An obese (450#) man in his early forties, with uncontrolled hypertension and diabetes presents to the clinic for follow-up.
Part of our first year medical curriculum involves shadowing physicians in an active clinic— this is to apply the doctoring skills we’ve been slowly accumulating, such as creating a thorough medical and social history and performing parts of the physical examination. I’m assigned to an internal medicine and pediatric clinic, meaning they treat patients from newborns to the elderly, the whole spectrum of human. I was a bit nervous going in: I have never really interacted with children or infants before. To this end, I made a concerted effort to introduce myself to every toddler and baby I came across, to become comfortable with tiny, little people.
On my first day of clinic, of the four patients that I met, all were older than forty except for one rambunctious fifteen-month old. This left me a bit blindsided going into the clinic— I hadn’t considered what it would be like to meet adults struggling with depression, chronic medical conditions, and the health care system as a whole.
A nice southern gentleman, this patient moved here about a year ago from his family in Mississippi for work in Florida. He first presented to the clinic with dangerously high blood pressure, and has ever since been working with the resident physician to control his hypertension as well as his type II diabetes. On a number of medications and pills, the resident conducted the interview with ease and humor, obtaining a clear interval history— he’s a perfectly compliant patient trying to do what is necessary for his health. He’s been eating salads for lunch, taking his blood sugars regularly, monitoring which foods spike his levels, and earnestly trying to exercise and move regularly but foiled by waves of depression.
And that’s where the hammer comes in. If you have a hammer, then every problem tend to look like a nail. But sometimes, you may be facing a screw. Engulfed within the modern medical behemoth, the resident finished the interview and discussed tweaking and modifying his medication plan, adding a pill here, upping the dosage there. The resident had dutifully noted his repeated mentions of depression, which stole his motivation on the weekends, when not at work, and left him alone in his apartment, inside and with no desire to leave until Monday rolled around. She left the room to confer with the attending physician, while I stayed behind to chat with him.
Alone together, I asked him about his depression. I asked him why he found it so difficult to exercise, and how he used to move his body in the past. With these questions, he opened up and showed me the screw that needed turning.
A self-described country-boy who grew up in a town where his nearest neighbor lived a mile away, he spent his summers throwing bales of hay under the hot sun and he now lives in a small apartment in the middle of Tampa, FL. Ever since childhood, he worked with horses and loved their transparent nature— if you were calm, they were calm, if your body language betrayed an underlying tension, they could mess you up. Cleaning stables and feeding horses soothed him immensely: honest work with tangible results.
That’s when a connection fired off in my brain: a few weeks ago, I visited a horse ranch in Odessa, FL, about thirty minutes from USF campus, called Quantum Leap Farms. There, occupational therapists, mental health counselors, and DPTs all work together with therapy horses to rehabilitate and serve veterans with PTSD, children with cerebral palsy, and adults with severe autism. A lovely piece of land next to hundreds of acres of nature reserve and a beautiful lake, it is the antidote to city-life: quiet, serene, and healing.
I spoke at length with this rural fella about the differences between the city and places where you can see the stars at night. About how you can be alone in a grassy field without feeling lonely. About how nourishing a green landscape is for the soul. About how simple work with dirt under the fingernails can leave you tired, but rejuvenated compared to an hour on a treadmill in AC.
An exercise or fitness regimen can take all the mental grit and fortitude in the world, or none, depending on how enjoyable the practice is to the individual. Some people love yoga, some people can’t stand it. In the same way, a globogym can help folks or turn them away from an active lifestyle. Since he found it so difficult to move his body regularly because of his depressive bouts, I recommended contacting the folks at Quantum Leap— perhaps he could volunteer there, work with the horses and help maintain the stables, or perhaps he could attend one of their many therapies. A good dose of sunshine, nature, horses, and sweat would do him wonders.
His follow-up visit is in two weeks. I hope he’ll come back with renewed energy and vigor, having found something he truly enjoys, rather than dreads. To me, this is the keystone that his medical plan has been lacking: addressing a nutritional gap in his lifestyle diet. Nature is as essential to our overall health as Vitamin C and protein. Some of us live our lives without knowing what we’re missing— a horse born in captivity never knows the free and open landscape like a mustang. With more and more of us living and dying in cities, away from the stars, this is the supplement that can save lives and heal wounds: connection to life and thus, each other.