This week was a first.
This week was the first time I was ever screamed at by a patient to leave their room. And we’re talking a boisterous bellow. A guttural “GET OUT NOW!”
I couldn’t help myself.
I was being too persistent. Too persistent in wanting to help this person realize the current path he’d chosen to follow was going to lead him to years of feeling miserable.
And not just miserable but a considerably shortened life span or (at best) succeed to the average life but with extensive medical bills and possibly loss of vision, limbs, kidneys, dotted by incidents of strokes and/or heart attacks.
When you meet a patient with kind eyes (even when mad), and you see their loving family surround them, you want that person whether you know them or not to be the best version of themselves.
At least I do.
Isn’t that after all why we get so upset with our own family members and those in our circle of love that make less than stellar decisions on how they spend their money, the foods they choose to eat, the cigarettes they smoke, the alcohol they drink, the tanning beds they use?
So when a patient shows up with a hgbA1C of 15.1%, which indicates an average blood sugar of 380mg/dl it’s not a matter of will this patient reap the potentially long lasting side effects of diabetes it’s a matter of when.
Diabetes by the way is typically diagnosed with a HgbA1C of >/= 6.5%.
So what prevents someone from change?
Talk about the million dollar question? Or perhaps the billion dollar solution?
Outside of private practice, I typically deal with 2 types of patients with diabetes in the hospital setting. The ones in denial and the ones with resistance.
The ones in denial typically start off by saying they were told they had pre-diabetes, “touch of sugar” or steroid induced diabetes when they were younger but no longer have it. This phase can last for years, depending on how often they see their primary care provider. It seems if the doctor is forthright in the diagnosis, explains the disease, the process of controlling it and refers the patient to diabetes education classes, the denial stage wanes. Especially if there is good follow up.
Obviously the denial phase can last a lot longer for the patient who chooses to see their PCP every 14 years or when medically urgent.
The resistance phase can be harder to crack. Like any change, there needs to be an intrinsic factor to motivate you or else 3 weeks in, you’re hitting up the local Krispy Kreme when the hot sign is lit.
There are a gazillion excuses to stay in the resistance phase for quite some time.
Too hard to follow a specific diet.
Too much money.
I don’t want to cook different meals.
I don’t know what to eat.
I don’t have the time.
I don’t want to poke myself.
The one thing with the resistance phase is that there is at least ownership that you have diabetes. And generally at least an ounce of trying to do what you think might be right even if it’s for just one meal, one time a week.
(By the way if you’re in the denial or resistance phase, I can help you. I know resistance well and it’s evil ways. We can break that beast together!)
But this patient was different.
At first I thought this was straight up denial, especially given a little back story by the nurses. For a second I even thought there might be some psychosis. But this patient as he quoted scripture after scripture “By our faith we are made whole” and “By the stripes of Jesus I am already healed” I didn’t feel this was either denial or resistance.
This patient was certain with all his being that enough prayer and faith in Jesus, all would be well.
So I did what any curious person might do, I hit up Google and looked up words like “Christianity, healing, diabetes research.” What popped up were several studies that talked about a religious Christian worldview among some populations, predominately African American with a distrust of medical professionals. One studied noted “collectively, participants described their religious worldview as grounded in the personal relationship with God, which is fostered through faith and giving one’s life to Jesus.”Another study reported “quantitative findings indicate African Americans, relative to Whites, are significantly more likely to believe in miracles and attend faith healing services.” And many will disregard medications in lieu of tonics, teas, supplements and other forms of alternative medicine.
When I read these studies, so many light bulbs went off of where our conversation turned. How the sour began. If only I knew some of these things, the approach would have been so different. Since my rapport with this patient was significantly damaged and the floor supervisor even phoned me to say the patient specifically requested I not return, I did the only thing this dietitian felt was right; I wrote him an apology letter.
In this letter I let him know my intention was to never upset him so much he felt the need to yell. I let him know that he did possess in his faith, the ultimate power of healing. And I let him know my side as a Catholic who prays daily for purpose; to be put where I’m needed most. To be given “neon signs” since I’m stubborn. That with food and not necessarily medications his diabetes could be controlled.
I truly thought his 15.1% HgbA1C was in fact my neon sign of the day.
And maybe it was.
I’m hopeful my letter helped plant a seed in my patient in pursuing an avenue that spiritually meets his needs to control his diabetes before it’s too late. Prayer is strong medicine. Prayer for strength in knowing your responsibility in taking care of yourself can be even stronger.
As for me, I’m going to continue to pray for neon signs AND to know when to leave a patients room.
Are you being held back by something to be the best version of yourself? Need to talk it out? Drop me a comment below or email me at firstname.lastname@example.org. I’d love to hear your story.
In the mean time,
Hugs (and Prayers)