Your numbers were perfect, actually. Systolic blood pressure at a solid 128 nestled cozily on top of a diastolic reading of 72. Just what the doctor ordered. To make things even better, your blood sugar reading on finger stick that morning was right at 80 and the little paper book into which you'd logged all of the other values you'd clocked over the last several weeks were similar.
I couldn't help but smile as I scrolled through the results of your recent lab tests because, on top of all of the other excellent stats today, your blood work cosigned that everything was indeed under control. Bad cholesterol, lowered. Good cholesterol, decent. Chemistry panel, reassuring with normal kidney function and electrolyte measurements. Even the hemoglobin A1C--the long range blood sugar tracker--was right at goal.
You, my friend, were a doctor's dream. Not only had you followed the directions and recommendations of your physicians, you always seemed to do so with a smile. Lucky for you, your efforts were paying off. The medications that you so diligently took each day were actually doing what they were intended to do without any annoying side effects or, perhaps more annoying, refractory response.
Admittedly, I've always found it difficult to reconcile you with your list of medical issues. Here you are--this mostly fit and youngish person with a metabolic trifecta that seemed more fitting for someone older or heavier in stature. High blood pressure, hypercholesterolemia, and diabetes, too. All attached to you thanks to the power of genetics.
"I try to do exactly what y'all told me," you said with a nod of your head. "Then on top of that, I do more. Like I track my food in a app on my phone and keep track of my work outs, too."
"That's amazing," I said. And I said that because it was true.
"I go as hard as I can because my goal is to get up off of all this stuff. These diabetes pills, these blood pressure pills, and the cholesterol pills, I'm trying to eventually not need none of that stuff."
I raised my eyebrows when you said that. Not knowingly, but I did.
"I'm for real!" you contended. That's how I knew my facial expression may have suggested otherwise.
"Oh, I didn't mean to seem like I was trying to discourage you." I said that even though what I was thinking would likely do just that.
"I play a full court a basketball three days per week, I lift weights and I take every pill at the exact same time every day. I'm glad everything is on point because that means I'm on the right track."
I couldn't disagree with that. We made some more small talk and eventually began to wrap up the visit. "We'll just go ahead and give you 12 months worth of refills, okay?"
"What? On all these pills?"
"On your current meds, I meant. Nothing new."
"Well. I was hoping we could cut something back. Or even out." Your eyes were fixed on mine letting me know that you were completely serious. "I was thinking I could drop one of the blood pressure pills. Or cut down on my diabetes stuff so that I can ease on over to getting off of it."
You were putting in the work. Of course you wanted to be rewarded with having things erased off of the chalkboard when it came to you and your list of health problems. As far as lifestyle modifications went, you were already doing everything tried and true and you weren't struggling with being centrally obese, either. So really, all I could say to that was damn. Damn because this was the point where I'd have to tell you that this wasn't a bad behavior thing but, instead, all about the genetic hand you'd been dealt.
"Um. . . . your numbers, I think, look so good because of your hard work but also the current medicines you take. I kind of think what we are seeing is a working plan with regards to you and keeping you healthy."
"But don't you think since I'm doing good, we could cut out a medicine?"
I swallowed hard and bit the side of my cheek. I hated to burst bubbles. "I think if we changed your medicines, things wouldn't be so well controlled, you know?"
"Can't a person eventually get off all this stuff though?" You wanted to know.
The fast answer was sometimes. Because sometimes people who have a lot of weight to lose or changes to make can overhaul their entire situations enough to get off of everything. But that wasn't your story line. Not one bit.
And so I told you that. I let you know that these were likely problems that you'd be living with for good. And I want you to know that sharing this little revelation with you sucked. It did.
"So I'm doing all this working out for nothing?"
"No! It's all making a huge difference. We're where we want to be now. So I think you exercising and all that you're doing is partly why everything looks so good."
I could see that your body language had changed. Your shoulders were now a bit rounded downward and your previously dancing eyes were quiet. "Damn. So I got life without a chance of parole is what you're saying."
That analogy stung when I heard it. And everyone knows that it is the truth that hurts the most."Well," I started, "I like to think of it more as a ball that you're running with. Just keep your hands on the ball and don't drop it. But, yes. For you, you'll have to keep running with the ball."
"Running the ball all the time gets tiring."
You looked down, sighed, and then tried your best to sit up in your chair to look hopeful again. "I hear what you're saying. But I'm going to keep fighting. And trying to pass this ball. Or get parole for my good behavior." We both chuckled when you said that. But I could tell you were serious.
You know? Nothing would please me more than to have you wave a finger in my face and tell me I was wrong. I mean that.
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?