“Mornin’, Dr. Harper, the bus has arrived! I just brought back two because of acuity. A hypertensive lady with a headache. Here’re her vitals and EKG,” she said, passing me the first of two. “I already put in her labs. I know you like a chest X-ray, so I ordered that, too. Do you still want it?”

“Yes, please. Can you add a head CT, no contrast, so we can look into that headache? I’ll see her first, I just want to get her into the CT queue since they’ve had a long wait. I’ll cancel it if I change my mind.”

“Will do. There’s also a guy with depression, Mr. Wade, here for detox. Here’s his EKG,” she said, handing me the second electrocardiogram. “Said he’d been drinking on his way here. You’ll see his heart rate is a little tachy, at one-nineteen, but he’s fine.”

I quickly entered the standard orders for psychiatric clearance and alcohol intoxication for Mr. Wade, complete with a banana bag (an IV solution comprising normal saline and vitamins. The yellow color of the fluid is the reason for the nickname), before starting on my hypertensive patient.

Two additional main ER patients awaited triage. At 8:55 a.m., I heard the thunderous greeting of my co-attending for the day. Dale was always punctual. He arrived early and then worked slowly. He, too, had a love of coffee, and I always enjoyed his political commentary and music selections for the shift. Even if it was a busy day, it was fun to have him by my side.

“Hello, dear,” he bellowed.

“Lovely to see you, sir. Such a peaceful morning, and now you’ve arrived with the bus.”

“Yeah, well, what’s new? It’s always busy here anymore. I knew you were gonna be here, so I brought an additional container of my extra-dark-roast coffee with a hint of coconut oil. It’s magic in a cup! I know we talked about coconut oil losing its superfood status with that questionable cholesterol information, but I figure in moderation, it’s a justifiable indulgence.”

I adored Dale’s coffee: There was something special about that added coconut nectar. His kindness in bringing this gift so we could enjoy it together during a busy shift made our morning ritual that much more delicious.

“To the elixir of life,” he cheered as he handed me a thermos filled with my portion of coffee and then raised the other in a gesture for us to toast.

“Thank you again, Dale. I’ll be right back after I see this lady with a hypertensive urgency situation.”

I double-checked her electronic medical record: Olivia Hernandez, fifty-seven-year-old female with a history of hypertension, anemia, reflux, and being overweight. Her only medication was HCTZ, for her blood pressure. No allergies. Her medical record showed she had regular medical follow-ups and was pretty healthy. All appeared unremarkable.

I approached the room to see a woman who would have appeared much younger than her stated age if not for the mask of fatigue heavy on her face. She was neatly dressed in a pressed white dress shirt, snug blue slacks, and black ballet flats. Her thick black hair was secured in a casual ponytail that fell limp over her shoulder. While she was listed as overweight, it couldn’t have been by more than fifteen pounds or so. She was arranging her phone so that it lay visible on her lap and had placed her black satchel next to her on the stretcher when I approached her room.

“Good morning, Ms. Hernandez. I’m Dr. Harper. And how are you today?”

“Good morning, Doctor. I’m good, good. I called to see my doctor this morning because I haven’t been feeling well. I just knew my blood pressure was up.” She paused. “Well, I should be more specific.” Her phone beeped, and she silenced it before putting it away. “I’m sorry, Doctor,” she said, letting out a long exhalation and rubbing her forehead. “Where was I? Yes, I called my doctor because I’ve been getting these headaches sometimes. When I saw the nurse, my blood pressure was high, one-eighty over one-ten, so she said I had to come to the ER to be seen because it was too high for the clinic.”

“Of course, Ms. Hernandez. That makes sense,” I said, smiling at her. “How are you feeling now?”

“Actually, right now, I feel good. When I came to the hospital, I had a terrible headache. It was pressure all over here,” she stated, motioning across her forehead to both temples. She gave me a puzzled look. “Huh, you know my headache is still there, but better. I’m sorry, I feel so silly. I feel fine now.” She seemed embarrassed as she turned to look at the monitor behind her. “How’s my blood pressure now? I’m so sorry to take up your time here. I should go,” she said, as she started to gather her belongings.

“Let’s see,” I said, walking over to the monitor. “Let me ask you a couple more questions while it’s checking.” I hit the button to cycle the blood pressure. “So, I know you said you feel fine now. Did you have any chest pain, heart racing, or difficulty breathing?” She shook her head, indicating that she did not. “Any change in vision, numbness, weakness, leg swelling?” Again, no. “Difficulty urinating, blood in urine.”

“No.”

“And now the headache is mild?”

“Yes. Now that I’m here, I’m fine. My goodness. I’m so sorry to waste everyone’s time!”

“This is no waste of time.” I looked up at the monitor to see the new reading. “And your blood pressure is coming down a little since you came in. Now it’s one-sixty-nine over ninety-eight.”

“Still high, but better. Thank goodness!”

“It is. And we haven’t done a thing to you.” We both chuckled. “Any recent change in your medications?”

“No, Doctor. I’m only on one medication anyway. It’s called hydro . . . hydry-something.”

“Yes, your hydrochlorothiazide.”

“That’s it. I take it every day like clockwork.”

“Hmmm. Any smoking, drinking, drugs?”

“Goodness no. I mean, maybe a glass of wine rarely, but I really don’t even do that. Trust me, I’m sure I need a drink, but these days I really can’t.” She laughed, a moment of levity.

“What about stress?”

She let out a sigh. “Geez,” she said, slicking back the sides of her ponytail. “Do I have stress!”

I paused, squinting at her. “You seem like you’re a caretaker. What’s going on with your stress?”

“Well, Doc, as I sit here, my husband is also at the hospital. I’m sorry. That’s why I was checking my phone earlier. He was recently diagnosed with cancer. Unfortunately, it’s already spread. He’s been in and out of the hospital, back and forth to doctors’ appointments. And then we . . . well, now I also take care of my granddaughter. She’s four and autistic. Her parents . . .” She stopped and shook her head. “Well, anyway, we have full custody of her now. I just haven’t had the time for anything.”

“Of course. That makes a lot of sense.”

“I haven’t been eating as well as I used to,” she said, pulling at her blouse and then pointing to the buttons anchoring the fabric gaping open over her belly. “Doctor, this just happened last month.” She rolled her eyes upward as if scanning for glimpses of her former self.

“Well, you certainly do have a lot that you’re juggling right now. While there are many reasons for hypertension, I’m pretty confident your recent spikes in blood pressure have a lot to do with your stress.”

“I’m sure, too.”

“I know you have a lot going on, but is there anything you can do to cope with the stress you’re under now in some beneficial, positive ways?”

She laughed at this question. “Actually, there are some good things. My brother told me today that he can help out with appointments and errands for my husband. So, that helps.”

“What about your granddaughter?”

“Yes. Her parents are my greatest disappointment. They weren’t doing anything for her, so we’ve been playing catch-up. I’m pretty sure we’ll qualify for some kind of services for her, but I have to look into it. So much legal work. Let’s not discuss that right now, Doctor, if you want my blood pressure to stay down!”

“I gotcha,” I said, smiling. “So, the good news is that it sounds like there are some possibilities of assistance that will free up time and space for you to take care of yourself. ”

“Take care of myself, ” she said dreamily. “I’d like to get back to that. I need to.”

“Are there things that you enjoy? Some kind of physical activity, for example, could help with your blood pressure, mindfulness, and general wellness.”

“Believe it or not, I used to do martial arts. I did it for years. I really enjoyed it. There was something very calming about it, too. My sensei was a spiritual man, so he emphasized meditation in our practice. Because of him, I started meditating on my own. Just five or ten minutes a day. It really helped. I’ve been wanting to get back to it.”

“That’s something that could really help you now. Even as you finagle your schedule, you might just start the meditation again.”