Doctor’s orders

Edwina called me late yesterday afternoon to tell me that she’s in the hospital at Princeton, a facility just a couple of blocks from her apartment. On Saturday, she said, she got “to coughing real bad” and “couldn’t catch [her] breath.” The ER folks clocked her oxygen level at 80%. The docs also discovered blood clots in her legs, so Edwina’s been receiving blood thinners along with oxygen and steroids for her COPD.

I made my way to Room 5117 this morning, bearing gifts of red grapes (Edwina’s favorite!) and a word search book focusing on the scriptures. Edwina’s face lit up when I handed them over.

We talked for more than an hour. Edwina told me that she was ready to go home, since she has an oxygen machine and her CPAP machine there to use.

“The doctor says I got to use both of my machines all the time,” Edwina told me, looking weary at the very thought.

Plus, she said, “I kicked Tyrone out. He make my blood pressure go up. And Joe-Joe [Edwina’s brother] says he ain’t gonna smoke in my apartment anymore or let in anybody who do.”

Edwina told me she was worried about how to get all the prescriptions she was probably going to need when she was released from the hospital.

“I already get four medicines,” she said, listing them off on her fingers. “And Medicaid only lets you get five prescriptions every month.”

I requested a visit from one of Princeton’s social workers, who arrived within ten minutes to talk over the problem with Edwina. Mandy told Edwina that she’d send the pharmacist from the hospital up, telling Edwina that this woman is particularly effective at finding the cheapest routes possible to filling prescriptions. Through coupons and special delivery plans, Mandy thinks Edwina might be able to manage.

The doctor’s visit interrupted our conversation, as a tall man in a white coat strode in with a team of doctors in training.

After a brief check on Edwina’s breathing, the doctor told her that she’d be going home either later today or tomorrow.

“You’ve got the oxygen machine and the CPAP at home and I want you to use them,” he said sternly.

“And,” he continued, “either you quit smoking or you’ll die. It’s that simple.”

I chimed in with a question about how to make the nicotine patches more afforable for Edwina. Her last attempt to use them cost her $85 at Wal-Mart, and she wasn’t able to buy more than one box.

“How much do cigarettes cost?” he replied.

“‘Bout $4 a pack,” Edwina said.

“So what’s a better deal, cigarettes that are gonna kill you or patches that are going to help you stop and save your life?”

“Yes, sir, I know I got to quit,” Edwina responded, lowering her head–a sign that I’ve come to recognize as Edwina’s response when she’s embarrassed about being scolded.

All I could think as I walked down the hospital hallway at the end of my visit was how hard the doctor’s reasoning would be to implement. I’m certainly not in favor of Edwina resuming her smoking habit, but the fact is that she can afford $4 many days to pick up a pack of cigarettes. But her lack of money management skills makes reserving $85 for a box of nicotine patches close to impossible.

In situations like this, I’m reminded of the need for medical professionals to educate themselves about the circumstances of many patients’ lives that make following doctor’s orders a lot more complicated than it might seem on the surface.

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