Tag medicine

Understanding The Costs Of Diabetes Treatment And Planning For The Future

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Original post can be found at:
https://www.thesimpledollar.com/understanding-the-costs-of-diabetes-treatment-and-planning-for-the-future/


by DeVonne Goode
Updated on 06.05.18

Diabetes is a prevalent disease. However, it can still take many by surprise, and leave them struggling to pay medical bills.
With the complexities of the condition and the wide range of costs involved with treatment, having a financing plan is necessary. Health insurance is obviously one of the primary methods of assistance. But not everyone has the adequate coverage to cover
the costs – let alone the out-of-pocket cash to put on the counter every time out.

Opening a savings account, particularly one with high interest, could be a worthwhile investment toward consistently managing the disease today and into the future.

Diabetes at a glance
Type 1 Diabetes

A condition that keeps the body from producing enough insulin. Insulin shots are used to control blood glucose levels. Most diagnosis occur among children and young adults, which is why it is also referred to as juvenile diabetes.

Type 2 Diabetes

The most common form of the condition where the body doesn’t properly use insulin to convert sugar, starches and other food into energy.

Gestational Diabetes

Occurs when women experience high blood glucose levels during pregnancy. It’s usually easily managed and goes away after pregnancy.
Prediabetes

When blood glucose levels are higher than normal, but not high enough to be diagnosed as Type 2 diabetes. A large number of Americans are living with prediabetes (1 out of 3 adults). But taking early action to manage glucose levels can prevent diabetes from forming.

People who have diabetes are at higher risk of developing the following health conditions:
Blindness
Heart disease
Stroke
Kidney failure
Blindness
Loss of lower appendages (toes, feet, or legs)

Keep in mind – these conditions occur in the case of severe complications with the disease. With consistent attention to diet and other medical treatments (like most living with type 1 or type 2 diabetes undergo), these conditions are avoidable.
Diabetes by the numbers

According to a recent report from the Centers for Disease Control and Prevention (CDC), more than 100 million U.S. adults are now living with diabetes or prediabetes. Of that, only 12% were aware that they had it. And with approximately 1.5 million new cases being diagnosed every year, the need for education and financial support is clear.

Prevalence
Infogram
Rates of diagnosis for the following ethnic groups
7.4% of non-Hispanic whites
8.0% of Asian Americans
12.1% of Hispanics
12.7% of non-Hispanic blacks
15.1% of American Indians/Alaskan Natives
Breakdown among Asian Americans:
4.3% diagnosed were Chinese
8.9% diagnosed were Filipinos
11.2% diagnosed were Asian Indians
8.5% diagnosed were identified as other Asian Americans
Breakdown among Hispanic adults:
8.5% diagnosed were Central and South Americans
9.0% diagnosed were Cubans
13.8% diagnosed were Mexican Americans
12.0% diagnosed were Puerto Ricans

Underreported deaths due to diabetes

Diabetes is one of the leading causes of death in the United States (seventh as of 2015). However, studies have found that it is also among the most underreported. According to the American Diabetes Association®, only 35% of people who died with diabetes had the disease listed on their death certificate. And of that number, only 10% had diabetes identified as the cause of death.

Underreported Deaths
Infogram

There are a number of possible reasons for the underreported rate. But a lot points to the lack of ability to pay for adequate diagnosis and proper medical treatment.

What specific costs will someone with diabetes have to address?

If you or your child are diagnosed with diabetes, or you’re told that you have prediabetes, management and prevention take center stage. While a lot involves diet and exercise, medication will inevitably have an effect on your finances as well.

According to the American Diabetes Association® (ADA), medical costs for a person with diabetes averages out to $16,750 per year (a total of $327 billion nationwide in 2017). Of that amount, $9,601 is attributed to treatment specifically for diabetes. That’s more than twice the medical cost for people without diabetes.

Of the $327 billion nationally, $237 billion was attributed to direct diabetes medical costs and $90 billion was attributed to indirect costs – absenteeism and reduced productivity at work. Understanding the different forms of diabetes treatment, as well as the direct and indirect costs, is important for wrapping your head around plans for financing.


Type
Treatments

Type 1 Diabetes
Diet
Exercise
Insulin therapy
Regular blood glucose tests/monitoring

Type 2 Diabetes
Diet
Exercise
Insulin therapy
Other medication
Gestational Diabetes
Diet
Exercise
Monitoring sugar intake
Monitoring the baby
Direct Medical Costs ($9,601/year)
Indirect Medical Costs ($90 billion nationally)
Prescription medication (30% of total cost)
Loss of productivity due to mortality ($20 billion nationally)
Hospital care (30% of total cost)
Inability to work as a result of diabetes ($40 billion nationally)
Routine doctor’s office visits (15% of total cost)
Reduced productivity while at work ($30 billion)
Other medications and supplies (25% of total cost)
Reduced productivity due to increased absences and loss of employment from diabetes ($6 billion)

Insulin

Insulin injections are one of the primary forms of medical treatment used to manage diabetes. Especially for those living with type 1 diabetes, who can’t produce insulin of their own, these types of injections are vital for survival. However, the cost for insulin has skyrocketed in recent years, leaving many in the position of having to choose between going into debt or cutting back on medication.

Average cost for insulin as of 2015: $100-$200 per month
Average cost for insulin as of 2018: $400-$500 per month

WIDELY USED INSULIN BRANDS AND INSULIN INJECTION TOOLS
Insulin
Apidra, Humulin, Lantuo, Lente, Levemin, Novolog, Novolin, NPH Insulin, Regular Iletin, Regular Insulin, Velosulin
Insulin Syringes
BD Ultrafine, Levemir®, Monoject, NovoFine®, Ulticare, UniFine, UltiGaurd
Insulin Pumps
Animas, Deltec, Medtronic

Diabetes screenings and other medications

Along with your normal doctor’s visits, diabetes screenings are an important part of the process for identifying the disease. Specifically, if you have been diagnosed, testing your blood glucose levels will become a regular part of your life. Much of the costs for medications involved should be covered by your health insurance. And there are a number of home testing devices you can invest in to help make things more convenient and cost-effective.


WIDELY USED DIABETES TESTING BRANDS AND OTHER MEDICATIONS
Blood Glucose Test Meters and Test Strips
Abbott Freestyle®, Abbott Flash, Accu-Chek Compact®, Ascensia Elite, Ascencia Breeze, Ascensia Contour, Lifescan One-Touch©, Prestige
Injectable Medications
Byetta (Exenatide) injection and Symlin (Pramlintide Acetate) injection, Victoza (lLiraglutide- rDNA origin) injection
Oral Medications
Acarbose, Avandia, Chlorpropamide, Diabinese, Glipizide, Glucophage, Glucotrol, Gylset, Meglitol, Metformin, Prandin, Precose, Repaglinide, Rosiglitazone (These drugs act in different ways to lower blood glucose levels and may be prescribed in combination with other medication.)


Diabetes health expenditures according to group

Depending on whether you or your child has type 1 or type 2 diabetes, total expenditures can vary. Those who manage their condition at home, through diet, exercise, and home testing will have different averages than those needing regular appointments with specialists. According to the American Diabetes Association®, average total healthcare expenditures for diabetes treatment differ according to gender, race, and states with the highest populations of people diagnosed.

Gender
Men: $10,060
Women: $9,110

Race
Hispanics: $8,050
Non-hispanic Blacks: $10,470
Non-hispanic Whites: $9,800
States with highest population of people with diabetes
New York: $21 billion in healthcare expenditures
Florida: $24 billion in healthcare expenditures
Texas $25 billion in healthcare expenditures
California: $39 billion in healthcare expenditures

Options for diabetes treatment financing

In a recent online survey of 500 adults with diabetes, more than half of the participants acknowledged the medical costs involved has had a negative impact on their finances. Many also admitted to going to “extreme lengths” to cover the costs. These lengths include accruing credit card debt, borrowing money from family or friends, and tapping into a savings or retirement account. Many may feel the need to take some extra financial risks because they don’t feel as supported as they’d like. Understanding your options will help you make the most informed choices.

Insurance

Government insurance, such as Medicare and Medicaid provides most of the financial assistance for diabetes care. The military also takes care of a good amount of costs for veterans. The remainder of the cost is covered by private insurance or out-of-pocket cash. According to the National Conference of State Legislatures, 46 states mandate that diabetes be covered under state insurance.

Diabetes Health Insurance Coverage
Infogram

These states require coverage for diabetes treatment as well as equipment and supplies for home use (insulin, pumps, syringes, test meters). Four states do not have that same insurance mandate, however – Ohio, Alabama, North Dakota, and Idaho. Anyone with diabetes who live in any of those four states will most likely need to deal with a private insurer or explore other methods of financing.

Coverage from private insurers usually come through employer-sponsored group plans or individual health plans. Advisors would suggest going with employer-sponsored plans, because they offer higher protections due to being subsidized. On the other hand, if you are unemployed and venturing into the individual market, it may be difficult to find affordable coverage. The reason is that diabetes is considered a “high risk” disease. Insurance companies anticipate a high amount of claims, especially from those with pre-existing conditions. So it will be reflected in the pricing.

HSA

People who have diabetes but don’t have coverage that’s comprehensible enough for their needs may utilize a health savings account (HSA). An HSA is primarily useful for people with high deductibles (at least $1,350 individually, or $2,700 for family). Also, those who are a part of low-income families or don’t live in a “mandate state” may see this as a helpful tool. One big benefit of an HSA is that you take the money with you. There’s no “use it or lose it” policy like some other savings plans. Being able to set aside pre-taxed dollars to help pay for medical expenses can go along way when trying to manage diabetes.

FSA

Another way to set aside dollars for medical expenses is through a flexible spending account (FSA). An FSA is provided through your employer with a $2,650 limit. You can also use it to cover medical expenses for your spouse and dependents. One thing to keep in mind with FSA’s is that they do have an expiration period. You’re generally required to use the funds within your plan year. But your employer may offer extensions at their choosing. The benefit is, it can be used with any type of health plan. And diabetic supplies are eligible to be paid through FSA’s.

High interest savings account

If you’re not interested in dealing with your employer for coverage or a flexible spending account, a high interest savings account could be a good option to explore. It’s just like any other savings account, only with fewer restrictions. Not only are you saving for your medical needs, but your money is also making money. High interest savings accounts are opened through online banks – which means they don’t have to worry about maintaining branches all over the country. They can offer you higher interest rates, with the benefit of accessing your money whenever you want.

Unlike an HSA, a high interest savings account isn’t tied to a high deductible health plan with a dollar limit. And unlike an FSA, there’s no expiration date on when you can use your money. It removes any additional stress so you can concentrate on managing your condition properly. And as you earn interest, you can still take advantage of a number of outreach resources available for people with diabetes.

This condition can be a tough one to get a handle on, but it’s not insurmountable. Let your understanding of diabetes, your knowledge of its treatments, and your strategy for tackling costs work in your favor.

Stacking The Deck

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“So…what do you DO?”

This question is incredibly annoying to me, and I cringe every time I hear it. I resent the fact that many people are so quick to assess someone on the basis of what they “do” for a living, as if there are no other dimensions which should be taken into account.

I completely resent the demand to pick one career that defines me. To add insult to injury, when people find out that I am a medical doctor, they struggle with the stereotype of what they expect doctors to be like, in other words, very conservative in dress and demeanor, and without any flavor or personality. Well, I’ve got news for you. I will NEVER be a typical doctor. And please don’t doubt my credentials or schooling. I am NOT a nurse (not that there is anything wrong with this highly respected profession). I am a fully licensed and board certified physician.

However, I do not consider myself to be ONLY one thing, “only” a physician. Yes, I am a board certified physician. But I am also a degreed (Bachelor’s) fitness professional, professional athlete (IFBB Pro), certified nutrition coach, writer, model, brand ambassador and contest prep coach. If that’s too much for one to process, too bad. Because I am ALL of those things, and then some. I am just as much about fitness, bodybuilding and wellness as I am about medicine, and I shouldn’t have to choose one over the others. I am damned proud of what I have accomplished in bodybuilding, especially because I was in my forties when I took things to the next level, not when I was a young whipper-snapper, and I was already established in my medical career. I will not apologize to people who are confused by the sampler plate philosophy by which I live and who don’t believe that it’s possible to be more than one thing. Truth is, I live as what Marci Alboher describes in her book One Person Multiple Careers as a Slash, and I am proud of it. I know it’s unusual, but why is that so hard for people to grasp? I mean, here I am, doing all that I do, switching gears constantly, and sending a message to the world that no one should have to be one-dimensional and boring.

I am honest. I have sass, and I speak my mind. I will NOT hide parts of myself which some overly judgmental people may have a problem with. I am NOT going to apologize for having a sense of humor, for using cuss words here and there (though I don’t use them while seeing patients). I am not going to paint a false picture of who I am. If you don’t like what I am doing, no worries. Move on.

Here’s a message to you if you find that you are someone who is compromising your own vision, dreams, or goals, because you perceive a need to choose one thing to define you. Perhaps you need to re-examine why you are allowing that to occur. If you subscribe to a no limits philosophy, then you would never even consider pulling the reins back. I will always encourage driven people to go for whatever they want, and if it doesn’t fit in with the conventions of one of their chosen careers or hobbies, even better. Break stereotypes and show people what you are made of! Don’t hide all the facets which make you who you are!

Yes I Write Prescriptions. No I Won’t Write One For Your Brother.

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As a fully licensed, board-certified physician, I have written my share of prescriptions over the years for medications, imaging studies, etc. I recognize that it is an incredible honor and privilege to be able to write scripts, and I never take advantage of it. However, there are people out there who think nothing of asking me to write prescriptions for them, simply because I am a fully credentialed physician conveniently standing there in front of them. What is especially irritating is when people dare to ask me to conduct curbside consultations or write prescriptions for their family members or loved ones who not only aren’t there with them to be examined, but who are complete strangers to me. Tell me, how in the world am I supposed to conduct a medical evaluation on a complete stranger, sight unseen? These same individuals also tend to get offended when I kindly tell them that their loved one needs to be seen in person by a qualified medical professional who can assess their condition and administer the appropriate treatment.

So if you are the kind of person who is in the habit of asking doctors to do similar favors for you or your family, please understand that your requests are unreasonable and inappropriate. If your husband, sister, son, cousin, or best friend needs medical attention, do the responsible thing and either tell that person to go see a doctor, or take that person to the doctor.

Of Orifices and Zero Freedom

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As a physician, I have had the incredible honor and privilege of studying every part of the human body, to the most minute detail. I have hovered over cadavers which were fileted and displayed for they eyes of inquisitive medical students, and scrubbed in on colon resections, open heart surgery, neurosurgery, cataract removal, etc. During my first month of internship as a newly minted physician, I massaged a dying heart with my gloved hands (no, the patient didn’t survive). I have also delivered over 40 infants via vaginal and Cesarean methods, and have pronounced the demise of patients in the wards. In fact, there are many stories I have collected over the years, some incredibly sad, some disgusting, some frightening, and some infuriating, but all true, and all part of my experience as a doctor.

I knew full well that by signing up for an education in medicine, I would be subjected to disgusting, morbid, frightening things, and that I would face mortality on a regular basis. However, after several years of working in family practice, I began to notice that I wasn’t thrilled with the fact that I examined orifices of every kind on a very regular basis. Whether it was a nostril, a mouth, an ear canal, an anus, a urethral meatus (layman’s term pee-hole), or vagina I had to examine, I was never thrilled about it, and the orifices below the belt were certainly much more bothersome to address. My intense dislike of such examinations, combined with the tedium of primary care and the low insurance reimbursement for services and procedures provided, caused me to retreat from primary care and focus more on the areas I had more interest in, namely, physical medicine, cosmetic dermatology, and anti-aging medicine, all of which are much cleaner and which do not require me to conduct examinations on private parts.

Another feature of primary care which made me cringe was the intense demand on a practitioner’s time. The only time it ever seemed reasonable for me to literally lose sleep night after night as a physician was when I was in training. At this point, there is no way you could convince me that such a thing is healthy, and I refuse to sign up for that. I won’t give up weekends to take on three stacked 12-hour work shifts, and I will not give up the few holidays I celebrate (Thanksgiving, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day) in order to work. As it is, I give up other major holidays to work, but since the work I perform on those holidays is in bodybuilding and fitness, I don’t mind it at all.

I love being a physician, and I find it incredibly rewarding to make a positive impact on my patients. However, I will not sacrifice balance in my life, or the freedom to pursue my other interests, in order to prove to society what a good physician I am. I don’t believe for a second that running oneself into the ground working as a physician ever sends a positive message to others. I don’t ever want to be the kind of doctor who is saddled with so many chart notes to write that an entire weekend is devoted to completing them. Not for me.

Lasty, I think it’s so strange that society still assumes that doctors are supposed to give their time and knowledge at a moment’s notice, on demand, yet I don’t see those same demands placed on people in other industries. I can’t tell you how many times I have been in a brief conversation with a complete stranger, who dares to ask me a medical question as soon as my profession is revealed. I swear, one of these days I am going to get a t-shirt made that says, “THE DOCTOR IS OFF-DUTY RIGHT NOW…NO MEDICAL QUESTIONS PLEASE”!

Of Bikinis And Medical Degrees

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In contrast with the illusion that society is prepared to welcome empowered women with open arms, I have met with a tremendous amount of opposition when I am evaluated for my medical expertise. Wanna know why? Because I competed onstage in blingy bikinis, because I continue to model in bikinis, and because I am not afraid to flaunt what I am blessed to still have. And it pisses me off.

You would think that societal influences have relaxed enough to allow a female physician to flaunt her femininity without getting dinged for it, but I continue to encounter resistance. In keeping with this double standard, there aren’t too many female docs who are confident enough to push the envelope and post images which may be considered more alluring. Female doctors are expected to remain covered up, with very little skin showing, in social media posts. I’m not talking about jeans and a t-shirt. I’m talking about professional business attire and a white coat, or scrubs. Evidently women who are physicians aren’t allowed to reveal who they are outside of the clinical setting. That’s ridiculous, and I refuse to give in.

If a client has a narrow-minded view of physicians and expects me to fit the mold of an uber-conservative nerdy person, that client will quickly reject me. I think it’s utter nonsense that my credibility has been questioned, simply because I also happen to be a model. I have a LIFE. I have a certain manner of dressing which includes a certain fashion flair. The way I dress for work is by no means gaudy or slutty, but because of my abhorrence of ultra conservative clothing and the white doctor’s coat, it is obvious that I refuse to play the stereotype game.

Tell me this: how the hell am I supposed to feel empowered when narrow-minded idiots insist on throwing their judgment on me? I admire a strong, intelligent, educated, accomplished person who also happens to beat the aging process and who isn’t afraid of flaunting it. Such people are courageous, not scandalous.
As a fully credentialed, board certified physician who also happens to be deeply involved in fitness, bodybuilding and modeling, I know that I stand out a bit in a sea of medical professionals, and to be honest, I am proud of it. A good portion of the world also seems ready for such empowered career women, but when those women are being considered for an ad campaign or other large scale project, they are quickly criticized and cast aside for their fortitude and boldness.

I don’t see why I should feel a drop of shame for modeling in bikinis. What the &*%@ is wrong with bikinis? Women all over the world wear bikinis, and even dare to go sans suits in some locales. So why should I be made to feel like I am being scandalous if I model in a bikini? I have modeled my entire life, and I have no plans to stop at all, especially if I have a physique which is bikini-worthy.

My life is so varied, full and exciting that I can easily escape the dry and often depressing climate of medicine and enjoy something that has twists and turns. None of my other pursuits diminish what I bring to the table as a healer. If anything, they add a humanness and relatability which I think my patients appreciate. I have said before and will say again that I have never been, nor will I ever be, a “typical” physician (whatever that means). So don’t try to mold me into something I am not.

I Had A Quick And Easy Divorce

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written by Ed Sherman

Many of your probably don’t know that I was married once. Back when I was about to start my second year of medical school, I met and was charmed by a guy who was about to start his first year of medical school at the same institution. He signed up to be one of my subjects for a study I was conducting on lumbar somatic dysfunction (I later found out that the main reason why he signed up was because he thought I was hot).

After I gathered scientific data from the portion of the study which involved him, he began asking me questions. Which mnemonic guides were the best for gross anatomy? Which professors were my favorite? Where did I typically study for exams? He then went in for the kill, taking me by surprise by asking me out. I liked him, and noticed he was different in a way that really grabbed my interest, so I said yes.

To make a long story short, that date progressed into a romance which was so intense that we were married a year later. In general, I loved being married, and though we had our difficulties, we made our marriage work for a while. Then it stopped working, and after three years, I asked for a divorce.

After the initial emotional anguish subsided, my husband and I spent close to a year trying to determine if divorce was the best option. Inevitably, we both agreed that being apart was actually much better for us both. Since we were both rather rational about our impending divorce, and retained a level of mutual respect which is quite rare among couples at the demise of their marriage, we agreed that we could probably bypass legal counsel and file the paperwork ourselves. I ended up purchasing a book called, How To Do Your Own Divorce In California, by Ed Sherman, and printed off the legal forms which were included on the CD in the back of the book.

I filed the initial paperwork and braced myself for the paper storm to follow. It was a bit of a hassle to complete all of the forms myself, but I saved a ton on legal fees. The total amount which I spent on the book and all the filings came to under $300, and I was happy to pay it. My husband and I were also able to complete the Marital Settlement Agreement without much difficulty, and we were able to reach a mutually beneficial arrangement.

Six months and one day from the day I filed, I received the final Divorce Decree in the mail. My divorce was honestly easier than some breakups in my life. And to this day, my ex-husband and I are on good terms. He remarried in November of last year (thirteen years after our divorce was finalized), and I can honestly say that I truly wish the best for him and his bride.

In case you are in the unfortunate predicament of a looming divorce, but feel confident that you and your estranged spouse can divorce without any drama or irrational behavior, you may want to consider the easy divorce route we took. The newest version of the book I used is now 20 bucks on Amazon. However, I am by no means endorsing this route, so you should explore other options if need be. If you are facing an ugly battle, you should definitely seek top notch legal counsel to aid you in the divorce process.

The newest edition of Ed Sherman’s valuable reference guide for divorce in California

Botox As An Antidepressant?

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The concept that Botox treatments can effectively treat depression has been around for a while, but a study surrounding this idea has recently been published in the Journal of the American Academy of Dermatology. Dr. Jason Reichenberg was able to determine that depression scores dropped over 40% in patients who had Botox treatments, versus 15% in patients who received a placebo. This was the case even in patients who were dissatisfied with the cosmetic result of Botox treatments.

The results point to Botox as an effective means of treating depression, especially in patients who are resistant to other treatments for depression. By relaxing the frontalis muscle and glabellar complex in the forehead, Botox makes it difficult for an individual to frown, which in turn appears to have a positive effect on mood and well-being. If you can’t frown, then you can’t fully experience the distress which a frown would ordinarily express, causing a modification of mood.

Botox is also used for correction of lines and wrinkles around the eyes, migraine headaches, temporomandibular joint disorder (TMJ), and excessive sweating.

For those of you in the Los Angeles area who are interested in Botox treatments, please visit http://www.drstaceynaito.com/botox-treatments

My Oldest Patient

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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?”

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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 138/72 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.