Given the time of year, it is not surprising that many people are talking about New Year resolutions. There are many articles written about being successful in achieving these January promises. I’m no expert but what I learned in medical school convinced me that change comes: (1) only when you’re ready; (2) when you focus on one thing instead of making an unwieldy list; and (3) when the goal is achievable (e.g., for most people, committing to an hour of exercise EVERY DAY is creating a setting for failure). I do, though, think that more than resolutions, we must all achieve real change. Too many of us don’t exercise enough, don’t consume enough fruits and vegetables, and have (at least) a few extra pounds on our skeletons. This time of year reminds me of the devastation caused by Type II diabetes that I saw during my medical education, which made it clear that we can avoid being part of sight-robbing, limb-chopping, and death-causing epidemic. It also makes me think of Wade…
Exiting the room, my attending physician turned right to exam room 9 (cough) and I veered left to exam room 7 (“follow up on hypertension”). Left in our wake was the decimated spirits of Wade, who seemed to flood exam room 8 with his sorrow and shock.
This was the first time that I had met Wade, and I liked him immediately. Sure, I noticed that he was morbidly obese. And prior to my knock and entry, I had noted that his hemoglobin A1c (a long-term measure of one’s blood sugars) was impressive in the worst sense of the word. And yet, his demeanor was disarming and his smile was infectious. Being with Wade made me feel like I was sitting next to a pleasant stand-up comedian who was taking a cigarette break at the bar.
All joking – and smiling, in fact – came to an immediate end when Wade’s doctor joined us and pulled the proverbial rug from beneath the examination table and the 260 pounds that fused to form Wade. This appointment was to determine if yet another diabetes medication could be added to make a difference for Wade. Though the first few minutes of the conversation were peppered by comments from Wade that confirmed that he knew that he “needed to keep a better eye on what I ate, “ and that he should “probably get some exercise to help his diabetes,” it was clear that he had not acted on his thoughts.
Wade was not the train wreck that most physicians speak about. The train had departed and instead, Wade was now walking a slow march to his grave, leaving behind a wife and two teenage daughters. When the doctor, in the plainest of words, expressed his dire concerns about Wade, you could actually feel the train hit a brick wall in the distance. I felt like the oxygen was being sucked out of the room as Wade took a long, slow, pitiful breath, and tried to absorb his physician’s assessment. If Wade did not make significant changes, his life would include limb amputation, loss of eye sight and likely a heart attack or stroke. The picture was the most bleak that I had ever heard the gentle family doctor who I worked with describe.
Reviewing the plethora of drugs that Wade swallowed every day, the doctor poked the end of his Gardasil™ pen in the corner of his mouth and shuffled through Wade’s voluminous record. Catching upon a previous note, the physician asked Wade about an earlier conversation that they had about gastric bypass surgery. Wade remembered and could only articulate that he had not pursued this remedy for possibly removing diabetes from his life because his wife did not like the surgeon that had been recommended (she works in the office of a competing surgical practice). Stunned by the lack of follow-up, the doctor reiterated that this was not only the best option for Wade but could possibly be his only option. As Wade digested the news, absorbing the gravity of his situation with each tick of the doctor’s wrist watch, the doctor suggested a meeting with Wade and his wife to address her concerns. No medications would be changed that day. Diet and exercising counseling were not discussed in the context of helping Wade’s diabetes. Rather, Wade was reminded that the suggested surgeon would not perform the gastric reduction if Wade did not demonstrate the ability to live on a diet, to exercise and make other modifications in his life.
Wade and his doctor seemed to share common thought on his plan. A long second of silence passed when Wade erupted like a happy puppy that just smelled a treat: “What about Weight Watchers? My daughter just lost over a hundred pounds!” Maybe, I thought, he just was not getting it. We reminded Wade of the many years that he has had to make meaningful changes in his life, reviewed his laboratory results, and re-directed this sinking ship to a meeting with Wade and his wife.
We said our goodbyes. I wished Wade luck, and he responded that “it sounds like it’s too late for luck.” Emitting an uncomfortable and nervous laugh in response, I followed my attending physician into the hallway. While reviewing the chart for the woman waiting in room 7, Wade came out and scheduled the meeting. When Sue, who coordinates the doctor’s schedule, asked long-time patient Wade how he was doing. He twisted his face into a pretzel of a smile and responded, “Well, I’m not dead yet.” Sue, unaware of the conversation that had preceded his appearance at her cubicle ledge, noted: “Well, that certainly beats the alternative.” Wade, without looking back, littered words behind him that – when put together – conveyed his sense that death was near. I can only hope that the meeting with Wade and his wife, scheduled on an upcoming evening, provided Wade with both a dose of optimism and recognition that he does have options. After all, I like Wade, and I would hate for him to let his diabetes kill him.
Wade had many opportunities to follow through on New Year resolutions. It’s never easy, and I don’t blame him. I just realize that it is important that we all take stock of our health, and make necessary changes. For the record, I’ve given up all fried food. Happy New Year!