Elevating my Blood Pressure

I just arrived in Kisoro. I have no idea how sick people in this hospital are. I check blood pressures on all my patients, and I’ve been getting a lot of them in the 80s over 40s.

“Damn,” I thought, “these Ugandans are a sick bunch!”

But they never seemed to have any symptoms. Most of them were getting up and walking to the bathroom.

One woman looked dehydrated, said she was dizzy, and her BP was 68/38. I freaked out and ran over to the nurse. I practically shouted that I needed stat IV fluids, NS wide open, large bore IV blah blah blah. Ten minutes later I saw the patient out on the lawn, squatting down and scrubbing her clothes in an orange plastic basin.

“Damn,” I thought again, “these Ugandans are a sick bunch AND tough as nails!”

But I was missing some diagnosis, and I knew it. I just couldn't put the pieces of the puzzle together.

Then today in clinic, the culprit was outed.

At the chronic care clinic, the nurse checks in my patients with a different blood pressure cuff, and then writes the BP on a piece of paper, which the patient brings me. If I have time I recheck the blood pressure. And my pressures are always 20-30 points lower than the nurse's. Today it finally clicked: my cuff is broken.

I confirmed this by testing my cuff on one of the local experimental animals (his name is Will, he’s a med student). He states that his BP is “always 120/80”. Mine gave him a reading of 95/65.

The real joke is that I was actually starting to toy with ways to investigate this. Seriously, I was pondering a research project into the low blood pressure “phenomenon”: A case-control study, or cross-sectional design? Could I get grant funding for this?

Geez....