Reflections from a Clinic Session at Grady: "It's in my nature."

*Note: Name changed, multiple details of story modified to protect anonymity.

"If they say, why, why?
Tell 'em that it's human nature

Why, why does he do me that way?

If they say, why, why?
Tell 'em that it's human nature

Why, why does he do me that way?

I like livin' this way
I like lovin' this way. . . ."

~ from Michael Jackson's "Human Nature"

_____________________________________________________________

"I stopped taking them medicines, I ain't gon' even lie."

That quickly explained why someone on three different blood pressure medications would still have a reading of 174/104. His muscular arms were folded tightly and he tapped his foot nervously on the floor. I couldn't quite tell his age. Salt and pepper at the temples, youngish facial features, and a bit of a spare tire--forty something? Hmmm. I couldn't tell.

"How old are you, Mr. Darby?" I decided to ask him instead of looking at the chart.

"Almost 46," he answered quickly. Then he added, "And I'm too young to be on all that medicine!"

"Yeah. . . ." I thumbed through his chart while facing him at the desk. The notes dated back to 2006. Each encounter said the same thing: Hypertension, poorly controlled. I looked up at him intently. "You are a young guy, Mr. Darby, but from looking through your chart, you've had a high blood pressure reading for a while. When did you stop taking your medicine?"

He raised his eyebrows and gave an exaggerated sigh. He didn't want to answer too many questions. "Look, can't you just put me on one strong medicine? I'm serious, doc, I ain't tryin' to take all these pills and potions. I'm for real."

"You didn't answer my question."

"I stopped them medicines like a month ago. My body just wasn't right and I didn't know which one it was so I said, 'to hell with all this stuff' and stopped it all." His cell phone started playing a loud rap tune and he leaned back in his chair, straightened out his right leg and fished around in his pocket to retrieve it. Without so much as an "excuse me, doctor" he took the call right there in front of me.

"Hey," he spoke quietly, "I'm in here with the doctor so you gon' have to call me back."

I could hear the garbled reply of what sounded like a pretty feisty woman speaking back to him. She didn't seem to care too much about the 'I'm in here with the doctor' or the 'you gon' have to call me back'. He listened intently for a few seconds and then interrupted her.

"Yeah, okay, but I need to go. The doctor right here staring in my face." (He didn't even look at me when he said this which is rather amusing.) More Charlie Brown's-teacher-esque talking from lady caller. Again he intercepted her tirade. "Okay! I will! Damn!"

Lady-caller got a little fired up with that snippy response. Although I had no idea what she was saying, I could tell it wasn't good. I take that back--I think I'm pretty sure I heard something in there that resembled "Aww HELL naw!" He let out the exaggerated sigh once more and slapped his open palm over his brow. Dragging his hand down his face, he shook his head and tapped his foot again. You could still hear from escalating garble that Lady-caller meant business. My patient decided to lay down the law.

"Look here, you 'bout to upset me. I said I would. Now that's the end of it. I'm getting off the phone with you now." And with that, he snapped his Motorola shut and stuffed it back into his pocket.

"Sorry about that, doc."

That's what you'd think he would've said, right? Think again. Mr. Darby didn't even flinch--or acknowledge that I'd just sat through an episode of the Peanuts. Crazy? Possibly. But so very "Grady" and blogworthy? Oh-yeah.

"What do you mean 'your body wasn't right?'" I launched right back in. If he wasn't planning on wasting time on pleasantries, neither was I.

"Just what I said. It wasn't right. Made me feel crazy and all 'flicted."

"You were 'flicted like how?" (By the way, 'flicted is a good ol' slang word used mostly by Southern African-Americans that's short for "afflicted." It's what you say when something is messed up, sick, injured, or just not right.) I could feel a smile creeping over my face because I found it endearing that he'd used such an advanced slang term with me. I knew Mr. Darby had unleashed this word because he felt comfortable and knew I'd get it--kind of like the way Spanish speaking folks start talking real-real fast to native Spanish speakers. And he was right. I did get it. His doctor was no "Grady gringo."

"So you was 'flicted like how?" I repeated, breaking my subject verb agreement just to reaffirm that he hadn't used "flicted" in vain. Mr. Darby just sat there staring at me with this exasperated flaring of his nostrils. I could tell that I was beginning to get on his nerves, similar to Lady-caller. That's when it dawned on me. Ah hah!

"Mr. Darby, sir? Can I ask you a question?"

"I got a feeling you gon' do that no matter what I say, doc," he retorted. I chuckled and was a bit relieved when he did, too.

"Mr. Darby, sir, tell me. . . . .your phone conversation. . . . .did it have anything to do with why you stopped taking your medicine?" My searing eye contact said, That's right, I asked it. And I ain't backing down. He cocked his head to the side and squinted his eyes.

Oh what the heck. Why not just go there, Manning? "Mr. Darby, why'd you stop taking your blood pressure pills? Was it because they. . . . affected your nature?" Yep, that's right, I said it. (Nature. Code for "ability to get an erection" but without the embarrassing words "ability" or "erection.")

He rubbed both palms over his eyes, tapped that nervous foot and then nodded his head slowly. "Lord have mercy," he mumbled under his breath, "I can't believe I'm speaking to a lady doctor about this."

"Mr. Darby, this isn't an unusual side effect, so don't worry." He glanced up at me sheepishly. "So let me just be sure. . .you want to be with your lady friend, right? Like, you have the desire?" I needed to make sure this wasn't a libido thing, which wouldn't be the blood pressure pills at all. He offered a fast nod. "Do you get there at all? I mean, like, enough to do anything?"

Mr. Darby folded his arms again and looked down. "I mean, doc, it get almost there but then run outta gas, you know? Not enough to do anything." It reminded me of what I once heard an elderly gentleman say to describe his aging "nature"--"It get a little heavy for me sometimes, doc, but tha's about it."

"Hmmm. What about when you first wake up?"

"Yeah, it seem okay when I first get up, but like I said, not enough to do the deed, you know?"

"Gotcha," I responded in the most non-judgemental way I could. "Okay, then. Well from looking at your chart, they added on metoprolol two months ago, right? Even though the other pills may cause problems with your nature, I think it might be from this one that just got added." I looked at him again, and he nodded for me to go on. "Why don't we start back these two, and bring you back in two weeks?" Mr. Darby looked agreeable. Whew. "We also need to talk about these cigarettes. You know they can mess with your nature, too, over time." Fortunately for me, and his nature, he was amenable to that suggestion, too.


We chatted a bit more about his overall frustration with his blood pressure, his erectile dysfunction, and everything in between. We wrapped up the visit with a plan for him to consider setting a "quit date" for smoking cessation, a careful plan for blood pressure control, and a close follow up appointment. After answering Mr. Darby's questions, I made my way to the door.

"Dr. Manning?" he asked, "How you know what she was asking about?" I looked back at him and shrugged my shoulders as if to say, I just knew.

"Mr. Darby, let her know we will try this first and bring you back, okay? We can talk about other stuff if that doesn't work. She can come with you if y'all want." He looked at me incredulously, and then let out a hearty chuckle. Then I added,"If I give you Viagra now, you might not come back to get that pressure controlled."

"Dang, doc, you good," Mr. Darby laughed as I pulled the handle to the door. "Listen here, doc. . . thanks for making me more comfortable. I sure 'preciate you."

'Preciate you. Aaaah. It's like a Grady gold star. . . .one of the highest compliments a Grady patient can give you.

***

"Why'd you stop taking your medicine?"

Sometimes it's "nature," other times it's something else. . . . one thing I now know for sure after nearly a decade of working at Grady is this: people don't just stop taking their medicines for nothing. Maybe it's money or transportation to the pharmacy. Could just be fear or lack of trust. Or who knows? It could be that you simply feel 'flicted every time you take it. Just maybe it's all of the above. No matter what it is, whenever somebody keeps missing medicines, missing appointments, and altogether missing the boat, now I know that our job includes the following steps:

Wonder.
Why.
Ask.
Why.
Listen.
Why.
Think.
Why.
Figure.
Why.
Discuss.
Why.
Determine.
How.

. . . .even when you feel frustrated and even when you don't feel like it. . . . .and just maybe your thoughtful listening and care will eventually become second nature. (Couldn't resist the pun--totally intended.)

***

Mr. Darby's ringtone chimed in the hallway as he exited the clinic. After the tell-tell snap of his flip phone opening, the last thing I heard him say as his voice trailed away was this:

"Hey. Yeah, yeah, we talked about it. Naw, I didn't get what you said, but we talked about it. . . and . . . .I think we gon' be alright. . . . ."