Potty meat.

*Names and details changed to protect anonymity . . . . .you know what's up!

Low in salt. Just not sodium.

"What questions do you have for us?" my intern asked his patient diligently one morning on rounds. Mr. Purifoy immediately craned his neck over to his wife who sat next to his bed.

"You gon' ask about what you was sayin' earlier? About my legs?" he asked her.

Mrs. Purifoy did all the talking. No matter how many times we tried to get him to ask his own questions, he preferred to have his wife take care of such formalities.  Which reminds me. Tonight Harry was trying to add a new "app" to his iPod Touch and for whatever reason "needs" me to assist him with all things Apple. Seeing as I love him and don't mind pushing the two to three (super easy) buttons on the device to get him what he needs, I just go ahead and help the brother out. And Harry always turns my car around in the car port and also gets rid of any scary/non-ladybug insects in my sight. Even if I was the one who did the honors of squashing it with my Ugg boot (which yes, I do wear in my house even though it's summertime.) Sigh. . . yes, I digress. But, see,  the point of me telling you this is that I get Mr. Purifoy leaning on his wife for certain things that he technically could do himself.

Antywho.

So Mrs. Purifoy, who had just sat down to the bedside tray table with a full meal/snack that she'd just brought in, looks over in our direction with her mouth a-watering and her eyes half-mast. She then looks back at her husband. "You talkin' 'bout the water pills?" She shifted back to us. "His legs was swelling sometimes. Tha's why we was wondering does he need more Lasix pills in case they swell again."

I looked down and inspected his legs once more. He had very trace amounts of swelling, and he had no signs of volume overload.  Before I could say anything, my intern chimed in. "Your legs look fantastic, Mr. P. We've had you on a low salt diet, and I think that's helped a lot."

"See, I told him don't be eatin' all that salt!" Mrs. Purifoy announced with a curl of her lips. She picked her teeth with her thumb nail and nodded. "Ummm hmmmm. I told him. See me? I don't use no salt.  I mean, I know it can hide up in stuff but I don't eat that stuff."

I looked at the tray table and surveyed her bounty.  The entire meal was from the hospital gift shop--which couldn't possibly be low on salt since everything needed to have a decent shelf life.

Here is an inventory of what she had:

• A jumbo bag of Ruffles potato chips.
• A big, dill pickle.
• Some kind of sandwich wrapped up in foil, from where--I do not know.
• And. Wait for it. . . . wait for it. . . .
• Yes. A can of Vienna Sausages.

Vienna Sausages?Seriously?

0_0 ----> look on my face

My little Harry buzzy-bee/guardian angel (whose sole purpose is to get me to mind my own business) began furiously swirling around my head. "Watch your own lane!" he hissed. "Don't even START with this lady! She is NOT your patient!"

"But how is she just gonna bust on his salt intake when she has VIENNA-freakin'-SAUSAGES at the bedside? That's, like being a TOTAL hypocrite, man!" I subconsciously replied.

"STILL!" the little imaginary drill sergeant hollered. "It AIN'T your lane, nosy girl! Drive in YOUR lane!"

And for two seconds I did drive in my lane. But then she started situating herself to eat what might has well have been a salt lick and I could. not. take. it.

"So. . . .uhhhh. . . .do y'all know how much salt you should stay under for the day?"

I directed this right at Mrs. P since she seemed to be the speaker of the house. And she lit right back at me, calm as could be. "Oh yeaaaaahhh.  I checks all the labels for saturated fat and all that."

"Okay. . .let's just go over it again to make sure it's fresh on your mind, okay?"

She nodded--while still getting her food ready.

"Mind if I use this for example?"

The Harry buzzy-bee was in my ear again.  "You KNOW you are wrong if you pick up those Vienna Sausages. You are TOTALLY being an a-hole if you do because you know how salty they are."

"Go right on ahead," she said. "Bay? Make sure you pay attention 'cause you be the one eatin' all that salt.  See me?  I got sugar diabetes and I don't eat no salt. Tha's him. See bay? No salt."  She bit the pickle.

Lawd, Lawd, Lawd.

Could. Not. Take. It.

"Okay, so here is where the sodium is. You know this already, but  the sodium is the salt. You both want to keep it under 2000 milligrams of sodium. So you have to count it up. . . ."  I looked at the label of the can. "If you eat this can. . .it has 2.5 servings total. . . . . and if you eat the whole can. . .that's like a third of what you can have for the day in terms of salt.  And let's check the chips. . . . okay. . .so 590 milligrams in this bag. . . . and you're already well over half of what you can have for the day.  See? Watching salt is really, really hard to do."

"He eats potty-meat. Tha's waaaay worse than Vi-ennas. Tell him, doctor."

0_o

"Potty-meat?"

"POTTED meat!" a voice of another patient clarified from the neighboring bed.

On second thought, "potty" meat may have been more accurate.

"Aaaaahhhh," I said.  "Is potted meat pretty salty?"

"Horrible!" exclaimed Mrs. Purifoy. "Jest HORRIBLE!"

I stood there for a few beats watching Mrs. Purifoy as she popped the airseal on the bag of chips and peeled open her can of Vi-ennas.

"Mrs. Purifoy?  You both really need to watch the salt. If you have diabetes you probably should avoid this stuff, too."

"I told you. I don't be eatin' salt like he do."  Again she bites the pickle.

Killing me.

I glanced up at the clock and then at my interns. They were shifting on their feet and obviously wondering how long I would let this go on.  Much to my disappointment, I knew I would be forced to do the unthinkable--get in my own lane.

"Do you think we can get you both to come see us at the Primary Care center?"

"Oh yeaaaaah. He definitely need to see y'all."

"Okay. But. . .what about you, Mrs. P? Will you see us, too?"

"I could probably see y'all, too."

"And can you do me one more favor, Mrs. Purifoy?"

She raised her eyebrows.

"Can you make this your last can of Vienna Sausages after today?"

She looked down at the can and back up at me. "It's that bad?"

I nodded slowly (knowing that if Harry were there he'd be shaking his head and giving me the hairiest eyeball ever.)

"Okay then," she conceded.  "But Dr. Manning?"

"Yes, ma'am?"

"Make sure you tell HIM about that potty-meat, okay? 'Cause I just know tha's waaay worse than Vi-ennas."



Ummm, yeah.

If this makes you dry heave, that makes two of us.

Confession: I read this post to Harry who had this to say:

Harry: "You never had some potty meat on crackers? Shoooot! You trippin'!"

Me: 0_0

Harry: (laughing hard) "With some crackers, Babe? Some Saltines? Shooooot!"

Me:  x_x   eeeww.

*sorry, just threw up in my mouth a little bit*

Seriously?  Never. Kissing. Him. Again. Ever.

***
Happy Tuesday, y'all.

Reflection on a Tuesday: Throwing Salt in the Wound and in the Game

True story--This week at Grady:

Me: "We could probably get your blood pressure down quite a bit by making some changes to your diet. That can be as helpful as adding a medication.

Patient: "Oh, I already eat a no salt diet, so that definitely ain't my issue.

Me: "Wow. . . I've heard of a low salt diet, but seems like it would be tough to have a no salt diet."

Patient: "Yep, well it ain't that hard. You just gots to put your mind to it, you know what I'm sayin'?"

Me: "I hear you. You know sometimes salt can be hiding in stuff."

Patient: "Not my food. I prepares all the food in my house. So it ain't no salt in none of it. Matter of fact, we don't even have no shakers in our house." She smacked her lips between each sentence for emphasis.

Me: "Wow, that's impressive. . . uh. . I mean, great. What do you season your food with?"

Patient: "Mostly Accent or Zatarain's."

Me: "Umm, Accent or Zatarain's?"

Zatarains = creole-seasoned salt, Accent = MSG

Patient: "Yeah ma'am. Or just bouillon. You don't never cook with no bouillon? I drops me a block off in jest about everything. Make it taste so good without salt." Alrighty then.

Me: "Umm, bouillon? In everything?"

Patient: "Oh yeeeeeeaaah. Vegetables, rice, all that stuff."

bouillon = meat stock flavored SALT

Me: "Uhhh. . . . okay. . . so. . .tell me this--what'd you have for breakfast this morning."

Patient: "A sandwich and some coffee. Biscuit with a little piece of meat. . .some leftover fatback, tha's all. But I didn't sprankle no salt, though, and this time, no bouillon." She smiled and still smacked her lips with each point.

a little piece of fatback on a biscuit

Me: "What about dinner last night?" I could feel myself breaking out in a cold sweat.

Patient: "Chicken and some butterbeans, oh and some white rice."

Me: "The chicken. . .baked, fried? And how'd you season the butterbeans?" Please don't say it. Please don't say it.

Patient: "I ain't gon' lie, it was fried. But I seasoned it only with the Zatarain's. The butterbeans just had a ham hock in it, tha's all." Tha's all. Sigh. I looked at her stout middle, and thought about her initial complaint, How can I lose some of this weight? I keep trying but nothin' is happening. . . .

Me: "A ham hock. . . .did you. . .eat it?"

Patient: "Ummm hmmm. I ate only part of it, but not all of it. But no salt, though. Definitely no salt."

smoked ham hocks, unsalted. . . .?

She was so proud of herself. Chest all poked out and proud about her no salt diet. It hurt my heart to have to burst her bubble about the foods she'd grown up on like ham hocks and fat back. This particular patient was low literate, and wasn't very good at reading labels. It felt so enormous, trying to think about how to start explaining sodium intake to her. Like Zatarain's is seasoned salt. And a bouillon cube is pretty much dehydrated chicken or beef stock and, well, salt. And Accent? It wakes up the flavor because of the sodium. Sodium wakes everything up. Sigh. The fat back is salt cured, and so is the smoked ham hock. So, in other words, don't eat any of the things that you call comfort foods. Your specialty? Don't cook it. And all those foods that don't perish in 3 days that your fixed income can afford you? Out of the question.


Some of these interactions start out funny, but then quickly evolve to not funny at all. Fresh food costs money. Education and exposure to different things in life is a privilege that often comes with, well, money. I truly believe that this woman was really giving her personal best. She deeply believed that her diet was indeed a "no salt diet."

And so, first, I congratulated her on her effort. I told her that effort is where it all starts, and that she was ahead of most for that reason. I silently berated myself for allowing the six ridiculously expensive organic peaches I bought from Whole Foods last week go bad. Then I took a deep breath and then slowly began explaining sodium to her. Showing her labels so that she could know the word by sight. And after looking crestfallen, she finally said, "Damn, I can't eat nothing."

And you know what? Considering that I was sitting across from her in a public hospital where she'd just told me that she could barely afford her medicines, the co-pays for her visits, or even the cost of public transportation to come and see us, it was hard to argue with her.

"The percentage of food shoppers who are obese is almost 10 times higher at low-cost grocery stores compared with upscale markets, a small new study shows. In the Seattle area, a region with an average obesity rate of about 20 percent, only about 4 percent of shoppers who filled their carts at Whole Foods Market stores were obese, compared with nearly 40 percent of shoppers at lower-priced Albertsons stores."

-University of Washington Study

celeb Rachel Bilson doing some swanky grocery shopping. . .but definitely not on a fixed income!