It was the typical patient. He was in his 50s and suffered from high blood pressure and high cholesterol. He came to the emergency department because he was having a headache and could not think clearly. After checking his vitals and labs, it was clear he was having a hypertensive emergency episode with systolic pressure running to 220 and evidence of papilledema on physical exam. He was admitted to the teaching service.
Once admitted, he was put through the ringer on intravenous medications to slowly bring the blood pressure down. Later that morning, I met him for the first time. Here was a burly man full of life, ready to get out of the hospital. He explained to me his past medical history, his compliance with medications and his awareness that his condition is pretty serious and could lead to a stroke or heart attack. As we were talking about beta blockers and statins, his lunch arrived. Immediately, his focus shifted and he began to look through the meal tray. His comments were peculiar: “I wonder what salt products a large hospital uses,” and “Why is hospital Jell-O always red?” as opposed to the usual, “This food looks bland” and “Why did I get the meatloaf again?” Let’s face it: hospital food is not fine dining. Speaking of which, my patient began to tell me about his true love–being a chef at a local restaurant in the city.
His story started with the time he enrolled in culinary school and ended with becoming a premier chef. His love for cooking was vibrant. As if I was not hungry already, his technique, passion and creativity got my taste buds going. He told me that his entire life was about running the kitchen, exploring new ingredients and pushing the envelope. He strikes the perfect balance of daring yet delicious in his meals. He uses international herbs and spices, fresh local ingredients and has a knack for infusing a variety of cuisines together. His restaurant is successful but his passion continues to grow. Likewise, so does his body mass index. This is a man whose life revolves around food. To a man with a hammer, everything is a nail. Likewise, to a chef, everything is worth eating.
We had a heart-to-heart conversation over the next day talking about diet, exercise and his love for cooking. He quickly admitted to a poor diet, excessive salt intake and infrequent exercise. He then said something that will forever stick with me: “I know this food stuff will kill me one day, but not being the chef and working the way I do will kill me today.” He was fully aware of it. He could not imagine a meal with less salt and openly wondered how better food would be if it was deep-fried as opposed to pan-fried. I was in an awkward position. Here was a man whose quality of life revolved solely around food, yet his habits would likely comprise his quantity of life.
I did not want to change who he was. I was certainly not going to take this man’s singular passion away to get blood work and blood pressure to a suitable level. We discussed the risks of his intake and ultimately I told him to continue his lifestyle. This was his identity. In medicine, we preach to do no harm and always advocate for the patient. In this unusual circumstance, my prescription for him was to continue living life to the fullest with carbohydrates, fats and grease.
Patients are the true storytellers. They come in with pathology, we interpret physiology and prescribe pharmacology, but their stories are what we remember. They shape our experiences and how we practice medicine.