This afternoon would be my last day in clinic until I return from furlough in December. Some of my favorite patients were scheduled, and I was excited to see them one last time. First was a woman in her 60’s who came with her son, who was just barely younger than me. She had a high blood pressure, so high that I had asked her to take a strong medicine, but she just wasn’t ready. Interestingly, her son had a similarly high blood pressure five years ago when I met him. Since then, he has controlled his blood pressure by eating a vegan diet and walking one or two hours a day. He sat by his mother and told her that he was willing to show her what he did, to help her try to control her blood pressure just like him. I reminded them that not every patient could expect a miracle, but we prayed together for strength and healing, and celebrated that she had at least improved 17 points since Tuesday. I prescribed the medication and asked them to pick it up in case she still had high pressures by next week, and gave a form for lab tests that they would email me in a couple months.
My next appointment was a couple, I last saw them six weeks ago, had recommended some lifestyle changes for their high blood pressure and high cholesterol, and hoped that they were doing well. The wife had improved her blood pressure incredibly, from 178/115 to 111/78 without medications. She also had improvement in all areas of her cholesterol panel and in her sugars, simply with diet and exercise. After I celebrated her improvement, her husband smiled and switched to the seat closer to me. “I had even more improvement” he said. He was right, each of his cholesterol measurements had improved by 30-50%, and the risk to his heart had decreased by 40%, putting him in the intermediate-low risk category now instead of the high risk category. We had started a very low dose cholesterol medication last time, but that would, at most, only explain 10-20% of an improvement. I told the couple that I felt like a coach whose athletes had both just won the Olympics. Our prayer was a prayer of thanksgiving for miraculous improvement, and for wellbeing in the months to come.
When I called my next patient, I didn’t even recognize her coming in from the waiting room. She used to visit every month for about a year, during which time she lost 44 pounds and 20% of her body weight. I hadn’t seen her for the last 10 weeks. She hadn’t lost any more weight, but she lost an additional inch from her waist and two inches from her hips. “None of my clothes fit me anymore” she said with a smile, and showed off a bright, fitted floral dress. She looked like a different person. We celebrated her success and talked about her life goals – finishing a current building project, then going back to school and obtaining an associate’s degree. “Who will I see while you are gone?” She asked. That was easy for me to answer: “In July I gave a presentation to all the doctors, nurses, and clinical officers about healthy weight loss.” I said. “I explained best-practice measurements and diet advice, and I even used your story as an example of how to lose weight steadily and to keep it off. No matter who you come in to see, they will know what to advise, and they will even know a bit about you, even though they won’t know your name or that you are the one from the story.” In reality, the only reason this woman needs to come in regularly is because she doesn’t have a scale at home and wants to make sure she is on track. Other than that, I feel like I just celebrate and congratulate her each time. Our prayer is a prayer of thanksgiving, and a prayer for wisdom as she embarks on her other goals.
My final patient of the day is a 9-month-old child. He doubled in size since I saw him at his 6-month visit. His medical records were lost in a current family move, but it was easy enough to piece together his past vaccines. He was meeting all his developmental milestones, so we talked about things like introducing table foods and preventing accidents. The family confided that they might have a next child sooner than planned, and that they might choose to travel to a different country. I volunteered to help them sort out a vaccine record which conformed to CDC guidelines. I prayed a blessing for the child, and then my appointments were over for the day.
It took me almost an hour to finish things up in clinic. I stapled together the pages in my appointment book so that the front desk wouldn’t be confused and book someone while I was gone. I wrote 12 prescriptions and 2 lab request forms and left them stamped at the front desk for the proper individuals, since there are no verbal orders or automatic refills here. I took a pen and wrote on the hallway whiteboard “Dr Miller – Away until 6 December.” I already had most of my appointments booked on that day, and I would be very ready to see my patients again. But for the next few months, I would need to use email to answer questions and trust my colleagues to do the rest. But what a fantastic last day. I felt blessed to have such wonderful patients who were experiencing blessings and healing, and I get to be part of their journeys.