I have a patient who I will call Antonia.
Antonia is in her early 70’s. She came to the United States from Guatemala many years ago, but never learned to speak much English. This doesn’t cause her much of a problem; her community is small and tightly-knit, so she doesn’t have much need to speak English in her home or her neighborhood. And she has a large family—children and grandchildren and great-grandchildren—who live close by.
Antonia is one of my favorite patients. We communicate in different languages, and taking care of her is a series of endless frustrations. But I love her contradictions.
She seems so little when she sits in the chair in my exam room, feet up on the bar supporting the chair’s legs, her body folded up around the purse clutched tightly in her lap. But when she talks, she shines; she is larger than life. We enjoy ourselves. I like her, and I like being her doctor.
Here is Antonia’s medication list:
Metformin 1000 mg: 1 tablet 2 times daily
Glyburide 5 mg: 1 tablet 2 times daily
For pain associated with neuropathy (a complication of her diabetes):
Gabapentin 300 mg: 1 tablet 3 times daily
For high blood pressure:
Hydrochlorothiazide 25 mg: 1 tablet 1 time daily
Benazepril 20 mg: 1 tablet 1 time daily
To protect from heart attacks:
Aspirin 81 mg: 1 tablet 1 time daily
For a recent bout of depression:
Escitalopram 10 mg: 1 tablet 1 time daily
Omeprazole 20 mg: 1 tablet daily
Os-cal 500mg: 1 tablet 2 times daily
For cough of unclear etiology (maybe asthma?):
Albuterol Inhaler: 2 puffs four times daily as needed for cough
Despite these ten medicines on her official list, Antonia’s blood pressure is often too high when she comes in to see me. Her blood sugar is way out of control. And she has had a cough now for many months. I don’t know why she has a cough, because she has not completed most of the tests I have ordered for her. All of this troubles me.