Visiting a patient today, his friend/assistant complained to me how my patient is not taking good care of himself, neglecting his medications at times, smoking, eating poorly, even in the midst of terminal cancer and other disease processes.
When I questioned my patient's friend about her own health, she shared with me an apathy so deep that I was shocked by her clear articulation of its breadth and depth. With blood sugars usually in the "300 to 400" range, she described for me how her apartment is often like a "candy store". Addicted to sugar and sweets, she now injects well over 200 units of insulin per day, barely convering her insulin needs. "Every time I see the doctor, they look at my numbers and raise the insulin again," she laughs, as if it were a game she were playing. And perhaps she is. When I ask her about the potential consequences of her actions, she laughs again. "I'm already old. In 20 years, I'll weigh 100 pounds more!" She gestures at her already obese body. She's 41---my age. We share the same birth year: 1964. She sees her life as almost over.
Flabbergasted, I paint a picture of dialysis, amputations, blindness, cardiac disease, nursing homes. She only laughs more. "Anyway, the Lord is coming, the world is ending, so I don't have to worry about it. I'll go to Heaven." When I ask her what will happen if the Lord does not return to Earth in her lifetime and she gets gravely ill, she looks thoughtful for a moment, then laughs again. I hold her hand and tell her that I care about her and want her to survive and be healthy.
"I'm not going to change. I'll just keep getting fat. I love sugar. There's just no reason to try."
No. Denial is NOT a river in Egypt. But it runs deep, and its waters are treacherous beyond belief.
1 comment:
Keith, it is stories like this that prompted me to suggest that we need to adopt a Hearts and Minds age as an educational tool with people: a compare and contrast of chronological age with a risk-adjusted age estimate. It wouldn't work with your client - but a combination of her physical and physiological markers, plus what you've revealed of her attitude would lead me to guess she is a biological 41-year old with an adjusted age of someone around 78.
As ever, I admire your ability to do this work.
Best - Tony
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