Kristene “Kris” Diggins, nurse practitioner

I hurried into the exam room to see the next patient on my schedule. It was a busy day in the office, and I didn’t have much time to review charts.

When I opened the door, I noticed there were two people in the room. This is not unusual, as many patients bring family members to the office. Glancing at the patient’s chart—she was a middle-aged woman struggling with nasal allergies—I was somewhat surprised that she had brought her mother with her to discuss the problem. Not until I began to interview the patient did I realize that she suffered from autism. She answered all my questions without difficulty, even though her mother attempted to talk over her. I detected an unspoken tension between them.

As the interview progressed, I discovered that the young woman resided in an assisted-living home. I was struck by the fact that she had all the mental capacities expected for someone her age. She was a bright and clever young woman, yet it was apparent she was accustomed to being treated as a child. The more time I spent with her, the more aware I became of her mother’s overpowering presence. In addressing her concerns for her daughter, she inadvertently belittled her.

I could tell the daughter was not accustomed to being addressed directly, and she seemed to relish the attention I gave her. As we talked, her demeanor began to change from timid to confident. Her frustration with her mother’s constant interruptions was apparent, but she seemed to accept them as a reality of life. Though stricken with autism, she apparently had all the mental capacities needed to make her own decisions, independent of others.

I offered the best care I could for her allergies but desired to help her in a more important and lasting way. I wanted to help empower her toward independence and autonomy.

As health care professionals, we can be our patients’ best advocates. We can attest to their abilities to make their own decisions. No single diagnosis should cause loss of autonomy. I can’t help but wonder how much better served that young woman would be if her abilities were validated, without constant focus on her special needs.

She came to the office for only a short visit that day, but she reminded me of the advocacy I can provide for patients. My hope is that, at least in our office, this woman will be affirmed and validated. Maybe this place will be one small corner of the world where she can be recognized as an independent and autonomous woman, capable of making her own decisions. It’s a small step, but it’s often in small steps that life changes and begins to take on a new look! RNL

—Kristene C. Diggins, RN, MSN/FNP, lives in Porto Velho, Rondonia, Brazil, where her duties as a nurse practitioner include dispensing medications, suturing, ordering diagnostic tests and extracting teeth. Diggins, presently in the United States, enjoys writing about her experiences working in a rural-setting health program. “I think it’s good for us to remember the global picture of health care,” she says.