1) Joe is a 48 year old insurance salesman who presents to you with a chief complaint of impotence. He doesn't want anyone to find out, because he has an image to maintain. He is gray haired and has an anxious frown on his face. He was an athlete (football, golf) in his teens and 20's, and could eat anything he wanted. For years he played golf in the afternoons, but now he goes home from work and sits in his recliner feeling exhausted. He likes to snack frequently because he fills up too fast if he sits down for real meals. He is overweight. He says his belly is gassy and bloated, and that he is mostly constipated but has bouts of diarrhea. In his early 40's was diagnosed with type 2 diabetes. He doesn't want to inject insulin. He knows he's supposed to stay away from sugar but there is still candy hidden in his desk. Lately his sexual function is declining, and he's panicked about it. He isn't in a relationship, but has several girls that he sometimes sees. He sleeps on his right side, facing the wall.
2) Malea is a 32 year old woman who is pregnant with her second child. She presents to your office wearing a dark hijab and the flowing robes of Muslim dress. All you can see of her is her eyes, which are blue and brimming with tears. Her eyelids are puffy with swelling, and there is a faint mist of sweat across her nose. When you reach out to shake her hand, she steps past you and sits down. She sits very erect in her chair with her knees together and a slight forward lean. Her chief complaint is back pain which radiates down her legs. She is also worried about her next birth, as the first one was long and difficult. When someone outside slams a car door, she starts. It turns out that she is American but she married a Palestinian because she likes the morals and structure of Islam. She willingly adopted the hijab, and looks down on American women who wear revealing clothing.
3) Fred is a 64 year old man who works as manager in a local small business. He has worked there since 1988, and has no intention of retiring anytime soon. He is highly organized at work, and his desk is always clear except for what he is working on. He thinks the business will fail without him. He is offended that the owner wants to cut his hours, and irritated at his wife for agreeing with his boss. He complains of back pain which he treats with a hot water bottle. He also has an abdominal pain localized to the right ribline. He likes to go out to the bars when he leaves work, and when he was younger he liked a good bar fight. He would take offense at something somebody said, and get in their face. Now he goes home to his wife after having a few. He says they have a good love life. She can vouch that it's not safe to talk to him in the morning until after he has his first cup of coffee. He is generally constipated, and coffee helps him go. He drinks at least a pot a day. He is irritable, and sleeps poorly. If he can get to sleep, he wakes up at 3am thinking about work, or feeling a spasm in his back.
4) Alice is a 19 year old female presenting because she is sure she is about to die. She is very lean, and looks tired. She sits beside your desk and begins fiddling with the pen holder cup. When she is done, everything on her side of the desk is aligned perfectly parallel with the edges, and spaced exactly. She attempted suicide once last year, and you can see deep longitudinal scars on her wrists. You ask her about them, and she says the scars still feel strangely hot sometimes. She lives with her parents, but they are ready to put her in a home, and she is in a panic. She cannot sit still. She gets up and wanders around the room while you try to get her to talk. She gets a cup of tea and takes tiny sips of it, but she doesn't like the fruity flavor. Her favorite drink is a hot toddy with scotch and lemon but no honey. She says that she wakes up at midnight with her heart pounding, worrying about where she is going to live when her parents kick her out. She is afraid she may end up a bag lady.
5) Gunther is a 93 year old Austrian man with arthritis. He hates the rain and damp here, it makes his arthritis worse. He is so stiff he can barely get up in the morning, and it makes him cranky. Sometimes he sweats in his bed, and has to get up in the middle of the night to put on dry pajamas. He misses the Alps, the snow and the cold clear air. He is lean, almost gaunt, and he has some swollen glands in his neck though he doesn't feel sick. His last wife used to cook bacon and eggs for him every morning, but now that she is gone he doesn't eat as much. He would like to find another wife, one that doesn't have any cats. His chief complaint is tooth pain, and when you take a look his teeth are worn down as if he grinds them at night. He probably has some cavities in there too. He has a rash on his legs that has been there for the last decade, and nobody has been able to make it go away. He was always stubborn anyway, and never really satisfied with anything.
6) Mark is a 56 year old man who has spent much of his life in therapy. His handshake is warm, and he asks how you are and comments on the gorgeous flowers outside. You know from prior visits that his parents were alcoholics, and his mother had diabetes and died horribly because she would not stop drinking or take care of herself. His father ended up institutionalized in a madhouse, so Mark was on his own from his teens onward. He was never sick as a child, but now he has various aches and worries which change from visit to visit. He is a regular in your office, a very nice man with a very nice wife and children. Mark returns today because he's been suffering from insomnia, and can be quite irritable and discontent. He feels terrible after he snaps at someone. He feels better if he can express his passions in his paintings, which are rich with emotion. When he paints, or travels, he doesn't bite his nails as much.
2) kali carb
3) nux vomica