CASE STUDY EXAMPLES
CASE G: DIABETES MELLITUS
G is 20 and was recently diagnosed with diabetes following a severe period of dehydration which he mentioned to one of his cousins, who happened to be a nurse. She gave him a book on diabetes management and referred him to an experienced endocrinologist. At first, G is overwhelmed with the implications of his diagnosis. He needs to monitor his sugar levels weekly, sometimes daily, adapt his diet, and exercise regularly. As a college student, G fears his change in lifestyle will drive his friends away. His physician helps him prioritize his goals: tracking his nutritional intake, then learning to cook, and finally, developing an exercise routine. He also introduces G to support groups for people living with diabetes. G is frustrated with the costs associated with his condition: living in a non-Medicaid expansion state, he needs insurance coverage for test strips or insulin pumps, which would make his daily life easier.
CASE H: CHRONIC KIDNEY DISEASE (CKD)
H is 14 years old and is a member of his high school’s track and field team. He has been feeling weak and drowsy for a few weeks. One day, he vomits and experiences blurry vision. His mother takes him to their family doctor, who suspects a stomach bug and prescribes treatment for it. As H’s symptoms do not improve, his mother asks her friends for advice. One of her friends’ brothers, a nephrologist, suspects kidney disease. He sees H in consultation and confirms early signs of kidney failure, which he then treats and stabilizes. Recurrent swelling and symptoms of uremia (nausea, dizziness, blurry vision) lead H to be referred to the intensive care unit of the children’s hospital, where he stays for over a month for twice-weekly hemodialysis. He also attends training sessions to learn how to manage his chronic kidney disease. Afterwards, H returns to school where he struggles to catch up and laments his inability to attend track and field competitions, which are not compatible with the daily peritoneal dialysis prescribed by his physician. However, supported by friends, family, and healthcare workers, H is proud of his healing progress and remains optimistic.
CASE N: SUBSTANCE USE DISORDER
N is 30 years old and lives in New York City. She was born into a privileged and wealthy family: she lives in a spacious apartment that belongs to her family and has a part-time job at her dad’s firm. N has an assistant that handles her schedule. She is very impressionable and usually does what her friends do or tell her to do. Like many of her friends, N has a substance use disorder (alcohol and cocaine). She was arrested for driving under the influence and went to rehab twice following court orders. She relapsed after both times in rehab. She considered signing up for a health education program, but her best friend quickly talked her out of it, arguing, “There’s nothing wrong with having a little fun”.
CASE O: STRUCTURAL RACISM
O is a 40-year-old woman from a Native American tribe. For a few years now, a growing lump in her stomach has been bothering her. A physician at her local Indian Health Services (IHS) clinic diagnoses a hernia that requires surgery. O is referred to a private hospital outside of the IHS network and IHS paid for part of the costs. O undergoes surgery, but when she tried to schedule her follow up appointments they were denied. O goes to people in her community to get help and try to understand what the problem with her appointments is, she was not asked if she was willing to pay the costs which she thought felt discriminatory, because she is Native American, the hospital staff assumed she would not pay for them. O’s community pools money together and helps her pay for the bills of her surgery and post-surgical care. In the process, she also learns that she now qualifies for Medicaid and applies for the next year.
CASE T: OBESITY
T is 25. She is 5”4 and weighs 210 pounds. She is a professional urban dancer. She has a packed schedule, attends daily practice, and maintains a strict diet. T takes care of her body and loves watching videos of her shows; she finds herself beautiful and unique. She has supportive friends and family, including her dance crewmembers. However, T usually tries to avoid flying because she does not fit comfortably in the seats on the plane. She also dislikes taking the elevator, as she feels upset by the glares of people that, she feels stigmatize and discriminate against her because of her weight. During her annual check-up, T’s physician tells her that she really needs to get her weight under control and stop eating fatty foods, because she is obese by the CDC’s standards. She calmly replies that she exercises regularly and monitors her nutritional intake, but that that is just the way her body is, and always has been. As she is about to leave the doctor’s office, he gives her a pamphlet on obesity-related complications and bariatric surgery.
CASE V: POST-TRAUMATIC STRESS DISORDER (PTSD)
V was raised in a middle-class household. His father accused him of breaking the law even though he had not, told him that he lied, yelled, and screamed at him, and swore and cursed at him. His father then blamed him and his mother for his father’s own harmful behavior and their failed marriage and family. His father would have angry outbursts at V and at V’s mother. V’s father scared V and made V fearful of him. V’s father controlled V and aggressively talked him down from a very young age. V’s father made him feel badly about himself and have low self-esteem and V developed a sense of hopelessness and powerlessness. At 17, V left his house and worked temporary jobs to afford to live in a shared apartment. One day, V is attacked at knifepoint in a clash involving his roommate. After the attack, V filed a report at the local police station. V begins having nightmares and anxiety, which escalate into frequent panic attacks and an overall sense of severe insecurity. V has trouble concentrating on and completing his daily routine. His anxiety worsens to the point where he is unable to leave his house, subsequently losing his job. Now 25 years old, V has just been diagnosed with PTSD and was offered medication and behavioral therapy by his local community health clinic.
