The Case:Arturo Gonzalez: Attempted Suicide? Dr. Brown

The Case:Arturo Gonzalez: Attempted Suicide? Dr. Brown walked into the doctors’ lounge at Blueville Hospital, rubbed his temples, and groaned. He knew that he would spend a good portion of this Sunday night waiting for the social worker. The boy, Arturo Gonzalez, would make it, but until the social worker got there, no one could really communicate well enough to figure out what happened, or why. Arturo spoke English, but he was in no shape to talk. His mother, Maria Gonzalez, spoke mostly Spanish, so the social worker would have to get the story from her. Dr. Brown was not sure how the conversation would go, though. Mrs. Gonzalez, normally a small and quiet woman, was totally out of control today: screaming, crying, trembling, and flailing about violently. The emergency room staff had admitted her when she fainted, then they called him. He wished that Dr. Rivera was back, but she would not return until the following morning. Dr. Rivera normally treated the Gonzalez family, but Dr. Brown had seen them in the office last week while she was visiting family in Puerto Rico. The irony of Arturo’s attempted suicide was that he took a handful of Amitriptyline, the very prescription that Dr. Brown had recently renewed to combat the boy’s depression and anxiety. Dr. Brown thought back to his review of Dr. Rivera’s notes, where he had learned that Arturo felt depressed and anxious about school. It seemed like usual “14-year-old stuff” to Dr. Brown: Arturo was overweight and Mexican, so therefore different, and the other kids teased and bullied him. Dr. Brown thought that the kid just needed to exercise more and to learn to stand up for himself, but Dr. Rivera had prescribed the Amitriptyline (as a less expensive alternative to Sertraline since Mrs. Gonzales was currently out of work), and Dr. Brown was not about to stop or change the treatment without consulting her. There was another issue too. When Dr. Brown asked Arturo if he was seeing a counselor, Arturo replied angrily, “I went a few times, but I hated it, so I stopped going.” At the end of the session, Dr. Brown told Mrs. Gonzalez that he wanted to speak with Arturo alone for a few minutes. Dr. Brown told Arturo that counseling was important and asked why he stopped going. Arturo stared sullenly at him then replied, “The counselor thought we should talk about my sexual orientation.” He used his fingers to make quotation marks as he said “sexual orientation.” Arturo continued, very angrily, “She was so judgmental about me liking other guys. It’s none of her business!” Dr. Brown started to follow up with a , but Arturo exploded, “It’s not your business either,” then abruptly got up and left the office. Dr. Brown knew that Arturo had neglected to take his medication for some days. From what Dr. Brown could understand from his conversation with Mrs. Gonzalez (Arturo, not surprisingly, was not very cooperative in helping his mother and the doctor understand each other), she would have Arturo take two or three pills at a time when she discovered that he’d missed a dose. That’s what made Dr. Brown nervous. Did Arturo really attempt suicide, or did his mother think that he was supposed to take a handful of pills all at once? Dr. Brown was sure that he’d explained the dosing clearly – one a day, every day, in the morning. He may even have jotted it down on a note pad for her, but he could not remember. Now it seemed silly to even think about it; why did he think that she could read English better than she could speak it? But it made him very nervous. He’d seen that “ER” episode in which a patient ended up in the hospital because of the doctor’s written instruction, “once a day.” In Spanish, “once” means “11.” Dr. Brown sipped his coffee and reassured himself, “But that’s just TV.” His worried brain retorted, “Is it really?” 1. How do you feel about the situation? What is your attitude toward Arturo Gonzalez and Dr. Brown? 2. What troubles you the most? What are the major issues that Arturo Gonzalez and his family must deal with in this situation? What are the major issues that Dr. Brown must deal with? How are Arturo Gonzalez’s medical issues clouded by cultural misunderstanding or miscommunication? 3. Would you have approached the initial medical encounter differently than Dr. Brown did? If so, how? 4.What is the patient’s perspective? How might Arturo Gonzalez and his mother feel about the care that they received from Dr. Brown? SCIENCE HEALTH SCIENCE NURSING NURS 450

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