A challenging home visit to see a schizophrenic man with very poorly controlled diabetes tested my patience this morning. A thought/personality disorder and a chronic illness in need of very tight control don't mix well. We conflicted and argued somewhat over his health and high blood sugars, his paranoia kicking in and making mincemeat of my arguments for improved self-care. For the first time, this gentleman really pushed my buttons and I held myself in check and brought the conversation around to a positive feeling again. The visit ended on a good note and I regretted that his brother/guardian had not been present for the session. Nonetheless, some headway was made and the door left open to further discussion, not to mention dramatic increases in insulin to counteract consistently and frighteningly high blood sugars.
The next visit was more pleasant and easy-going: a bipolar woman with emphysema, diabetes, a smoker’s cough, and a black cat who curled in my lap as we chatted. This woman’s blood sugars are superlative, and she spent most of the visit psyching herself up to quit smoking. Fortunately, a recent CT of the lungs revealed that shadows on a recent chest x-ray were just emphysema and fluid, not the dreaded cancer she fears. That said, further smoking will only increase the risk that, one day, another CT scan might bring most unwelcome news. She complained of the cost of nicotine patches and the fact that Medicaid won’t cover them. I asked her how much she spends on cigarettes a month. She laughed and looked away.
Trying to avoid the highway construction I noticed on the way downtown, I zigzagged my way through a neighborhood that I don’t always traverse. My descent down a narrow street was delayed by a strange sight: a red and pink heart-shaped helium balloon tied to a ribbon with one of those little plastic discs at the end of the ribbon to anchor it and keep it earthbound. The phrase “I love you” graced its flank in cursive script. This balloon was literally crossing the street, skipping up and down in the air, lightly touching the macadam as it made its way safely from one sidewalk to another. An oncoming car also stopped to let it cross. It reminded me of that scene from American Beauty, where the young man/filmmaker records the ballet-like gyrations of a white plastic shopping bag caught in the concrete corner of an alley by a temporary urban whirlwind. (The whole movie is worth that sequence, if you ask me.)
Having avoided the traffic, I leave the balloon to its own devices, Todd Rundgren’s song “A Dream Goes on Forever” in the CD player. You just never know the strange blessings that will cross your path in the course of a day.