The Supreme.

"This ain't no place to be if you planned on bein' a star."

~ from Rose Royce's Car Wash

There is this car wash here in Atlanta that always tries to add on a bunch of other services every time you go there. Like, if all you want is a simple car wash, you know, with bubbles first and water second, they start blasting you with this laundry list of other choices such as tire shine or Armor All on the dash or chassis wash or you name it.  I don't get my car washed too often but when I do, you can pretty much guarantee that I'm not looking for it to cost the same as a car payment.

The last time I went, I had plans for a preemptive strike.

"I'll have the regular wash--and nothing else unless it's included in the price of the regular wash."

"So, just want to be sure," the car wash dude replied, "You don't want any tire shine or to have the alloy wheels scrubbed, correct?"

"Is that included in the regular wash?"

"It's included in the supreme wash, ma'am. That's only five extra dollars."

"No thanks."

"You can also get tire shine or alloy wheel cleaning a la carte if you wish."

"Is it free?"

"It's only three additional dollars."

"Per wheel?"  I muttered that under my breath but he heard me.

"No. Per service."

I sat up in my car and beamed with my brightest, fake-est smile. "I'll have the regular wash, then. And nothing else unless it's included in the price of the regular wash."

Car wash dude finally conceded.


On Monday I was seeing this woman in the residents' clinic who was in her mid-sixties. She had high blood pressure, diabetes and high cholesterol.  She also smoked a pack of cigarettes daily and was fairly overweight.  But her approach to this clinic visit was quite similar to my preemptive strike at Cactus Car Wash.

"I just need to get my medications refilled--and nothing else," she stated matter-of-factly.

I looked at her electronic chart and what the resident physician had documented. Her blood pressure was well-controlled as was her cholesterol. Her insulin regimen could use a teeny-tiny tweak here and there, but on the grand scheme of blood sugar control, hers wasn't too bad.  She really needed to strongly consider quitting smoking and getting on some sort of exercise and dietary program would also be indicated. Oh yeah, and seeing as she was sixty-something she also needed some screening and health maintenance things.  According to her chart, she wasn't up to date on her mammography, a colonoscopy, bone density screening, a pneumonia vaccine or a flu vaccine.

In other words, she needed the supreme wash, not the regular one.

"Okay," I answered carefully, "We can refill your medicines. Your doctor is going to make a small increase to your insulin, but otherwise you've been managing your blood pressure and cholesterol just great."

"Alright then," she said with her eyebrows raised. She totally had my number.

"I see from your chart that you keep your appointments. I also see your key chain with the photographs. Are those your grandbabies?" I continued.

She looked at me suspiciously. "Yes. I gots twelve grands but this is the little ones. I got some that's older."

I smiled and said, "It looks like you have a lot to live for. I'd like to talk about ways to keep you at your best beyond your medication refills. Would that be okay?"

"Honestly, doctor? No, not really. I don't take no flu shots, mammograms hurt like hell and the last time I got one they said I had to do it again and nothin' was even wrong. Tha's when I said to hell with that test."

"I see. You know, the idea is to catch things before they become an issue. I agree--I've had a mammogram and it's certainly no fun. But you obviously care a lot about your health because you keep all of the appointments. Would you consider--"

"I'll consider getting my pressure pills, my cholesterol and my insulin. Y'all need to be glad I even let y'all give me them insulin shots. My grandmama lived to make ninety and she ain't never had none of that stuff. Including that camera up her rectum." She shuddered and shook her head. "I really ain't getting that one."

My resident chimed in. "Did your grandmama smoke?"


Fail.  What did he say that for?


"Naw. My grandmama did not smoke."  She looked like she really wanted to add on "smart ass" but chose not to. Thank goodness he had the sense to stop that line of questioning.


"Can we strike a deal?" I quickly added. "Like, maybe we could look at them and decide what could be the most important to you."


"I told you what was important to me."


"Can I at least tell you the reasoning behind offering these things so that you can think about it?"


She nodded and at least gave us that, so I took what I could get.  My resident and I explained what could be prevented or caught early by getting a flu shot, a pneumo-vax, a bone density scan, a mammogram, and a colonoscopy.  We talked about which things disproportionately affect African-americans, which she happened to be, and described how missing an opportunity to make an early diagnosis could make a difference.  And she listened. She at least listened.

At the end of that visit, she got exactly what she came for--her medication refills and that's it.

I saw her in the hallway when she was leaving and she asked, "Miss Manning, have you had the colon test?"

"No, I haven't," I answered. "But my sister and my parents have. I hear it's not exactly fun, but I know from my patients that colon cancer is a lot worse."

She looked at me intently and nodded. "Hmmm. I might thank about that one," she finally said while folding her coat over her arm.

"Good," I replied with a genuine smile because I could respect that. I offered her a quick hand squeeze and wished her a great rest of the week.

That afternoon as I left Grady I stood looking at my car in the parking garage. I noticed the black smudge all over the fancy alloy wheels that I'd paid extra for back in 2004 when I got my car.  I imagined them gleaming like the way they looked back then and paused for a moment. Next I glanced at the dusty tires and narrowed my eyes. . . . 

Hmmm.  Maybe the tire shine and alloy wheel cleaner wouldn't be such a bad idea after all. I just might think about that one next time.

***
Happy Wednesday.

Now playing on my mental iPod. . . . Car Wash.