Abstract
This is the story of a loving relationship between a doctor and a vibrant, elderly woman. In the story, the doctor learns to accept his patient’s noncompliance with medical regimens; at the same time, he learns something about his own noncompliance.
Like many doctors, I have the unfortunate habit of scanning my office schedule to see which patients will make or break my day. This morning, I’m happy to see Sally’s name on the list. She waves to me as Anne escorts her into an examination room. A few minutes later, I walk into the room and notice the large plastic bag at her feet. Before I can say hello, Sally pulls two boxes from the bag.
“Fifty-one”, she says proudly. “Make that 52. Here’s one for you, and one for Anne.”
“Fifty-two?” I ask.
“Don’t look so surprised, doc. I baked 52 of ‘em over the holidays. Lemon pound, chocolate layer, apple-orange, and a few other favorites.”
Last visit she brought me the best lemon pound cake I’d ever tasted, and I let her know many times. Sally’s cakes are so good my colleagues tease me about having her return to the office every month! In truth, she comes in only when she is sick.
“You’re pretty amazing,” I tell her.
“So are you.”
She has been entertaining 30 people at her house every Sunday afternoon for the past 50 years. Ham, turkey, vegetables, and pound cake for everybody.
“Okay, Sally. Don’t tell me. You’ve been coughing and wheezing for the past 2 weeks.”
She smiles.
“You’ve also run out of your inhalers. You’re waking up at night coughing and carrying on. You’re here today because you’re worried you won’t have enough wind to make Sunday dinner. Did I leave anything out?”
“No, that’s about right.”
We both laugh. We both laugh because it’s the same story every time she comes in, and I know it well. When I was younger, I used to reproach Sally about her noncompliant behavior. She never gave me her reasons. After years of caring for her, I now understand: it’s about pride, a tight budget, and her unwillingness to entertain the concept of prevention. It’s also about my own inability to follow a strict, medical regimen (ie, reduce my fat intake).
“Hop up here,” I tell her.
She climbs on the examination table with ease. As I examine her, I playfully scold her about waiting until the last minute to come in. “Pick up the phone,” I tell her. “Call me. Call Anne.” Again, she prefers to tough it out.
I hear wheezes throughout her lungs.
“You get this prednisone filled as soon as you leave here.”
“Yes sir,” she barks out, in the middle of a cough.
“And here are a few steroid inhalers (remember these?) to keep your asthma in check.”
Of course, whom am I fooling? She never uses her steroid inhalers.
“They don’t work like the other ones,” she says, “and besides, why should I take them when I normally feel so good?” she says.
How do you feel now, I want to say. On second thought, no sense getting upset about it. Not much I can teach a spunky, 91-year old woman about how to live her life.
As I slice another piece of lemon pound cake, I muse, “High-fat snack. Cholesterol 245 mg/dL last week. Remember what the scale showed this morning?”
“True, but I’d hate to disappoint Sally!”
Footnotes
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Conflict of interest: none reported
- Received for publication June 26, 2003.
- Revision received September 15, 2003.
- Accepted for publication September 30, 2003.
- © 2004 Annals of Family Medicine, Inc.
