Patient File 230988: Aquella Lewis
New patient Aquella Lewis presented with complaint of localized pain in lower right leg. Bruising evident, approx. 4.5 cm. Patient indicated she “fell off bench at beach.” Inquired about trip to beach, as nearest is approx. 241 km away, and environmental impact regulations allow only two visits to High Environment Impact Regions annually. Patient said she “needed to get away,” and that the beach was “the only place she felt herself.” Confirmed this was her first trip this year. Palpitated bruising with soft articulated manipulator. Patient winced.
Diagnosis: moderate bruising. Prescribed ice, NSAIDS. Reminded patient of one beach trip left this annum.
Patient presented with complaint of irritation and discharge of right eye, onset 4 days prior. Patient believed it was due to smoke from fires in western hemisphere. Reminded patient that dome filters 96% of pollutants. Patient noticeably turned eyes upward and crossed arms. Body language suggested disagreement. Scanned eye with retina diagnostic laser. No evidence of irritant-induced inflammation.
Diagnosis: conjunctivitis. Prescribed moxifloxacin eye ointment.
Offered patient brochure: “Dome Safety and ULPA Filtration;” accepted.
Patient presented with complaint of hearing difficulty, left ear. Onset two days prior. Patient described sounds of “crackling” and “fluttering.” Fitted eye with laser otoscope for examination. Patient expressed distress. Upon questioning, patient admitted fitting of otoscope onto eye distressed her. Assured her this was normal practice. Patient submitted to exam. Discovered beetle (3 mm), inner ear. Fitted firm articulated manipulator with tweezers; removed beetle.
Asked if patient had taken her second trip to a High Environment Impact Region, as opportunities for authentic human-insect interaction are scarce in dome. Patient looked down and away, speech paused noticeably (rated 4 on Stegman’s Dishonesty Scale). Patient indicated beetle entered ear during sleep, as patient had not traveled since last visit to beach. Did not press further.
Diagnosis: foreign object in ear. Prescribed otic drops.
Offered patient brochure: “Robotic Nurse Practitioners and You;” declined.
Patient presented with complaint of nasal and throat irritation, insisting due to smoke from fires (western hemisphere fires are noted to be extreme this year). Informed patient that while there is some indication ULPA filters are not as efficient with current particulate levels, they are removing 89% of pollutants. Patient vocally disagreed. Patient refused examination. Reminded her non-compliance with robotic nurse practitioners is considered a level 1 transgression within the Confederated Health System of the Alliance of Western Remaining Countries, with loss of travel privileges most common outcome. Patient allowed examination, revealing mildly irritated nasal and throat passages.
Patient asked if she could see “a real doctor.” Further questioning revealed her desire to see a human doctor. Reminded patient of Standard Ladder of Escalating Care, requiring human care only at Step 3 or higher, given both rates of infectious disease and dearth of human medical providers.
Offered brochure; declined.
Patient presented with complaint of pain, blisters, and swelling of her lower legs. 65% of lower legs show second degree solar burns, approx. two days post sun-exposure. Patient indicated she sustained burns in garden. Reminded patient that dome blocks 90% of UVA/UVB rays; such burns are not possible in dome. Upon further questioning, patient admitted traveling to beach again, though insisted she utilized SPF 85 sunblock. Informed patient that level of burn suggests otherwise.
Patient began crying and was unable to communicate for 2-3 minutes. During this time, I articulated appropriate burn care steps. Patient asked what level her injury was on “care ladder” [note: referring to “Standard Ladder of Escalating Care”]. Told patient this was Step 2: “moderate injury or illness, likely to resolve with appropriate robotic nurse practitioner care, and/or prescribed medications/supplies; likely requires follow up visits.”
Reminded patient she has now consumed her two High Environment Impact visits per annum. She stopped crying and indicated she received a High Environment Impact Forest Preserve pass for this year (provided to each resident once every three years). Informed patient rationing her exposure to natural landscapes is wise, given such exposure preserves her mental wellness and gives her something to look forward to, an important meta-cognitive process for humans.
Prescribed silver sulfdiazine cream, and Noro 5/325 mg for pain, with return in three days for re-assessment.
Patient returned for re-assessment of burns. Patient arrived 27 minutes late and presented clearly in pain and unable to ambulate efficiently. Burn site was inflamed and purulent; used olfactory sensory device to determine there was a smell of sulfur. Skin was torn and damaged in places. Does not appear patient used prescribed cream. Patient was visibly struggling to keep composure; inquired as to her use of antibiotic cream and analgesics. Patient insisted she had used both, though, per Stegman’s Dishonesty Scale (rating 7: “showing faux surprise with animations of remorse and worry”), that is highly unlikely. Patient had a body temperature of 39 C (approximately 102 F).
During assessment of burns, patient asked if this was “Step 3.”
Upon lengthy questioning, patient revealed she had deliberately caused burns and neglected their care to advance to Step 3.
Questioned patient about deliberate self-harm; indicated given disregard for self, recommendation for revocation of High Environment Impact Forest Preserve pass is possible. Patient said, “everything is burned anyway.” Informed her that while the fires in the western hemisphere exceeded typical annual estimations, they would be contained and abated, and some forest preserve saved. Indicated that there would be something for her to visit, should she maintain the requirements for her pass. While fires this year are statistical outliers, threatening much of the forest preserve, hope is an important cognitive element for humans.
Patient cried but nodded agreement. Completed Visual Assessment for Mental Health; patient scored 7 (likely in need of immediate mental health care).
Completed form 33N1, “Escalation of Patient Care for Mental Health Reasons.” Declined form 72-E, “Revocation of Travel Privileges for Medical Reasons,” as humans are goal-oriented and patient’s next caregiver may require such a goal for successful care.
Left patient in secured room.