The Beauty in Breaking

by Michele Harper

  “Mornin’, Dr. Harper, the bus has arrived! I just brought back two because of acuity. A hypertensive lady with a headache. Here’re her vitals and EKG,” she said, passing me the first of two. “I already put in her labs. I know you like a chest X-ray, so I ordered that, too. Do you still want it?”

  “Yes, please. Can you add a head CT, no contrast, so we can look into that headache? I’ll see her first, I just want to get her into the CT queue since they’ve had a long wait. I’ll cancel it if I change my mind.”

  “Will do. There’s also a guy with depression, Mr. Wade, here for detox. Here’s his EKG,” she said, handing me the second electrocardiogram. “Said he’d been drinking on his way here. You’ll see his heart rate is a little tachy, at one-nineteen, but he’s fine.”

  I quickly entered the standard orders for psychiatric clearance and alcohol intoxication for Mr. Wade, complete with a banana bag (an IV solution comprising normal saline and vitamins. The yellow color of the fluid is the reason for the nickname), before starting on my hypertensive patient.

  Two additional main ER patients awaited triage. At 8:55 a.m., I heard the thunderous greeting of my co-attending for the day. Dale was always punctual. He arrived early and then worked slowly. He, too, had a love of coffee, and I always enjoyed his political commentary and music selections for the shift. Even if it was a busy day, it was fun to have him by my side.

  “Hello, dear,” he bellowed.

  “Lovely to see you, sir. Such a peaceful morning, and now you’ve arrived with the bus.”

  “Yeah, well, what’s new? It’s always busy here anymore. I knew you were gonna be here, so I brought an additional container of my extra-dark-roast coffee with a hint of coconut oil. It’s magic in a cup! I know we talked about coconut oil losing its superfood status with that questionable cholesterol information, but I figure in moderation, it’s a justifiable indulgence.”

  I adored Dale’s coffee: There was something special about that added coconut nectar. His kindness in bringing this gift so we could enjoy it together during a busy shift made our morning ritual that much more delicious.

  “To the elixir of life,” he cheered as he handed me a thermos filled with my portion of coffee and then raised the other in a gesture for us to toast.

  “Thank you again, Dale. I’ll be right back after I see this lady with a hypertensive urgency situation.”

  I double-checked her electronic medical record: Olivia Hernandez, fifty-seven-year-old female with a history of hypertension, anemia, reflux, and being overweight. Her only medication was HCTZ, for her blood pressure. No allergies. Her medical record showed she had regular medical follow-ups and was pretty healthy. All appeared unremarkable.

  I approached the room to see a woman who would have appeared much younger than her stated age if not for the mask of fatigue heavy on her face. She was neatly dressed in a pressed white dress shirt, snug blue slacks, and black ballet flats. Her thick black hair was secured in a casual ponytail that fell limp over her shoulder. While she was listed as overweight, it couldn’t have been by more than fifteen pounds or so. She was arranging her phone so that it lay visible on her lap and had placed her black satchel next to her on the stretcher when I approached her room.

  “Good morning, Ms. Hernandez. I’m Dr. Harper. And how are you today?”

  “Good morning, Doctor. I’m good, good. I called to see my doctor this morning because I haven’t been feeling well. I just knew my blood pressure was up.” She paused. “Well, I should be more specific.” Her phone beeped, and she silenced it before putting it away. “I’m sorry, Doctor,” she said, letting out a long exhalation and rubbing her forehead. “Where was I? Yes, I called my doctor because I’ve been getting these headaches sometimes. When I saw the nurse, my blood pressure was high, one-eighty over one-ten, so she said I had to come to the ER to be seen because it was too high for the clinic.”

  “Of course, Ms. Hernandez. That makes sense,” I said, smiling at her. “How are you feeling now?”

  “Actually, right now, I feel good. When I came to the hospital, I had a terrible headache. It was pressure all over here,” she stated, motioning across her forehead to both temples. She gave me a puzzled look. “Huh, you know my headache is still there, but better. I’m sorry, I feel so silly. I feel fine now.” She seemed embarrassed as she turned to look at the monitor behind her. “How’s my blood pressure now? I’m so sorry to take up your time here. I should go,” she said, as she started to gather her belongings.

  “Let’s see,” I said, walking over to the monitor. “Let me ask you a couple more questions while it’s checking.” I hit the button to cycle the blood pressure. “So, I know you said you feel fine now. Did you have any chest pain, heart racing, or difficulty breathing?” She shook her head, indicating that she did not. “Any change in vision, numbness, weakness, leg swelling?” Again, no. “Difficulty urinating, blood in urine.”

  “No.”

  “And now the headache is mild?”

  “Yes. Now that I’m here, I’m fine. My goodness. I’m so sorry to waste everyone’s time!”

  “This is no waste of time.” I looked up at the monitor to see the new reading. “And your blood pressure is coming down a little since you came in. Now it’s one-sixty-nine over ninety-eight.”

  “Still high, but better. Thank goodness!”

  “It is. And we haven’t done a thing to you.” We both chuckled. “Any recent change in your medications?”

  “No, Doctor. I’m only on one medication anyway. It’s called hydro . . . hydry-something.”

  “Yes, your hydrochlorothiazide.”

  “That’s it. I take it every day like clockwork.”

  “Hmmm. Any smoking, drinking, drugs?”

  “Goodness no. I mean, maybe a glass of wine rarely, but I really don’t even do that. Trust me, I’m sure I need a drink, but these days I really can’t.” She laughed, a moment of levity.

  “What about stress?”

  She let out a sigh. “Geez,” she said, slicking back the sides of her ponytail. “Do I have stress!”

  I paused, squinting at her. “You seem like you’re a caretaker. What’s going on with your stress?”

  “Well, Doc, as I sit here, my husband is also at the hospital. I’m sorry. That’s why I was checking my phone earlier. He was recently diagnosed with cancer. Unfortunately, it’s already spread. He’s been in and out of the hospital, back and forth to doctors’ appointments. And then we . . . well, now I also take care of my granddaughter. She’s four and autistic. Her parents . . .” She stopped and shook her head. “Well, anyway, we have full custody of her now. I just haven’t had the time for anything.”

  “Of course. That makes a lot of sense.”

  “I haven’t been eating as well as I used to,” she said, pulling at her blouse and then pointing to the buttons anchoring the fabric gaping open over her belly. “Doctor, this just happened last month.” She rolled her eyes upward as if scanning for glimpses of her former self.

  “Well, you certainly do have a lot that you’re juggling right now. While there are many reasons for hypertension, I’m pretty confident your recent spikes in blood pressure have a lot to do with your stress.”

  “I’m sure, too.”

  “I know you have a lot going on, but is there anything you can do to cope with the stress you’re under now in some beneficial, positive ways?”

  She laughed at this question. “Actually, there are some good things. My brother told me today that he can help out with appointments and errands for my husband. So, that helps.”

  “What about your granddaughter?”

  “Yes. Her parents are my greatest disappointment. They weren’t doing anything for her, so we’ve been playing catch-up. I’m pretty sure we’ll qualify for some kind of services for her, but I have to look into it. So much legal work. Let’s not discuss that right now
, Doctor, if you want my blood pressure to stay down!”

  “I gotcha,” I said, smiling. “So, the good news is that it sounds like there are some possibilities of assistance that will free up time and space for you to take care of yourself. ”

  “Take care of myself, ” she said dreamily. “I’d like to get back to that. I need to.”

  “Are there things that you enjoy? Some kind of physical activity, for example, could help with your blood pressure, mindfulness, and general wellness.”

  “Believe it or not, I used to do martial arts. I did it for years. I really enjoyed it. There was something very calming about it, too. My sensei was a spiritual man, so he emphasized meditation in our practice. Because of him, I started meditating on my own. Just five or ten minutes a day. It really helped. I’ve been wanting to get back to it.”

  “That’s something that could really help you now. Even as you finagle your schedule, you might just start the meditation again.”

  “That’s true.”

  “So, here’s the thing: I have a feeling that your blood pressure elevation and headaches are stress-related. Now, I don’t want you to think I’m minimizing the importance of your high blood pressure by saying that. But we know there’s a powerful mind-body connection. Stress can lead to heart attack, stress can lead to stroke, stress can lead to infection. You get the idea. Because of this, even when I feel your symptoms are due to stress, we should check your blood to take a look at your kidneys, do a chest X-ray to take a look at your heart and lungs, and an EKG as well to look at your heart. Let’s do a head CT, too, to make sure there’s no bleeding or other abnormality, given your new headaches in the setting of elevated blood pressure. This may seem like overkill, since I’m pretty confident they’ll all be normal, but I still think we should check to be safe. Make sense?”

  “It does. I have a feeling they will all be normal, too. I think it’s just stress. I don’t want to take up any more of your time. But since I’m already here, I might as well get checked out, because goodness only knows when I can come back. You’re right. I definitely can’t afford to get sick now, so better to play it safe.”

  I nodded. “And you could even practice that meditation you mentioned while we’re waiting for your results.”

  Ms. Hernandez reclined on the stretcher, and her face softened into a smile. “Good idea.”

  “Excellent. Just relax. Do you want the lights on or off?”

  “Off is good. Thank you.”

  I flipped the light switch and as I left the room, I heard Transportation calling to take Ms. Hernandez up to radiology. Perfect timing. After refreshing my computer screen, I saw that all her labs, as expected, were normal.

  Next, I moved on to Abraham Wade, a tall, muscular white man who’d come in for alcohol detox and depression; his repeat vitals were normal. I tapped on the door and completed the routine introductions. His hair looked as if it had been recently cut, and it was dark and slick with the same sweat that ringed his collar. Although he had told Angela he’d just been drinking, he appeared sober. He didn’t seem to have any acute medical issues. He explained that after being in the military, he had had a bout of prescription drug abuse: He’d been prescribed oxycodone for the chronic back pain he developed during his deployment overseas. His mental health care notes explained that his primary care provider and pain management specialists had worked together to get him on a non-narcotic pain regimen. When I asked him about this, Mr. Wade agreed that it was partially true, but added that it was truer to say that he had simply decided he didn’t want to be addicted to narcotics anymore. He had stopped taking them and started working out more, which had alleviated his pain.

  I completed the required history and exam and then prepared to get back to my coconut coffee.

  “Well, Mr. Wade, my part is done. I just do the medical screening. Your labs are all cooking, and I’m pretty confident they’ll be fine. The other parts, the depression and alcohol use, you and the psychiatrist will discuss,” I stated as I began to back out of the room.

  “Doctor, do you know who the psychiatrist is? Do you think he’ll send me home? I mean, I’m not suicidal or nuthin’. I was just so desperate. I want to live. I want to be better. I’m a good guy,” he said, pointing at his chest. “I’m really a good guy. You might not know that from all the shitty things I’ve done, but I am.”

  “I believe you. We all do shitty things sometimes,” I said, unable to stifle some knowing laughter.

  “Yeah, right?” he said, nodding.

  “As for who’s on, it’s Dr. Masetti. I really don’t want to speak for him. He’s super nice and thoughtful. A really sweet man. I know he will do whatever he can for you. Anything else before I go?”

  “Ma’am, I just really want to do this,” he continued. “It’s time. I never talked about my drinking when I was here before,” he pleaded as he kneaded his hands.

  I took a couple of steps toward him and rested against the sink to show that I was listening.

  “Ever since I got out, I’ve been drinking. Come to think of it, I was drinking before the military. I remember I would drink when I was a kid. When my father wasn’t home, which was always—thank God, because he was a tyrant—I would break into the liquor cabinet and take a bottle out for me and my friends. I did stop drinking when I enlisted. I mean I only drank between deployments. I liked to say that I would only have a drink with dinner or socially.” He frowned and wrung his hands. “But I was pretty social, Doc.” He laughed. “Come to think of it, ma’am, I was always a mess. Ever since I was little, I tensed up when men yelled. So, what do I do? I join the military, of all places,” he said, throwing up his hands. “When I got back, I was always wound up. I’d start sweating in crowds—markets, malls. God forbid a car would backfire. I didn’t even realize until recently that that is not normal.” He paused. “I’d just go home and have a drink.

  “Ma’am, I had a good job. I was the foreman at a big construction company and ran my own side business, too, doing floors, some painting. I was doing great. But then I started drinking more and more. I didn’t know what was happening. I mean, I literally didn’t know because I would black out. My business was the first to go. Then my wife left with my son, just last month. She did the right thing, too, Doctor. I was an asshole.” He paused, frowning again. “Look, I’m sorry. I know you don’t have time for all this. I know you have other patients.”

  I was listening to him, taking it all in. “It’s okay. I have a minute before I have to scoot.”

  “Thank you, ma’am. I just wanted to ask,” he said, clearing his throat. “Well, I’m sorry. I mean, first, do you even know how I ended up here? A couple weeks ago I somehow called my wife—or ex-wife; I don’t even know what she is now, but I called her. I don’t know what happened. I was drunk. She had left to stay with her parents and stopped taking my calls the week before, so she didn’t even get my voice mail until the morning. She checked it and heard me spewing craziness. She tried calling me at home; I didn’t answer. She called work, but they said I wasn’t there. She was too afraid to come home, and I don’t blame her.

  “I woke up to men in SWAT gear breaking down my door. Meanwhile, I’m curled up in a fetal position on the floor with my guns laid out around me. Next thing I knew, all these armed men rushed the room. They got a call from my ex saying she had to flee the house the month before because her husband, who’s ex-military, is a depressed alcoholic and he just left a message screaming about how he’s gonna kill himself. To tell you the truth about it, I was really embarrassed, but I was also more than a little pissed off that they busted my doors. The police took me to the closest ER, but I refused treatment. Instead, I went home to fix my fucking doors.”

  Realizing he’d used an expletive, he interjected, “Oh, I’m sorry, Doctor. Please excuse my language.”

  He continued: “Yesterday I blacked out and woke up this afternoon with my b
edroom door on the floor—I don’t think I ever fixed it right. Two empty bottles of vodka were on the floor from I don’t know where. I had a voice mail from work, since I was a no-show, and one from my five-year-old son, who I haven’t seen in three weeks. So today, I drove myself in. There really isn’t much left for me to lose. I have to do this. I know this isn’t your decision, but I just want everyone to know. I want everyone to know now that I need help. I’m a good guy under all this bullshit. Oh, sorry again for that.”

  I studied his ruddy face. I felt the determination in his voice. “No worries, I get it,” I said. “You’re a good guy, and you’ll get through this. You are getting through this. I’ll let the psychiatrist know what we spoke about.” What I meant but couldn’t say to Mr. Wade, for fear of implying a promise that was not mine to make, was that I would beg Dr. Masetti to admit him to the hospital today.

  “Ma’am, again, I’m sorry to keep you. I just wanted to ask you something before I went off on that long tangent. I want to ask you how hard will this be? How hard is detox?” His tone seemed to convey even more sincerity than before. He was a strong man, a smart man, one who right now was desperate and open. In this moment, he was a man who wanted with every fiber of his being to transcend this part of his life.

  I looked at him, wanting that transcendence for him, too, wanting it with every fiber of my being. “That, my friend, is a good question. I’m going to tell you the truth because I think you want it, I think you deserve it, and it will only help you get through this so you can live the life you want, which is the life you deserve.”

  He nodded silently, listening raptly.

  “Let’s talk about the physical part first. It’s true the body can become dependent on alcohol. Some people have more of a physical dependency than others. As you detox, you might feel anxious, you might feel sweaty. You might feel your heart racing. In severe cases, people hallucinate—and the list goes on. But we have medication for all that. Honestly, even if you have a seizure, heaven forbid, it’s going to be okay because we can manage the physical part for you while you’re here. This medicine will soothe you and help prevent any of the dangerous complications.