“Clarice, good to see you again. Welcome back.” Dr. Wilson pulled up his roll-around stool to the edge of the exam table and patted Clarice’s hand. “What can I do for you today?” [How long since I saw this patient?]
“Actually, I just needed a refill on my blood pressure prescription.” Clarice checked her watch. “But your nurse wouldn’t okay the refill ‘til I came in to see you.”
“Well, I haven’t seen you in . . . how long were you in Vermont?” Dr. Wilson flipped through the medical record in his hand. “You’ve been gone four years. [Nurse’s note: BP=185/100. When did you get the diagnosis of hypertension? That’s not on my disease list.] How’d you know you have hypertension?”
“Oh, I was having headaches after Cal died – and dizzy spells. A nurse in the mall took my blood pressure, said it was high. So I saw a local physician who said I needed medication for my high blood pressure.” She shrugged. “He never did anything for my headaches. Went away on their own, I guess.”
[Wow! Potential stroke? Carotid artery problems? Cerebral aneurysm? Aortic valve disease? What else is hiding here?] “So you’ve been taking the medicine regularly?” he said, quickly writing notes as to how he would find the answers to all the questions that were coming to his mind.
“Oh, yeah, whenever I remember.” She shrugged. “I always know when I haven’t been taking it because the headaches come back.” She checked her watch again. “Can I just get the prescription?”
“Of course.” Dr. Wilson looked into her face, smiling his empathy, hiding his anxiety about the unknown disasters lurking in the wings. He uncoiled his stethoscope from around his neck. “Tell me, what kind of tests did the doctor in Vermont do?” he asked as he listened to her heart, then listened over each carotid artery. [No murmurs in the aortic valve; no bruits over the carotid arteries.]
“He listened to my heart, took my blood pressure, drew my blood – stuff that doctors always do.” She resisted slightly, then relaxed as Dr. Wilson palpated both of her wrists simultaneously for pulses, then raised her arms above her head and put them down again. “I don’t know. I never heard about any of the results.”
[Pulses are equal in both arms; no water hammer pulses. Looking for cardiac stress enzymes? Possibly a pheo? Hyperthyroid? Did he do a stress echo?] “Could I get you to sign a release so that I can send for your records?”
“Oh, sure. I’ve got his address somewhere on a card.” She rummaged through her purse, then looked up. “Am I going to get my prescription today? The headaches are back and I really need it.”
“Yes, we’ll get your prescription today.” He smiled through his concern. “But I need to know why you have high blood pressure; what it might be doing to you. I would like my nurse to take your blood pressure every fifteen minutes – three more times before you go. Is that alright?” [Both arms.]
“Okay, whatever.” She rolled her eyes.
As Clarice left the waiting room with her daughter, she said, “He was hardly in the room five minutes. Just wanted to bill me for sending for my old records and for his nurse taking my blood pressure. Except for the money, I don’t think he even noticed me. I don’t know what he was thinking.”