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Am Fam Physician. 2022;106(4):458

Author disclosure: No relevant financial relationships.

8:30 a.m.

On today's schedule, I have a follow-up visit with an Afghan woman who recently arrived in the United States. She has an anxiety disorder and dyspepsia. Because we are unable to get a Pashto-speaking interpreter, her husband translates. He is a professional interpreter for the U.S. Embassy, and it shows. Nevertheless, I feel uneasy discussing mental health issues with him interpreting, so I focus on her dyspepsia and refer her to our integrated behavioral health therapist.

9:10 a.m.

My next patient is a 26-year-old speech therapist who presented two weeks ago with a right facial droop and vertigo. At the initial visit, I diagnosed her with Bell palsy with vestibular neuritis. She explains that her facial droop has improved 50%, but she still feels dizzy. My eyebrows rise when she says she now has diplopia with left gaze. I explain to her that double vision is not part of Bell palsy, and I recommend she go to the ER. I give her my personal cell number and ask her to call me if the ER doctor wants to discuss her symptoms.

11:30 a.m.

I hear through the door, “Hi Honey! How have you been?” I recognize the voice immediately as that of Maria, a 78-year-old patient from El Salvador with hypothyroidism and mild dementia. She is gregarious and calls everyone “Honey.” I can't help but smile when I hear her voice. Her youngest son accompanies her to her appointments. He is soft-spoken and patiently explains everything to his mother. The medical assistant remarks, “When I get old, I want to be treated by my children like that!”

1:40 p.m.

I am in the respiratory clinic this afternoon and examine a 19-year-old with fever, cough, body aches, nausea, and vomiting. This patient is one of thousands detained at the Texas-Mexico border and then sent to Washington, D.C., on a bus that arrived last week. I perform a rapid COVID-19 test and a urine pregnancy test, both of which are positive. The patient knew she was pregnant, and she begins to cry. She left Guatemala to reunite with her husband in New York City, but she was raped by the men accompanying her. Her husband no longer wants her to come to meet him, and she doesn't know where she will go. I call the social services team for help.

2:20 p.m.

I receive a text message from the patient I sent to the ER earlier today: “I'm at the ER, and they want to discharge me.” I responded, “What did they say you have?” The patient texted, “Bell palsy.” I quickly tapped on my phone, “Did they do an MRI?” She responded, “They said they don't do emergency MRIs.” I then messaged, “Ask the doctor to explain what cranial nerves are involved, and if Bell's can cause all of your symptoms.”

5:10 p.m.

My phone vibrates in my pocket. It is a physician from the University Hospital. “Dr. Hayashi, I'm the attending in the ER. Thanks for sending us your patient. We had a very good in-service with the residents on cranial nerves. We did an MRI, and it looks like MS. The neurology team is with her, and she will most likely be admitted.”

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This series is coordinated by Jennifer Middleton, MD, assistant medical editor.

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