...One hell of a drug.

54 year old African-american female came into our clinic today. When I rescheduled her last week for this appointment, she wasn't "feeling good"; she then called back the next day to complain about how someone from the clinic called her to "give her hell" about how she didn't come to her appointment. After surveying all employees at the clinic, I found that her accusation was indeed false.

So back to today: she comes into the clinic wearing skinny black spandex pants and a backless shirt showing more cleavage than I thought was physically possible. It's 96°F outside and a cool 60°F in the townhome-turned-clinic and she's complaining to herself in the waiting area that it's "too hot in here". As I'm looking through her patient history, one major detail piques my interest. When she started coming to this clinic in October 2008, she was taking a lot of prescription pain-killers that were not prescribed to her, an assortment of uppers, down-ers, and numb-ers: Vicodin, codeine, Xanax, and Zoloft were among the ones that I recognized. Her last appointment with us 3 weeks ago shows that she's now enrolled in a program at a methadone clinic. Methadone basically keeps you from feeling the symptoms of opioid withdrawal while maintaining "pain relief" [really is awesome stuff, suggested wiki reading].

I call her to the back. I look over her prescribed medication list and ask if she's still taking her lisinopril, to which she replies "I did today". I take her blood pressure and I am completely blown away: 174 over 98. 'Impossible', I thought to myself, 'How is this lady even living a normal life?' I took it again on the other arm: even higher this time. Starting to doubt my blood pressure reading abilities, I said, "Let's go weigh you and we'll try this again". Weight's fine. Tried the BP readings again, and to my dismay, both arms were at/around a high of 177 over 102. Now this entire time she's bumbling to herself about how pissed off she is about this and that, I would have only been able to hear it had the thoughts in my head not been screaming "STAGE II HYPERTENSION" at me. After excusing myself from the treatment room to find the overseeing nurse, I'm thinking to myself that we need to get this lady to an ER (while I text the same thought to my best friend). The nurse looks over her chart and shakes her head in disappointment, "Missed appointments, drug rehab, methadone clinic, and she's still taking a 30 day prescription that was supposed to run out last month...let's go try talking some sense into her".

I followed her into the treatment room and listened to the nurse explain how the BP medication needs to be taken regularly while setting up for another reading. Record high score: 184 over 104. Awesome. The nurse asks a few questions about the rehab treatment she's been undergoing recently then tells her that she needs to be seen by a physician. The patient angrily yelled, "<removed for explicit nature>! And I sure as hell see enough doctors every week, I don't need another one telling me how to live my life!" Game over. We lose.

Things I must ponder at a later date, when I have time:

• She's been enrolled at this methadone clinic for at least 2 months now. Methadone causes low blood pressure and hypoventilation [1][2]. Why does she have high BP now?
• IF she indeed took the lisinopril this morning, why didn't she have lower BP today than 3 weeks ago, when she had not taken it for a week? With the other people I've seen, even if they haven't been taking their BP meds regularly, if they take it the morning of their appointment, their BP shows a drastic decrease.
• With no health insurance, no steady job, possibly family that has abandoned hope for you; why would you NOT take the FREE assistance from people that are experienced and professionally licensed health care providers?

The unappreciative nature of some people disgust me.