Clinic Vignettes - March 18th, 2006

The man with severe hypertension survived the night, is still alive, has reduced his tobacco intake, and is now at a level of Blood Pressure that is relatively controlled. i used a technique with him that i've been experimenting with for folks with high blood pressure. most folks cannot "feel" high blood pressure, it is a silent disease in many ways, until arteries start popping and people lose sight, kidney, heart or brain function. interestingly, many people claim their headaces are from high blood pressure related to stress but i am told by my medical colleagues in research that this isn't the case at all, that people cannot really feel high blood pressure.

so how can we help patients understand what is happening to them? what high blood pressure means and why it needs to be reduced?

this is my technique - while the cuff is inflated i hold the pressure at their systolic for a moment and ask them to feel that pressure on their arm, then i drop it to a normal systolic (120), let them feel that, then their diastolic for a moment, then a normal diastolic (70). then we have a conversation about fluid mechanics, pressure, and micro-arterial damage. once they feel the different pressures it is no longer an academic or intellectual exercise, nor is it faith or belief or trust in your doctor - it is REAL. it seems to be helping folks get a handle on why hypertension matters.

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a musclebound weightlifter, Spanish speaking young guy came in the clinic the other day. he has had some issues with fungal skin infections that have responded well to diflucan. in the middle of our visit, something kinda cool happened. he asked me if i knew where he could find contemporary flute music. he had a shy look on his face and stated that he isn't like most other Mexican wieghtlifters who like ranchero or rock music. he's into the soft music of flutes. i found this to be so endearing and also insightful into the relaxed nature of the clinic, that a man could feel comfortable to ask his doctor to help him find flute music. i love that! i think part of the prompting came from the music we play in the reception area. it's an ipod loaded with lots of jazz, blues, some Mexican Indigenous flute music, Nora Jones, all the good stuff. turns out that Rasa, the naturopath, knows a couple yonung Mexican men producing their own flute music so we sent him in that direction. perhaps they will all click and the world will be a better place. :> here's to lots of broken stereotypes!

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a tile worker and her partner came in to the clinic with bad bronchitis bordering on pneumonia. fairly straightforward visit. towards the end of it, the patient asked me if she could help us finish our tiling in the bathroom. we are missing a transition piece that would act as a mini-ramp for a wheelchair, from the saltillo hallway to the slightly lower bathroom ceramic tile. i tried to barter her visit for the work but she and her partner refused, they paid the visit and once she is better, they will come back for the small volunteer job. they said were so happy to have found affordable, kind healthcare. and for them, it's only a few blocks away from where they live.

this past two weeks saw about four random and beautiful offers by patients to help us with various aspects of the clinic from finding new reception area chairs to the tiling to printing up more intake forms to helping us with our move to a new location, which will happen in about 3-6 months.

more than anything, these offers, and the continual small donations we get from our patients are the surest signs to me that we are on the right track, that we are offering something that really touches people, that inspires them to share a small part of their wealth, their skills, their time in helping us get even better.

andru