Hypertension and the doctor's mental pain

She looked older and rather haggard. She specially had requested to see me. She complained of severe unremitting headache. She had been taking pain killers these past few weeks but the headache never went away. At times she said she felt nauseous and this has affected her quality of life.

I know her. Two years ago she came to my clinic because her daughter had a fall and broke her arm. After treating the child, she had told me that she was on an injectable contraception and was having headache every now and then.  I took her blood pressure and found it to be high. As it was a first reading and also the fact that she was under a  lot of stress due to her daughter's accident, I told her to have some basic blood investigations ( even gave her the forms!) and to come for daily blood pressure monitoring for three consecutive days and then to return to the clinic in 14 days' time. I also cautioned her that she would be better to stop the contraception as it can cause an increase in blood pressure in some women. I was looking forward to analysing her laboratory investigations and reviewing her blood pressure. I thought of her a lot for some unknown reasons.

But she never did turn up. That was two years ago and in the meantime she had given birth to her seventh child, having stopped her contraception soon after she saw me.

Today her blood pressure was still high and her urine contains blood and protein, an indication that her kidney function is not normal. She needs to be treated for her hypertension which has caused constant headache. If treatment had started two years back, her kidney function would not have deteriorated. I explained to her the need to be compliant with the treatment to delay the progress to kidney disease. She looked unconcerned and I feared she would not turn up for review in a fortnight's time.

As a doctor I feel sad and rather angry with myself for not being able to prevent this outcome. It did not help either  as we were not able to contact her earlier as she had no contact number. She lives far away from the city and public transportation there is poor.  She has no car. Poverty does make life miserable. And she is 37 years old with many young children to care for.  How could she look after her own health?

It is my turn now to have a headache!