María's Burden

María is sick of the crisis. Literally. Neurologically.

Last Wednesday a middle aged woman — I’ll call her María — came to the Neurosurgery consultation I’m rotating through. Me and my fellow pasante buddy called her up, she looked like any other patient: short black hair in a ponytail, thick glasses, and a face that screamed for help.  We brought her in and our superior resident doctor started examining her.

María is 54 years old but looks at least 15 years older. She seems sad, overwhelmed. She told us she’d been having a terrible neck ache that extended throughout her arms for about 6 months, more recently an annoying tickling had appeared in her arms.

Checking the scans she brought in, we noticed something odd: they were perfectly fine.

It wasn’t her first time in the consultation, a few months ago she’d visited the same little, poorly lit, yet oddly comfortable examination room. That first time the doctor thought her pain might be due to some degenerative process in her spine, maybe even a hernia (uncommon at neck level but still possible.) Since further tests were needed, Maria was ordered to take a MRI and come back with it last week.

Checking the scans she brought in, we noticed something odd: they were perfectly fine. María had no hernia, her vertebrae looked strong and healthy. There was no evidence of any damage. Still there she was, about to cry from pain.

We explained her what we saw, that she seemed to be fine or that in any case, she didn’t seem to have any surgical problem, so there wasn’t much we could actually do for her. It was weird. She was as happy for not having to get into the operation room as she was sad for not getting an answer to her problems. But then something happened.

“Can you give me a report about today’s visit, doc? My boss is extremely suspicious, he has an eye on me,” she said.

Anamnesis is defined as the process of gaining information about a patient by asking specific questions: the key to getting the right diagnosis. It’s part of our training, so we turned our questioning to the subject of her work.

Every day, she deals with the usual problems facing at-risk Venezuelan youth: from universal violence to sky-high drop-out rates.

It turns out María is a teacher. She’s been working for about 30 years for the education ministry and she was currently laboring in a “high tension zone”. She was in charge of a high school located right in the middle of a colectivo-controlled area.

The work is horrible, she confessed. Every day, she deals with the usual problems facing at-risk Venezuelan youth: from universal violence to sky-high drop-out rates. Add to that a thoroughly politicized chavista boss who constantly monitors her work to make sure it fits “revolutionary standards”.

That comes down to turning up to every event called by local PSUV leaders. Refusing to do so means getting fired and losing access to the already scarce food she can afford with her meager salary.

According to María, his boss knows she’s not fully signed up to this type of “revolutionary activity,” so he constantly loads her with bureaucratic responsibilities. He’s extra vigilant to make sure she wears red and screams mottos she doesn’t believe in whenever Aristóbulo, Diosdado, Nicolás or even some random GPP diputado decides to show his face. Although she believes her boss can’t afford to fire someone as experienced as her, she can’t afford to take the risk.

Maria tells us a recent change in her contract status now forces her to work an additional six years before retirement. She’d been planning to retire next year, now it’s more like 2023.

And then it dawned on us: it isn’t a hernia causing her symptoms, it’s the insane amount of stress she’s under. María is depressed and on the verge of reaching her very personal llegadero.

We referred María to psychiatry, since her problems seem to be more related to the suffocating environment she’s immersed in than anything else. She should be coming back soon though, since we also asked her to get a new date to let us know if there’s been any improvement.

I see all kinds of sadness at the hospital every single day, but María’s story stayed with me somehow. Reality hits us harder every time, and it hurts each of us in our own particular way.

Juan Carlos Gabaldón

Medical doctor from Merida, currently studying Medical Parasitology at the London School of Hygiene and Tropical Medicine