SOAP (Subjective, Objective, Assessment, Plan) Note for Patient 117342 BAKER, Sarah

By Sarah Baker

Chief Complaint: Writer’s Block 

Subjective: (PMHx: Past Medical History): Childhood hx severe persistent asthma requiring repeated hospital admissions, gradual resolution over adolescence, adult history of mild intermittent asthma. Also, “bunions,” early onset severe bilateral functional hallux valgus, where her hallux (big toes) nestle snugly into their neighbors. Pt denies pain, or impairment of ambulation. Reports rare anxiety-well managed. Pt’s two front teeth are fake, and she’s allergic to cats. Otherwise, Pt is a healthy, 54-year-old female.

HPI (History of present illness): Pt reports 2-day onset persistent inability to perform creative duties related to writing. Denies premonition or precursor. First onset of these symptoms for her, last Monday. Pt reports normal ADLs including: she drank her latte, scanned the headlines, meditated, did a free-write. When Pt sat down to write a Hermit Crab essay, she went blank. Totally blank. She describes a “fortified box-like structure in her brain.” It was “empty,” Pt says, “the sides were made of impenetrable steel.” “No ideas were getting in or coming out.” Pt further describes onset of increased heart rate, shallow and audible breathing, impending sense of doom. Pt denies frank wheezes, chest pain, dizziness, loss of consciousness. 

Pt self-assessment and self-care: Pt takes a deep breath and types “Hermit Crab essay” in her browser. She finds an article that mentions the book Tell it Slant, by Brenda Miller and Suzanne Paola. Pt calls local bookstore to see if they have a copy. No copies. She calls another local bookstore. No copies. Pt tries local library. No copies. Pt describes googling “Hermit Crab essay” again, and finding an article by Miller. Pt reads it, but her inability to perform creative duties related to writing persists. Pt then searches Brevity’s website, and finds an article about Dr. Christine Stewart-Nuñez’s Creative Nonfiction class (where students write hermit crab essays) at South Dakota State University. Virginia Tufte’s book Artful Sentences is mentioned in the article. Pt owns this book. By page 16, Pt reports underlining sentences: Tennessee Williams’s “The Nothingness Continued;” Norman Mailer’s “Harmony settled over the kitchen;” Valerie Boyd’s “John Hurston, however, ached with ambition.”  

Pt describes further reading and underlining: Lawrence Durrell’s “They peel the morning like fruit;” Wyndham Lewis’s “Two stripes ornamented the sleeve.” Pt recalls thinking about metaphors, and vows to work on them, the way she works on her net game in tennis.  

Pt continues to struggle with Writer’s Block, and wonders if exercise might help. Or maybe psychedelics? She’s been thinking of a Michael Pollen-type journey and ponders if now is the time? 

A notification flashes across Pt’s computer screen: iCloud Storage full. She recalls running down the stairs to get her credit card. She remembers turning on the electric kettle, and running to the basement to put in laundry. Pt inputs her credit card, and fixes her iCloud storage. 

Pt begins to feel an easing of her symptoms. She’s just returned from four days away: Visiting her father, who has Alzheimer’s; dinner with her estranged half-brother; and a weekend of glamping on Governor’s Island for a friend’s birthday. Though Pt loves her view of the Statue of Liberty, she hasn’t planned for the all-night party boats that circle New York harbor. Pt concludes she is exhausted physically and emotionally. Pt reports needing someone to take care of her, and to give her permission for the way she is feeling. Pt recalls feeling relief to be home, and she hadn’t had a steady home growing up, and Pt is so grateful to have one now. Pt starts to cry. And all Pt wants is what she calls “a Doctor’s Note,” one that says it is okay that she has Writer’s Block. That it is understandable given her weekend, her life story, and all the baggage she carries around with her because she lost her mother when she was eight, her father had abandoned her, and she describes herself as a Leave No Trace girl. Pt recounts often performing, and trying to always be a good listener, and trying to make everyone else feel great. And Pt says she just needs “a Doctor’s Note” because she’s putting so much pressure on herself after deciding to leave her last job. And she’s been waiting to hear about a dream job, and has had five long, and what she thinks are successful, interviews, but the director isn’t getting back to her, or returning her emails. And her friends are wondering if this is a bad sign. And Pt describes sadness because she is a new empty nester and her youngest is living in Germany, and she is worried about his safety because that’s what mothers do. And that he is skipping a soccer practice to go to Fridays for Future meetings because he is prioritizing his climate change activism over his soccer, and that he is taking a 23-hour bus to Glasgow for Cop23, and Pt frets over when she will see him next because he doesn’t want to fly anymore, and a boat ride from Germany takes forever, and he doesn’t get that much time off from soccer. And Pt misses him.

Objective: What’s objective about reacting to life, grieving, regaining one’s footing, seeing the world for what it is? Maybe nothing’s objective…

Assessment: Life attack

Plan: Regarding the above note, it seems Pt’s symptoms eased after some distractions, and went away once she lightened up. In the future, when these symptoms appear, I recommend Pt relax, chill out. She’ll be fine. No medication required. If you have any questions, please feel free to contact me.  

Dr. Smith

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Sarah Baker is a freelance writer, and has been published in The Christian Science Monitor, CommonHealth on WBUR, and other places. She has been a magazine editor, radio producer, and book editor. Thanks to Phebe Kiryk, MSN-CNP for help with medical terminology. You can follow her work at SarahBakerStories.com.