Ham, Cheese and Pickles

During a recent urgent care shift, I encountered a man in his mid-50’s who had presented to the center with complaints of sinus pressure and cough. After I gathered more history and conducted a physical exam, the patient went on a tangent, asking me numerous questions about healthy foods. A commercial construction foreman, he was accustomed to being on site during the day, and insisted that his daily lunch was quite healthy and acceptable. As he prepared to tell me about this daily meal, he beamed with pride. What was it? Several slices of ham from the refrigerated section of the supermarket, a few slices of cheese, and a handful of pickles. He truly believed that the meal he consumed daily was incredibly healthy and nutritious. He even stated that he was consuming a high protein meal with produce (the pickle). The patient went on to tell me that when he was done with work, he often stopped at Arby’s to pick up a sandwich for dinner, and felt that the animal protein from these sandwiches wasn’t harmful in the least.

I shake my head in amazement when I encounter patients who have completely convinced themselves that somehow, their eating habits are completely clean and healthy, when they are actually abysmally deficient in nutritional value. What is more surprising is how insistent these people are on continuing their unhealthy habits, even when they ask for advice. The patient I mentioned above listened to me discuss the power of food as fuel, as sustenance, and nodded when I suggested he visit the fresh produce section of local grocery stores, select uncured meats, and avoid frequenting fast food establishments like Arby’s. I also mentioned that his blood pressure readings of 181/125, 179/127, and 185/122 (non-symptomatic) were rather alarming, especially since he stated that he had “forgotten” to take his blood pressure medications that morning. Was it fair to shake him out of his fog and inform him that with malignant hypertension, and a diet sure to compound the problem, he was on a short course to an unfavorable event like a stroke or heart attack? Did he even care if he was at high risk?

This is the kind of situation which I as a physician must often dance around. I have to determine how receptive a patient is to advice, and I also have to figure out the best way to speak to the patient without offending or discouraging him or her. It can be very tricky to reason with someone who has most likely gone through his entire life somehow believing that ham, cheese and pickles constitute an acceptable daily meal in anyone’s life!

What Are You Waiting For?

While working at a recent bodybuilding event, I had a very interesting conversation with one of the attendees. He was a 42 year old man who revealed to me that he had a couple of health concerns, and who very clearly stated that he wanted to be healthy for his sons (one son was about 10, and the other was about 13). He had a habit of eating fast food daily, and he never exercised because he figured that he was at a normal weight and didn’t need to work out.

He told me that he was so busy with work and with taking the boys to all their practice sessions that there was no time right now to train or to clean up his eating habits. He went on to say that he figured he would wait until the boys were older before he got into an exercise program and cleaned up his diet.

I very nicely told him to make every effort to fit in 10 or 15 minutes of intense plyometric or calisthenics work each day, between work and carting the boys around for their soccer and baseball practice sessions, but deep inside I was incredibly frustrated. I even told him that if he indeed waited a few years until the boys were older, major disease processes like diabetes or high blood pressure could emerge and put him in a dangerous health situation. However, I could tell that my words fell on deaf ears, and that this man would not take any steps towards a healthier lifestyle.

I honestly and truly believe that when it comes to anything in life, where there’s a will, there’s a way. If someone truly wants to positively impact his or her health, then steps can be taken immediately to develop a consistent regimen. There have been plenty of people who have made excuses and lived in denial, who were suddenly stricken by stroke or heart attack. Once a major event like that occurs, assuming someone survives it, there’s a big wake-up call and the person is forced to make the changes he or she didn’t want to make years ago.

Why wait?

My Oldest Patient

Shortly after I completed my residency training in family medicine in 2004, I worked briefly for a company which offered mobile physician home visits. Though I soon realized that driving to patients wasn’t my thing, I definitely met some very interesting people during that time.

My favorite and most memorable patient from my mobile medicine days was an elderly woman, aged 105. During my hospital days, I had seen and treated a number of centenarians, but this woman was the oldest. I was called upon to visit this woman’s home (I’ll call her Mary) to perform a blood pressure check and manage her hypertension. She lived in a charming duplex which was erected circa 1905. I knocked on the door and when the door opened, a friendly middle-aged man greeted me and introduced me as Mary’s caregiver (let’s name him Tim).

The interior of the duplex was a time capsule. I honestly felt like I had stepped into the 1920’s, because everything in the place was from that era: lamps, paintings, coffee cups, pens, furniture, curtains, pillows, etc. As my eyes scanned the room, I saw Mary sitting in a large chair with a walker in front of her. Mary’s face certainly was old and her body was frail, but she possessed fire in her eyes and a sassy attitude to match. I thought of how this woman, born in 1899, was witness to three different centuries, as a result of the year she was born as well as the longevity which extended her time on planet Earth far beyond that of the average person.

Mary smiled at me and motioned for me to come over.
MARY: “Well you’re a pretty young lady…what’s your name?”
ME: “Hello Mary, I’m Dr. Naito.”
MARY: “DOCTOR??? DOCTOR??? Tim, what have you tricked me into? Why do we have a doctor here?” Mary’s brow was furrowed.
TIM: “Well Mary, since you refused to take your blood pressure medicine, and since your blood pressure reading was very high today, I had to call the mobile doctor service to come see you. Now be nice to the doctor, will you please?”


At this point I asked Mary if I could take her blood pressure again, and she consented. I took her blood pressure reading: 175/95. I began to ask Mary questions: was she in pain anywhere, did she have a headache, was she dizzy, was she nauseous, was her heart racing, was her vision blurry? I took her pulse: 78 and steady. Mary had no complaints. I then conducted a physical exam on her, which was completely normal. I then asked Mary if she would please take her blood pressure medication immediately, to which she also consented. Once Mary took the medication, I informed her that we would wait about 30 minutes to assess her response to it. She responded by saying, “Well I like you, young doctor! We’re going to have a nice chat!”

The next 30 minutes were incredibly fascinating and funny as Mary settled into a stream of vignettes about her life, focusing mostly on her days as a true flapper, wild and carefree, wearing short dresses, “necking” with handsome young men, hanging out in jazz clubs, and being a general troublemaker. One of those young men managed to steal her heart, and they married in 1922. She spoke about how she became an actress quite by accident when her husband, who was a Hollywood film producer, began to cast her in his films. Mary and her husband were more interested in traveling the world and investing their money than buying an expensive home, so they lived in their modest duplex from 1922 until his death almost 60 years later, and Mary refused to move into an assisted living facility when she became an invalid. It was the same duplex I was visiting that day.

After thirty minutes of hearing the most engaging stories about Mary’s life, I didn’t want to interrupt her. But I was working, after all, so I told her I needed to re-take her blood pressure. This time it was 138/7 and Mary was still completely asymptomatic. I told Mary that it was time for me to go and began gathering my supplies.
MARY: “Oh no you don’t! You’re going to drink a martini with me. It’s my nightly ritual. Been doing it since I was 20 years old.”
ME: “Every night since 20?”
MARY: “Yes indeed. It’s kept me sane all these years, and I enjoy it.”
ME: “But I need to drive over the hill, and it’s rush hour.”
MARY: “Oh please! Now stop complaining and just sit. Tim, make my usual times two.”

After several minutes Tim emerged from the kitchen with two double gin martinis. I don’t like gin, but I wasn’t about to complain or refuse to drink the martini. Mary and I (actually, she talked and I listened) continued to talk for another 30 minutes while sipping on our cocktails. The martini was STRONG but well made, so I continued sipping. Mary polished off her entire martini like the martini drinking expert she was, and motioned to me when she took her last sip. “Well, dear? You’ve got some left in there.” I had to finish the last couple of sips of my martini while Mary watched me, making sure I did so. Once I did, she smiled warmly. “That’s my girl!”, she beamed.

I gathered my belongings and said goodbye to her, and when she motioned for a hug, I walked over to her and wrapped my arms around her. She hugged me and patted my back with her hand.

I never saw her after that.