Clinical Notes from Medusa’s Primary Care Provider Who Suspects Menopause

Subject

History of Present Illness:
The patient, a thirty-year-old female, describes “not feeling like myself” following an incident at the temple of Athena. Intake nurse documented patient as hostile when she refused to remove veil.

Chief Complaints
The patient reports experiencing chronic, localized hissing and turning others to stone on sight.

• Onset: Patient became a “victim of fate” overnight
• Location: Patient specifies sites of head and neck; clinical judgment dictates whole-body involvement due to known limitations of patient-reported symptoms.
• Duration: Patient claims symptoms precipitated yesterday; clinical judgment dictates more gradual onset.
• Characterization: Patient warned attending physician (AP) “don’t come closer” and urged AP to “look away,” both of which were easily heeded. Eye contact was avoided to prioritize AP safety.
• Severity: 10/10 on the Gorgon Scale

History:

• Medical: Allergic to penicillin. Normal menses, but no live births (infertility ruled out due to patient’s statement: “Save me from the shadows of men!”)
• Family: Biological parents are primordial sea deities. Maternal menopausal history unknown, but patient made inquiry regarding relevance of menopause to an immortal.
• Social: Worked as a priestess. Recently unemployed. Lives with two sisters who corroborate the patient’s account but are considered unreliable historians.

Objective:

• Vital signs: Multiple concurrent cardiac rhythms identified per nurse (rule out tachycardia due to anxiety)
• Weight: Four pounds gain since last visit (flagged)
• Location: Stone statues of unknown clinical significance observed at reception
• Physical exam findings: Deferred due to patient’s noncompliance. Rattling noted at scalp.

Assessment:
Older female presents with symptoms of anxiety, low libido, weight gain, and altered mental status, all likely induced by an etiology of hormonal dysregulation.

Diagnosis is uncomplicated menopausal transition. Differential diagnoses include perimenopause, estrogen deficiency-induced menopause, silent menopause, occult menopause, artificial menopause, and, less likely, mythic transformation.

Plan

1. Condition:

• Localized sibilance
• First-line treatment plan: Review sleep hygiene techniques.
• Second-line treatment plan: Hormone replacement therapy for diffuse symptomatology.

2. Condition:

• Episodic petrification of bystanders
• First-line treatment plan: Cognitive behavioral therapy for positive reframing of interpersonal communication.
• Second-line treatment plan: Referral to endocrinologist. Anticipated appointment availability: fourteen months.

3. Prognosis:

• Conservative management expected to be insufficient in typical female presentation.
• Tertiary salvage therapy: Surgical intervention to remove the offending organ—total hysterectomy.
• Condition(s) requiring presentation to ER: tragic decapitation. Prior insurance authorization required for reattachment. Usually denied as considered cosmetic.