She has uncontrolled diabetes. She was only in her 40s. Gainfully employed. Fully insured. She had a husband. Three kids. She came in because of syncope and was found to have acute renal failure from volume depletion. And a blood sugar of 500. Now that's uncontrolled diabetes. You see, she was also diabetic. With uncontrolled diabetes. I looked through all the data and then presented my case to her, for her. With her husband, her father her brother and her uncle all standing there, I discovered not only did she know she was diabetic, but she had also known this for greater than ten years.
And what had she done for her uncontrolled diabetes? Absolutely nothing. She had chosen to do nothing. These are the situations where we as physicians have to wonder what's going on in their head. The family says she's just stubborn. That's the way her mother was. They've tried for years to get her to take care of herself but she just wont. She says she's not depressed. The family says she's not depressed. She lives her life like every other middle class American. She just refuses to take care of herself.
Perhaps she's never had the diabetes lecture. It's quite similar to the lecture about smoking. Diabetes is not a disease of blood sugar. It is a disease of blood vessels. If one can imagine everywhere blood vessels go (which is everywhere), diabetes will destroy that part of the body. It will lead to a horribly disabled and miserable existence. I describe all aspects that she has to look forward to from uncontrolled diabetes.
- Memory loss
- Heart attacks
- Heart failure
- Ischemic bowl
- Painful neuropathy
- Diabetic myopathy
- Frequent infections
- Life threatening illness with septic shock
The list can go on and on and on. I told her that half of my hospitalized patients are likely there as a direct result of their out of control diabetes in one way or another. I told her about the life changing disability she was in for. I told her she presented with a high risk of death due to an acute illness within the next two years. Her admission now should be a wake up call for change.
I told her she is a grown woman of sound mind and body and is very capable of making the right decisions for herself. I told her, in my opinion, doing nothing and leaving her husband without a wife, her kids without children and her brothers without a sister and her father without a daughter was a very selfish road to take.
I told her she would need to find the motivation from within herself to do the right thing for herself and her family. I asked her what her motivations were for doing nothing. I asked her what we could do to help her take care of herself. Her family, full of diabetics, offered to help her in any way possible.
After laying out the cards, describing the brutal reality of her situation, telling her point blank that she risked death within two years due to a life threatening diabetic related complication and a life of misery if she choses to do nothing, her husband decided to "stick up" for her.
He said I was treating her like baby and told me not to come back. Which is fine. Except that attitude is a major part of the problem. Perhaps adults who act like babies, adults fully incapable of making grown up decisions (like showing some initiative in their own disease management); Maybe they should be treated like children.
I don't know what to do for someone who chooses not to help themselves. Free will is a powerful thing. But it works both ways. All I can do is make sure we do everything within our power to remove the barriers to patient's care. And hope they make the right decisions for themselves and their family. For many, insurance is not the issue. Having a husband obstruct that process seems to be a major barrier to success. I wonder If I should recommend a divorce.