The Vasculopath

I had an incredibly frustrating patient encounter yesterday – a 60-something gentleman who was recently in the hospital for an ischemic stroke. When I admitted him (late at night – curse this job), I mustered enough good charm to suggestively congratulate him on his first day of having quit smoking (I knew he wouldn’t). Super pleasant guy, with a supportive family all huddled around him in the ICU, but I just knew he couldn’t be reached on the smoking thing, even though he’d just dodged a major bullet by reversing all of his stroke symptoms after receiving the “clot-buster” medication just hours before.

Problem was, this guy is the ultimate “Vasculopath”. What is a “vasculopath”? It’s a rather informal term I apply to an individual with significant vascular disease, of which there are many risk factors and many manifestations. This guy had them all: high cholesterol, smoker, high blood pressure, family history of heart disease, age (>55), male sex, obesity, Diabetes Mellitus, and worst of all – personal history of heart disease, having had an MI (myocardial infarction) in the past. His regular physician had done marvelous work on him: normal blood pressure, controlled diabetes, normal cholesterol, had him taking aspirin – all the right things, but he refused to give up his cigarettes. As the saying goes: You can lead a horse to water, but you can’t make him drink.

Anyway, he convinced everyone at his bedside (at my less-than-gentle prodding) that he would quit smoking as a result of his stroke. I saw him back in clinic today and inquired about his 9 days since being admitted for a stroke – of course he’s right back to smoking with no intention to quit. [Deep breaths . . . count to ten] As I mentioned before, you choose your own death, in a sense. He’s basically playing a form of Russian Roulette – one of these days he’ll have “the big one”. My suggestion to clean up his diet and learn how to incorporate some physical activity into his daily routine fell on deaf ears, but he reluctantly agreed to try Chantix (a wonderful new addition to our smoking cessation arsenal) for the sake of his wife. [Mr. Passive-Aggressive, himself]

I can only hope that he sees the folly of his ways before it’s too late. A patient like this reminds me that I can do only so much as a physician – it’s times like this I just feel like a glorified advice-giver. It feels like a waste of my time, but maybe one of these times I’ll get through to him.

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One Response to “The Vasculopath”

  1. The doctor expresses the events beautifully. It is a treat to the eyes.

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