By Emmanuel Fashakin
Dateline: January 2012.
My spouse, Abby, had just qualified as a Nurse Practitioner. Her New York State license was pending.
“Perfect!” I told her. “Come with me to the office and sit behind me as I see patients. By the time you get your license, you will be the best Nurse Practitioner in the State of New York!”
In the second week of her apprenticeship, on a cold Monday morning, I glanced at my appointment list and saw Charlie’s name.
Charlie was hypertensive but rarely kept his appointments and never complied with his medications. Yet he was a very good man, a fine gentleman. Six feet tall, with charming sideburns. He never argued, no matter what you said. He would smile and nod in understanding, and then never follow the advice.
He had last been scheduled months earlier but never showed up. Despite repeated calls and promises, he stayed away until now, nine months since the last appointment.
In previous visits, his pattern was the same. His blood pressure would be dangerously high because he had stopped taking his medications. I would treat him, counsel him about hypertension being a silent killer, adjust his prescriptions, and ask him to return in a few weeks or months.
Occasionally, he surprised me by showing up. When he did, his blood pressure would improve significantly. I would encourage him and schedule a routine follow-up.
Then he would disappear again.
Charlie was a successful businessman. He owned a security company supplying guards to various organizations. Although he made good money, he never purchased medical insurance, despite my repeated advice. Instead, he enrolled in my practice’s subsidized program for self-pay patients, paying a modest annual fee for unlimited visits.
He would pay for the entire year, make one visit, and vanish.
Even when I grew exasperated, the smile never left his face. He nodded in agreement, in acquiescence.
Sadly, he never changed.
That morning, his blood pressure was 206/110, dangerously high, though not the worst I had seen on him. What concerned me more was his electrocardiogram. It now showed evidence of left ventricular strain, a change that had not been present before.
Charlie insisted he felt fine.
I told him he wasn’t. Under ordinary circumstances, I would have called an ambulance immediately. But he had no insurance, and hospitalization would cost thousands of dollars.
He refused outright. The expense would be too much. We argued.
Finally, we reached a compromise. I renewed his medications, which he had not taken for months, added a beta-blocker, and instructed him to return in two days. He was not to go back to work until I cleared him. I also referred him to a cardiologist.
He agreed.
Two days later, he did not show up.
We called. He said he felt okay and had returned to work. He promised to come the following week. I pleaded with him, but it made no difference.
The next day, Thursday, the hospital called.
As soon as they mentioned his name, my heart sank.
Charlie had collapsed after work. He could not be resuscitated. He died in the emergency room.
They were asking about his next of kin.
His closest relative, a brother, lived in the United Kingdom. His wife and children were in Nigeria. He had no immediate family in the United States.
I wondered why he had not brought them over. Perhaps immigration issues. Perhaps that was why he avoided insurance. Perhaps that was why he feared the hospital.
But why not take his medications? Why not keep his appointments?
I thought of the security company he had worked so hard to build. What would become of it now?
I do not know.
When Abby heard the news, she screamed and wept like a child. She had seen Charlie only once, but he left an impression, tall, handsome, unfailingly pleasant.
He was a very good man.
He just never listened.
Emmanuel O. Fashakin, M.D., FMCS(Nig), FWACS, FRCS(Ed), FAAFP, Esq.
Attorney at Law & Medical Director,
Abbydek Family Medical Practice, P.C.
Web address: http://www.abbydek.com
Cell phone: +1-347-217-6175
“Primum non nocere”
