Paradoxes within Practice

One of the patients at the assisted living facility is a gentleman of 86 years. In addition to surviving dementia he also has very high blood pressure, in the range of 180/120. What is so surprising to me about this is that we all have a very hard time finding his pulses. My ‘Western Analytical Mind’ would state if he has high blood pressure his pulses would be easier to feel. That is not the case, at all.
Yesterday when I was getting ready to give him a treatment I was feeling for his pulses, nothing detectable at all, any position, any level. Then I quieted my mind down, removed my fingers from his arm and very slowly started to reconnect my fingers to his arms. Just at the level of skin to skin contact, with the slightest amount of pressure I could contact with I could almost feel a pulse. Almost.
If I feel at his carotid artery I can definitely feel his pulse, but that is not where we palpate pulses for diagnosis. There is a Japanese form of pulse diagnosis that compares the strength of the carotid pulse to the strength of the radial pulse and based on the difference in force includes that into the diagnosis. I have been exposed to this, but I do not have enough experience in that to make a clinical diagnosis based on this information. It felt like the carotid pulse was at least 10 times as strong as the radial pulse. From what I remember my clinical supervisor, Jeff, talking about there is a 1-3 force differential that he uses. I have never heard him say anything about a ten-fold differential in pulse force. But I bet he could tell me a thing or two about this. I would also bet he would agree with my conceptual diagnosis.
One of the ways that TCM talks about death is that it is the ‘ultimate separation of Yin and Yang.’ As I have felt this man’s pulses over the last four to five months we have all felt this separation developing. He is technically a hospice patient, even though he lives in an assisted living facility. But his state of health is declining.
As a clinical supervisor I see this as an incredible teaching opportunity for the students, as well as for my own experience. We each try to feel the pulses that are ‘interesting’ or different. This gentleman’s pulses are always interesting, if we can find them. I remember one time we got him to laugh and his pulses became palpable for 15-20 seconds, then they retreated back to where they hide.
What I was originally going to write about was the dichotomy of a patient having high blood pressure, but as an acupuncturist we cannot feel his pulses. The paradoxes of one medical system seeing one thing, high blood pressure, and the other medical system not being able to detect the pulses. I still find this interesting.