Stephanie is a 64 year-old homeless woman who approached me today as I entered the shelter. She says in a hurry, “Doctor, I have high blood pressure, but I ran out of my medicine on Friday (4 days ago). Can you give me a refill? My head started pounding yesterday, and now my fingers are tingling.”
Given Stephanie’s active symptoms, I take her into the clinic. She is alert and oriented while I measure her blood pressure to be 180/95. She denies any chest pain, palpitations, shortness of breath, blurred vision, and abdominal discomfort. On exam, her lungs are clear and her heart sounds are normal with a regular rate and rhythm. Together, this reassures me that her blood pressure is not high enough to require immediate, urgent medical treatment for which we would either transport her to an emergency room or prescribe antihypertensive medications.
Turns out, Stephanie, like many women who frequent the shelter, is a victim of domestic violence. Up until a year ago, she worked as a sous chef at one of Boston’s upscale hotel restaurants. However, her boyfriend with whom she shared an apartment became a drug addict, and the more injection drugs he used, the more he beat her. It took her over two years to leave him, and by the time she finally did, she had lost her job, had no money, and was forced to live on the streets. Around that same time, Stephanie’s primary care physician of seven years retired, so in addition to losing her job, she also lost her regular source of medical care. When she ran out of her blood pressure medications 5 months ago, she was able to get her most recent refill at a local emergency room.
As I put Stephanie’s story together, I realize that this specific incident of running out of medication is just one hurdle in her large attempt at piecing her life back together. Instead of providing Stephanie a quick-fix by renewing her prescription, I thought it would be better to reconnect her to the medical system. After multiple phone calls, I find the young, enthusiastic physician who had taken over her previous PCP’s practice. When I speak to him, he is eager to see her after hearing her situation and together we arrange for Stephanie to visit his office in two hours. Although Stephanie is initially stressed that this visit will get in the way her job search, I am able to convince her that reestablishing a regular source of care will save her a lot of time in the future.
Many homeless women live in a world of uncertainty – precarious housing and limited income on top of complex medical and psychiatric problems. With so many moving parts, it is no wonder that some things fall to the wayside, as did Stephanie’s medical care in this case. By providing stable health care to these women, we hope to place some pieces of the puzzle in the right place.
No comments:
Post a Comment