A 41-year-old male patient presents at the community walk-in clinic with complaints of severe elbow pain

by | Nov 21, 2024 | essay

 

A 41-year-old male patient presents at the community walk-in clinic with complaints of severe elbow pain radiating into the forearm. His 13-year-old daughter is serving as a translator because her father is unable to speak English and understands only a few words in English. The daughter explains that he has been taking Tylenol to manage pain, but the pain is getting worse and is keeping him from working. You ask the daughter to describe the type of work her father does, and you notice she is hesitant to respond, first checking with her father. He responds, and she translates that he works in construction. Based on the response and the apparent concern, you suspect that the patient may be an undocumented worker. Further conversation reveals that several members of the family are working with the same local construction company.

You suspect the pain reported as coming from the elbow and radiating down the forearm is caused by repetitive motions, perhaps indicating lateral epicondylitis. What can you do to confirm this diagnosis?
While performing the physical examination, you ask the patient, through his daughter, if he has reported this injury to his employer, because the injury is most likely work-related. The daughter responded without consulting her father that this is an old injury that happened before he started working at his current place of employment. You could tell that she was becoming more distressed. What is the most likely explanation for her concern?
Visual inspection reveals erythema around the affected area with no evidence of overlying skin lesions, scars, or deformities. What other assessments should you perform?
How is lateral epicondylitis treated?
When discussing possible treatment approaches, you notice that the patient is very worried and seems to suggest to his daughter that they should leave. The daughter begins trying to explain why they have to leave right away. What would you tell the patient and his daughter to help them feel comfortable staying for treatment?

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

Confirming the Diagnosis of Lateral Epicondylitis

To confirm the diagnosis of lateral epicondylitis, a physical examination should include:

  • Palpation: Tenderness over the lateral epicondyle, especially with resisted wrist extension.
  • Range of Motion: Assess wrist flexion, extension, radial, and ulnar deviation.
  • Resisted Tests: Perform resisted wrist extension and supination to elicit pain.

Addressing the Daughter’s Concern

The daughter’s distress may be due to several factors:

  • Fear of Immigration Consequences: Undocumented immigrants often fear deportation and may be reluctant to seek medical care due to concerns about their immigration status.
  • Language Barrier: The language barrier may be causing additional stress and anxiety for the daughter.
  • Financial Concerns: The patient may be worried about the cost of treatment, especially if he is uninsured.

Confirming the Diagnosis of Lateral Epicondylitis

To confirm the diagnosis of lateral epicondylitis, a physical examination should include:

  • Palpation: Tenderness over the lateral epicondyle, especially with resisted wrist extension.
  • Range of Motion: Assess wrist flexion, extension, radial, and ulnar deviation.
  • Resisted Tests: Perform resisted wrist extension and supination to elicit pain.

Addressing the Daughter’s Concern

The daughter’s distress may be due to several factors:

  • Fear of Immigration Consequences: Undocumented immigrants often fear deportation and may be reluctant to seek medical care due to concerns about their immigration status.
  • Language Barrier: The language barrier may be causing additional stress and anxiety for the daughter.
  • Financial Concerns: The patient may be worried about the cost of treatment, especially if he is uninsured.

Reassuring the Patient and Daughter

To alleviate their concerns, you should:

  • Empathize: Acknowledge their concerns and reassure them that their well-being is your priority.
  • Explain the Process: Clearly explain the steps involved in the evaluation and treatment process.
  • Address Immigration Concerns: If possible, discuss potential resources and programs that may be available to undocumented immigrants, such as community health centers or free clinics.
  • Offer Payment Options: Provide information about payment plans, insurance options, or financial assistance programs.

Treatment for Lateral Epicondylitis

Treatment for lateral epicondylitis often involves a combination of conservative measures:

  • Rest: Avoid activities that aggravate the condition.
  • Ice: Apply ice packs to the affected area for 15-20 minutes, several times a day.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter pain relievers like ibuprofen or naproxen can help reduce pain and inflammation.
  • Physical Therapy: A physical therapist can 1 provide specific exercises to strengthen the forearm muscles and improve flexibility.  
    1. samarpanphysioclinic.com
    samarpanphysioclinic.com
  • Bracing: A tennis elbow brace can help reduce stress on the tendon.
  • Corticosteroid Injections: In severe cases, a corticosteroid injection may be considered to reduce inflammation.

By understanding the patient’s concerns, providing clear communication, and offering appropriate treatment, you can help alleviate the patient’s pain and improve their quality of life.

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