The Cost of Ignoring Medical Advice

Olivia was a middle-aged, somewhat overweight, medium height, soft-spoken woman.  As a middle-aged, somewhat overweight, medium height, soft-spoken man, I expected nothing unusual from her. As a physician seeing her for the first time, I expected to hear an unremarkable history, perform a few routine tests, and prescribe some innocuous medications. My Monday afternoons were filled with people like Olivia with little or no insurance, who were willing to wait hours to be seen by a different physician each time they came to the clinic. I always hoped for something special, something unique from these people, and Olivia delivered.

Her complaints were similar to those of thousands of people I had seen and would see.  She had chronic headaches on the right side of her head.  She took aspirin or acetaminophen (Tylenol) without any relief.  The headaches kept her awake some nights, but they never made her vomit. She felt well otherwise, except that she lost hearing in her right ear some years earlier.  I sent her for blood tests, a brain wave test, and a head x-ray. I wanted to get a CT scan of her head, but that machine was being used to study dog brains at that time.  This was an academic center, where publishing papers had priority over treating uninsured people.

Her blood tests were normal.  Her brain wave results were uninformative, but her skull x-ray report spoke volumes. The radiologist noted, “Bullet in head entering through right ear.” Grant you, having worked in a few New York City hospitals, I was not surprised to see a report of a bullet here or there, but I was surprised that it never came up in our initial conversation. I asked Olivia to come back to see me.

I approached the subject as tactfully as I could, but inevitably I had to tell her, “You have a bullet in your head.” She was not shocked or distraught, and so I continued my revelation to her. “That is probably the reason you are having headaches.” She looked authentically skeptical and asked, “Do you think that is what’s giving me these headaches?” I assured her that it was, and it was also the reason she could not hear anything with her right ear. She asked if I could give her something to lessen the headaches. I wrote a prescription for a pain killer.

She was getting up to leave when I asked her if she knew how she got a bullet in her head. She said, “Of course, it’s from when my husband shot me.” She had obviously survived this marital discord. I asked about her husband. “Is he still in jail?”

She looked authentically puzzled, and asked me, “Why would he be in jail? I never told anybody he shot me.”

I had heard about domestic abuse, but had never seen this scenario, one in which there was an attempted murder that went unreported and apparently unnoticed. And so I asked, “Are you divorced or separated?”

She looked at me as if I were from another planet or just exceedingly slow-witted and explained, “No. We never separated. He promised he would never shoot me again.”

Apparently confirming her suspicions about my lack of real-life experiences, I asked, “Did he keep his promise?”

She got up to leave as she explained, “He stabbed me once after that, but he never shot me again.”

I was still inexperienced enough to attribute her literally sleeping with the man who had twice tried to kill her to bad judgment or brain damage. After all, that bullet in her skull must have had an impact on her brain function.

She did not return for a followup visit. I suspected that either the medicine I gave her reduced her headaches or her husband broke his promise and shot her again.

At the time I met Olivia, her story seemed unusual. Years later, I realized she was not the exception.  She was the rule. She insisted on risking her life to maintain the status quo.  Whatever the reason (and my psychiatrist colleagues have written books explaining it), she would die at the hands of her low-life paramour before she would change.

I have seen this phenomenon repeatedly, and history is littered with examples of this human trait. When scientists established that smoking cigarettes caused lung cancer, emphysema, heart disease, bad breath, etc., most of the general public shrugged its shoulders and lit up one more for good measure. When construction workers were told they had to wear protective hard hats at work, there were national protests.  Wearing a hard hat was viewed as a sign of weakness. When drivers were told they had to use seatbelts to keep them from flying through the windshield in a crash, there was a blizzard of information on how to disable the seatbelts. Which, of course, brings us to the futility of Covid-19 precautions.

A population willing to change in the face of calamity would get the best advice it could secure and, at the very least, give that advice a chance.  A government “for the people” would be expected to promote measures to minimize the suffering of those people, not ignore the risks in the name of “personal liberty.” This virus has tested our willingness to change in the absence of duress, and we have failed. It has tested the candor of our leaders, and they have failed. Scientists warned that this infection would kill or cripple hundreds of thousands or possibly millions if we did not change the way we live.  The warnings were drowned out by assurances from trusted sources that this was nothing to be concerned about.

The next virus and the next will test our ability to protect our children and parents and neighbors. The next virus will determine if we join Olivia in her exercise of personal liberty.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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