the course of the next month, the patients were to call each other over a special telephone system and then return for a group session. At the follow-up, when we began to discuss how the conversations with their peers had gone, Mr. O spoke up right away. He talked about how isolating diabetes is and that many of his struggles with food were related to boredom. He told us that although his wife and daughter did all they could for him, no one really understood what it was like to live with diabetes unless they had it. He compared it to explaining being in Vietnam to people who weren’t there.
He told us about his own neuropathy and about a friend who had both legs amputated as a result of diabetes. He then turned to his partner and said, “You are getting some of the signs of neuropathy, but I am going to do everything I can to help you so that you don’t have the same fate as my friend.”
I was both surprised and moved by his concern and insight. At the same time, I couldn’t help but wonder if others in the health care system had dismissed him as I had—feeling there was not much that could be done or that he didn’t care about his diabetes because of his quietness and appearance. Once more I was reminded how harmful judgments can be and that every patient needs the opportunity to be heard and treated with respect.
Walking in the Patient’s Shoes
by Seyda Ozcan, nurse, Istanbul, Turkey
I have been working with people with diabetes for almost 15 years. In the beginning, I was both enthusiastic and inexperienced, I felt that any goal could be achieved if you were willing to work hard enough. I believed that anyone’s diabetes could be managed successfully if the patient really wanted to succeed. Unfortunately, with this naive optimisim, I sometimes made light of the difficulties reported by my patients. I had no real appreciation of the challanges they faced on a daily basis until one morning nearly five years ago.
I finished my morning appointments with the patients in the dibetes clinic. After lunch, I left from the clinic to attend to a diabetes postgraduate course. I met my friends in the lobby next to the pharmaceutical company’s exhibition area. While we were chatting, a man from one of the companies asked if he could check my blood glucose to demonstrate their new meter. He did the check and told me the result.
After a few seconds, the expression on his face and what he said sunk in. My blood glucose was 196 mg/dl. All of us thought the meter was out of order or the strips had expired. He opened a new bottle of strips and measured again with another meter. It was the same. my friends, who were physicians, dietitians, and nurses, were shocked by this result.
The representitive gave me a meter and some strips so I could check my blood glucose levels later. I figured that I would recheck later and see that the earlier result was incorrect. We went to the meeting room but I couldn’t concentrate on the presentation. I left early to go home.
I began examining my lifestyle, especially my unhealthy habits. I was eating too much junk food, too many desserts, and too much chocalate. I decided that the first thing I had to do was to eat healthy. But how? I love chocolate and the idea of giving it up made me miserable. I knew that recently I had gained weight and that I needed to start exercising. I thought to myself, “I can do this. I like exercise.” But mostly I thought, “I can’t possibily have diabetes, maybe I have impaired glucose tolerance (IGT).” At my age and weight I knew this must be type 1, which meant there was only one choice. I was going to have to take insulin. There was no getting around it.
I thought about all of this on the drive home. As soon as I arrived, I washed my hands and measured my blood glucose again, it was 172 mg/dl. I prepared a very healthy dinner with modest portions. I rechecked my blood glucose after one hour and once again after two. Although I ate a very small meal, it was still high. Part of my mind was saying, “Why is this such a big problem? You are a diabetes specialist. You explain to your patients how they can live well with diabetes, offer support, and encourage them by giving examples of how other patients manage. So why are you so upset?” Then I realized that it is one thing to know about diabetes, but knowing is utterly different from having diabetes. I felt overwhelmed as I lay in bed crying. I finally fell asleep after making some important decisions about changing my life.
Although the next day was Saturday, I woke up early and walked for two hours. Then I ate a very healthy breakfast. I checked my blood sugar before and after breakfast, and at last I saw normal numbers. I checked my sugar seven times that Saturday, and then again on Sunday. My blood sugar remained normal. All of my test results to diagnose diabetes were normal. No one could offer an explanation consistent with current scientific knowledge about the cause of this one-day episode of diabetes.
I am now acutely aware that what we know about diabetes through study is very different from the reality of experiencing it directly. Now I feel closer to my patients and appreciate the importance of listening attentively to each of them. Each patient’s experience is unique and I do my utmost to understand and acknowledge their uniqeness.
The Blind Leading the Blind
by Cathy Mullooly, clinical exercise physiologist, Boston, MA
For years, I have spent thousands of hours supervising exercise sessions as part of our diabetes services and curriculum. I have seen many amazing transformations and outcomes during this time, but one five-second snapshot of time sticks out in my mind.
One day I was waiting for the members of the exercise class to begin arriving. When the door opened, I saw one of our male members, who was blind, pushing the wheelchair of a female member with multiple sclerosis. There was also another female member with them, also blind, holding onto the man’s arm for guidance. This put a whole new twist on the phrase “the blind leading the blind.” I did not know whether to laugh or cry at this touching scene. I marveled at how they were able to use each other’s strengths to allow the group to succeed at the task at hand. Many people in their situation would have chosen to just stay at home and accept their fate, but not these three. They knew what they had to do and were finding ways to do it.
Over the years, I have often reflected on this snapshot in my personal life and in my patient interactions. I have learned not to underestimate what people can accomplish. I have learned to help people identify their strengths and when to look for support to overcome their weaknesses. I have also learned that the things we do as diabetes educators—and take for granted as just a part of our workday—mean the world to the people we have the privilege to teach and touch.
CHAPTER 2
Listening and Asking Questions
The Value of Authenticity
by Lynn Arnold, dietitian, Dayton, OH
Long before I knew anything about diabetes, I learned about listening. Prompted by the pain of relating to loved ones with addictive behaviors, I attended my first 12-step meeting. I had no idea what to expect. I learned that this meeting began with a standard opening reading and introductions before breaking into groups of 8–12 people. Each small group gathered around a table for discussion, or so I thought.
Two or three people talked before I contributed some suggestions I thought might help their situation. Few words escaped my mouth before someone let me know that advice was not permitted. I was taken aback and immediately stopped talking.
Eventually I realized that these small groups were not