Mrs. K. was a black lady in her fifties. She looked tired and depressed when she arrived to the floor. It wasn't the first time she was admitted - it happened at least three times in the last few years - "because her blood pressure was very high". She wasn't very good keeping her appointments with the primary physician, mostly because as she said: "each time when I went to see him, he was putting me in the hospital". This time she came to ER on her own. She wasn't able to move her right hand and leg for fifteen minutes. Symptoms resolved, but her blood pressure on admission was 260/140. It happened for the very first time and she was worried that it could be a stroke. She remembered that her doctor was warning her that something like that might happen. My intern thought that the case was a simple one. Patient should be ready for a discharge within couple of days and her primary physician will finish the work-up of TIA (transient ischemic attack - the first sign of impending stroke).
Well, but what next? Is she going to come back with the stroke? How are we going to convince her that this time she should take her medications? Is she going to listen to us if she didn't listen to her physician who she knew for a while? I decided to try, though all I expected was denial or one of the usual excuses like: "I forgot to take it", "I didn't have money to buy it" or "I lost my medication and I wasn't able to get an appointment with my doctor to get a new prescription". But when I began questioning her, she started crying. Yes, she wasn't taking her blood pressure medication, but she felt just fine. She didn't think that she really needed it. When she stopped sobbing, I gently touched her hand and asked why she was crying. Her eyes started watering again. "Because God has abandoned me..." she whispered. "That's not true" I said, " why would you say something like that?!"
She needed a few more minutes to quiet down. And then I found out why she wasn't compliant with her medications. She told me that members of her Church believe that the Holy Spirit is present when they pray together. She witnessed many miracles during their gatherings. Her Pastor laid his hands on her and prayed for her in the name of Jesus. She believed that she was cured, but her disease didn't go away. Apparently she didn't deserve the miracle...
I took her hand and started talking to her softly: "Fifty years ago there was no blood pressure medications. Hypertension meant paralysis or death. Itis a miracle that we have these medications now and that we can save so many people. We should be grateful to God for that and shouldn't look for any extra miracles if we have one at hand."
Then I pulled a small booklet out of my pocket. I usually give it to my Clinic patients. It contains diet and exercise instructions, reinforcement of the need to be compliant with medications as well as some space to write in blood pressure readings. The booklet is called "Ten Commandments For Patients With Hypertension". When she read that title she started crying again. "Now I realize", she said, "how ungrateful I have been. Miracle has happened indeed. Thank you for opening my eyes! I will take the medication for the rest of my life. I promise. " Three years passed. She kept her promise so far.