A couple of weeks ago I met a new patient. Ethenia is 54 but looks 30. Her skin is the color of coffee with a little cream and brown sugar, her teeth are straight and white and her hair is coiffed in long, thick braids. Her hands and arms are soft like warm soft dough and her face is sincere and concerned as she tries very hard to smile all the while wiping the tears that readily and continuously flow from her eyes. She is always dressed in black pants and a flowing blouse. She keeps her many appointments each week.
I was asked to see this member because her blood pressure is so high it is out of control. She is also bipolar. Her eyes stare straight and wide and her concentration is noticeable. As I take her blood pressure she searches my eyes for something unknown. I announce 210/105. She seems unflappable in a very fragile way like strong thin ice melting slowly on the outside. Her eyes stare, she shakes her head in acknowledgment and her Right hand shakes, always shakes. Although she is emotional it is hard to separate her emotions..they all seem to glob together like sand caught in a ice cream cone. Her emotions become the focus and everything else just surrounds her, almost invisible. How to pick out those granules and still get to have the ice cream? Seems impossible.
After a few visits and frequent trips to the emergency room with chest pains we figured out these panic attacks were causing the high blood pressure. I suggested a very low sodium diet, taking her medications regularly and on time, which she does, and yoga or meditation periods throughout the day and I suggested a medication called ativan to help alleviate the panic when it starts. She visits her psychiatrist and therapist 2 x a week and her Primary physician every two weeks. The emergency room gave her Percocett for the chest pains but she didn't want to fill the prescription for fear of an addiction and other side effects. She is on 9 medications a day, three for her bi polar, 2 for diabetes, 2 for high blood pressure and one for bad nerves and one for high cholesterol. Ativan would be the 10th.
Her blood pressure has stabilized but spikes periodically, her therapist agreed with me that yoga is a very calming practice and will help her sleep. Ethenia is trying. Her eyes still tear at every visit and her hand trembles, she habitually wipes the tears away but is unable to stop them from dropping. As I ready to leave after each visit she says, "be safe, be careful" and asks "will you be O.k.?"
I was trying to understand and help as much as possible and called the nurse case manager at the office. She is also concerned. "Did she tell you about her son?", she said. "No, what about him? I know she has a daughter and a grandson, sometimes, the grandson is there with her", I said.
A deep breath. "About 6 years ago her son was walking with his cousin in North Philly where the cousin lives", she said.
"Oh, yea, Ethenia sometimes goes to her sister's in North Philly", I said.
"Well, they were walking and some kids came up to them and pushed them..her son called them punks, the kids took out a gun, her son and his cousin ran but her son was hit with a flying bullet. The shooter walked up to him to see her son struggle and as he begged for his life the shooter shot him 4 times point blank in the head. The cousin got away. She has never gotten over it." "Her son was a musician, he wrote music and played different instruments, he was working on a CD"."There was no other reason for the shooting. No gangs, no drugs, no other reason".
How in the world is she going to forget that? How can she even give herself the attention she needs to tackle her own problems? She will never forget.
She'll have to start with some kind of forgiveness and acceptance and allow the ice cream to melt and start to build a new cone, a new life, one with a new meaning..the only thing, in my mind, that can help would be her faith. She has to try to pray and let go. She has to channel that energy into something purposeful.
Sometimes patients tell the nurses over the phone things they cannot say to another nurse in person. I'll have to try to steer her in the right direction without forcing her. I'll try to have her tell me the story.
Seems like her bipolar condition is a coping mechanism. Bipolar definition: having two opposing sides or systems; a disorder having alternating sides of mania and depression.
Hopefully it is a bridge to a more peaceful side, a life where she is able to cope and live.
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