Health & Medicine / Nutrition

There it was—a diet so deprived of calcium that his body had spent the last decade stealing the vital mineral from his skeleton and delivering it to the bloodstream to support critical functions throughout the body. He was now paying the price for his calcium deficiency with multiple vertebral compression fractures.

The severity of my patient's diet made me suspect that he was living with an eating disorder. When I suggested that he see a psychiatrist or other specialist, he said he felt no need to consult one. He politely turned down my prescription for a bone-strengthening drug, certain it would upset his stomach horribly. I explained that a simple increase in his calcium intake would halt the progressive dissolution of his bones and forestall any more fractures. He said he had no plans to change his lifestyle or eating habits.

After many years in practice, I was familiar with the feelings of frustration that may be evoked by patients who refuse to do what you believe is in their best interests. As a fledgling practitioner, I was often tempted to give in to those feelings, to try to coax or browbeat the patient into doing "the right thing." But a doctor does his patients no favor by pushing them away when they disagree with his recommendations. Ultimately, the patient must make choices and then live with the consequences. And the doctor must continue to provide care and support.

Year after year I continued to see the patient for his annual checkup. I was always glad to see him, even though whenever we discussed expanding his diet, he remained convinced that any change would "do him in."

So when he limped into my office that day with his weakened skeleton and told me about the terrible hip pain, I feared the worst. I sent him straightaway for X-rays. The results left me flabbergasted. The femur, or thighbone—the largest bone in the body—had lost so much calcium that it had fractured spontaneously, near the top, where it makes up part of the hip, while he was walking. He indeed had been limping around for a week on a broken hip. Apparently, this man of the cloth was also a man of steel.

He agreed to hip surgery, and it went without complication. Visiting him post-op one day I noticed that some of the food on his breakfast tray appeared to have been eaten. I turned to him with a wry smile. "Did you eat this?"

He sheepishly admitted that he had, adding that the food was "not bad." I encouraged him to keep it up.

Three months later, he came to see me after his physical rehabilitation. He didn't even need a cane as he stepped onto the scale. I pointed out that he'd gained six pounds since his last visit, when he'd hobbled in on a broken hip.

"Oh, yes. I've been eating more. There's a diner across the street from my church that sells wonderful cheeseburgers."

He was smiling. So was I.

H. Lee Kagan is an internist in Los Angeles. The cases described in Vital Signs are real, but the authors have changed the patients' names and other details to protect their privacy.

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