The outpatient clinic is a sight to see. There’s a large atrium with patients sitting with their families waiting to be seen. Some are coughing and wiping their noses, while others can be seen enjoying the sunlight that shines overhead.
The other day my final patient was a middle-aged man I had seen a couple of times before. Unfortunately, he recently had to quit work due to a neck injury he sustained at work. We spoke awhile about the difficulties of being unemployed but still having the responsibility of paying the bills.
We sat and chatted for a bit, and then I started to look over his chart when I noticed that his blood pressure had been elevated the last five times he visited us. I addressed his lifestyle, and I told him that I would start him on a low-dose of hydrochlorothiazide to see if we could get his blood pressure under control. I explained that hydrochlorothiazide was a very old and cheap medicine that cost just $4 for a 30-day supply of the generic. He put his head down and looked at his shoe, the sole of which was coming undone. He let out a sigh. After a second he looked at me with a hangdog expression and slowly said "I won't have the money for it until Friday"
He went on to speak about the financial troubles he was having and how his car broke down that very day and how he had to walk to the hospital. Knowing him from before and looking at his expressions, I could sense his honesty.
He is a very a pleasant guy, and I was saddened to see him going through such a tough time, but I knew that this medicine would help him avoid future problems.
I went out and spoke to my attending, and we spoke of how he had known the patient for years. We came into the room and began talking to the patient about his stressors and his hypertension. Then my attending asked, "Have you quit smoking?". My patient looked down for a split second and said, "Kind of. I don't smoke often, but last week I bought some singles." My attending asked him how much they cost, and the patient replied, “A dollar fifty for four cigarettes.”
It boggles my mind sometimes how there are so many patients who smoke regularly but are on five to ten mediations. I have to admit, though, that I was impressed that he was able to wean down from the pack-a-day habit he had a year before. We initially made it into a joke about how many tablets he could get for one cigarette, but we went on about how important it was for his hypertension and overall life that he quit smoking..
We finished up reviewing my plan and my attending left the room as I educated the patient about the medicine and about hypertension in general. A couple of minutes later my attending creaked the door open, handed my patient a $5 bill, and said, “Don’t tell anyone.” I was somewhat surprised actually because I had never seen anything like that done before.
I saw the gratitude in my patient’s eyes for this simple gesture, and it made me feel good. I’m actually looking forward to seeing him in a couple of weeks for follow up. I know we can't do this for everyone, but to know I was working with and learning from such a compassionate attending gave me a good feeling I’ll keep for the years to come.