I quickly skimmed through the rest of his chart. Mr. Lopes was an elderly Haitian man, a recent immigrant, who had visited the local emergency room for a bad headache, only to discover that his blood pressure was astronomical. Apparently, Mr. Lopes and his family considered him too sturdy a man to be retained at the hospital overnight, labeled as sick. So he fled.
And here he was, weeks later, to meet his new doctor. “BP: 190/100” read the nurse’s note in red.
I walked into the room, along with a professional interpreter. The haughty Mr. Lopes, whom I had molded out of printed words, crumbled. His counterpart in flesh and blood was a worn man: wrapped in grizzles and wrinkles. He looked up briefly from his crumpled posture to give me a weary smile and bent down again, covering his nose with a napkin. A bloody piece of cloth trembled from within his jittery fingers. Beside him stood a sprightly woman who introduced herself as his daughter, his next of kin and healthcare advocate in the alien land he now inhabited.
I inquired about his nosebleed.
“Oh, it’s nothing. He get it all the time. Lucky man,“ his daughter giggled.
Mr. Lopes chuckled in accord.
I asked if he had any medical evaluation in his country.
“He never go to doctors. He is healthy. This no problem. It will come and go,” reassured his daughter.
After examining him, I explained the relationship between his recurrent nosebleeds and uncontrolled hypertension. I went on to enlist all the complications that could ensue if not for timely treatment and assured that I would arrange for his transportation to the hospital.
“You worry too much, doctor. Believe me. In our culture, seeing blood means good luck. God telling you something good gonna happen. I pray for my father every day. You please don’t worry doctor,” she said, stroking my shoulder.
All my further attempts at persuasion and education were soon thwarted by her unflinching conviction.
Mr. Lopes concurred with his daughter’s decision and signed out against medical advice, yet again. He cancelled all subsequent appointments and did not answer my calls. I contacted the Elder Protective Services and waited. Weeks later, I received a note from the ER. Mr. Lopes had died of a stroke.