3 months ago finally managed to kick her heroin habit, thanks to daily cocktails of methodone. She'll have sex with anything that pays, in any way, shape, or form. She's been running her practice out of her house since she was 15. It costs more if her client doesn't want to use a condom (which surprisingly, most are willing to use). She also has a routine partner who also turns tricks (he, by the way, does not identify himself as gay... but the price is right as a male prostitute). They don't use protection when they sleep together.
These people, by the way, keep quite the company. Though today was a relatively quiet day, there is normally a 2 hour wait to be seen- and the people in the waiting room run the gamut from wealthy doctors to rural farmers to 13-year old girls coming with questions about their 27-year old boyfriends.
It was interesting to see just how sheltered Prudence really was. She barely realized that people catch STDs from oral sex, thinks that Bush's abstinence only education policy is working just great (let them know that God hates premarital sex and it'll work, right?), didn't know that people get their genitalia peirced, or that people in monogamous relationships will sometimes have routine partners on the side. The list goes on and on. The social workers were so down-to-earth and matter-of-fact about all of this stuff... and with every new fact, her eyes opened a bit wider. It was amazing to see.
And this is not to say that I wasn't surprised too. I think my jaw probably dropped when Julie (my patient) told me right off the bat that she had been a sex worker for the last 30 years. But I'm familiar with the knowledge that these things happen. Prudence... well, Prudence had a very novel experience. Reality just invaded her personal space in a very real, very "I-have-Hep-C-and-you're-sitting-2-feet-from-me" type way.
There will be a lot of other things like this for me in the future. I'll learn about diabetes and know that the treatment is tight regulation of insulin and careful monitoring of blood sugar levels. Then I'll run into a patient who is a noncompliant diabetic (because diabetes doesn't HURT... so you're less likely to care for it) and doesn't take care of their disease. And it will shake me out of my perfect world where everyone is treated, is healthy, and behaves like they're supposed to. I guess I'm kind of excited to see the real world clash with my expectations of how it should be.
By the way, something is wrong in a state where prostitutes are arrested by police if they have 5 or more condoms on them at a time. If they have 5, they are considered to be "actively hooking" and are taken in. It's ok for them to be walking around without any condoms at all, spreading HIV and who knows what else... but god forbid they have condoms with them. Treat the symptom, not the problem. I think we do that way too often in America. We'll cover a quadruple heart bypass through insurance... but not a visit to the dietician beforehand. Pregnancy... but not contraception. We're too reactive.