During one of my rotations, my patient was a 40-something year old lady with leukemia who was admitted for her chemotherapy. In one of her urine samples we found Trichomonas vaginalis, which is a sexually-transmitted infection (infects the vaginal tract but can come out in urine sometimes). I had to sit down with her and ask about her sexual history.
Are you currently sexually active? No. When was the last time you had intercourse? 2 months ago. She smiles shyly. How many partners do you have or have had in the past? She laughs a little to ease the awkwardness. Just one, my husband. How long have you been together? 25 years.
I pause and take a deep breath.
The reason I ask these questions is because we found an infection in your urine, and it’s an infection that you get from sex. … Oh my God! … There was a half-second delay in her response as it clicks in her brain that her husband must have cheated on her.
I expect her to break down and cry hysterically, but thankfully she keeps calm. I try my best to express sympathy but I need to continue with my explanations.
I’m sorry. (About what? I don’t know, everything that is happening to her, from her leukemia to her husband’s infidelity.) The good news is that with antibiotics, there is 90-something percent chance of getting rid of the infection, and we’ll give it to you today. Side effects can be some headache or nausea, but most people don’t have any problems. Also, after you take this medicine, you shouldn’t drink alcohol for a while because it will make you feel sick. I know you don’t drink alcohol and won’t be drinking while you’re in the hospital for your chemotherapy, but I need to tell you these things. She nods as I finish the “good news” and get ready for the part that is a bit more challenging.
But we need your husband to get treated with antibiotics. Since he is not our patient we can’t give him the medicine. You need to tell your husband about this and tell him to go see a doctor to get treated. Okay.
Awkward pause. I am still waiting for her to start crying, or to flip out. She doesn’t.
Do you have any questions? She probably has no questions but might need to talk some stuff out. Or is there anything you want to talk about? She shakes her head no. I give a small sigh. I’m sorry about all this. Let us know if you come up with questions or need anything else from us. We put in the orders for your antibiotics so the nurse will bring it to you later. Okay. Thank you, doctor. I keep telling her I’m a medical student but she keeps calling me doctor.
I hang up the interpreter phone we’ve been using for this conversation. I wish I knew how to speak Spanish.