It thrills me down to the core,
My day is never a bore.
A Discman’s a weapon
That doesn’t need schleppin’,
And the police can settle the score
I never have a boring day.
An alcoholic diabetic whom I have not seen since July showed today sober and fifteen pounds lighter. And ten pounds below the lowest weight recorded for three years. Smiling, bright, with blood pressure well controlled. No alcohol for three months, eating mostly a vegan diet, and not exercising. Still the glycohemoglobin (a long-term diabetes test measuring the sugar control for the last hundred days, also called an A1C, upper limit of normal is 6) was 6.1, down from 7.4 at last check. This is the second longest term sobriety of the patient’s life, and I don’t think I had much to do with it.
A diabetic golfer, whom I’d not seen before, came in with a urinary problem. The CT scan a few weeks ago showed a very large prostate, about the size of a baseball. I prescribed an alpha blocker to relax the offending gland, arranged follow-up with the usual doctor in timely fashion, then I got to ask about golf. The patient has three hole-in-ones at the local course.
One of my illiterate, Spanish-speaking, ketoacidosis prone diabetic patients came in. Though he has type II diabetes, I picked the patient up on an admission for ketoacidosis (a complication generally only seen with type I diabetes). For a long time accompanied by a very educated and erudite friend, the patient comes alone since the friend died. We both miss the sophisticated literary discussions. His biggest medical problem will soon be the lack of Spanish-speaking doctors in town.
My decision to slow down and rearrange priorities evidently has influenced a diabetic whom I’ve known for more than 20 years. The career started in a local facility at the bottom of the ladder, and advanced with training and experience to the top of the ladder and the growth of family. Then there was a transition to management in a large firm doing institutional service, involving insane amounts of driving. The patient came today to get blood checked and announced educational plans, which would lead to finishing a degree, getting more pay, staying closer to home, and working fewer hours. For more money.
A victim of domestic violence arrived with bruises and contusions and a migraine. Assaulted by a CD player-wielding family member yesterday in a non alcohol-related dispute, the patient faces a lot of stress. Also a lot of guilt for calling the police, of whom four were needed. The bruises done to the head weren’t nearly as impressive as the bruises from kicks. Which leads me to believe, all in all, that CD players are lousy weapons.
Another stressed patient came in facing the loss of a job, complaining bitterly of being picked on by management. After a while I got the patient to say what was expected of me, the doctor, and it turned out to be a good night’s sleep. Easily done, I said, do you have trouble getting to sleep or staying asleep?
The insomnia patient was unique in not being unique. I do a lot of career counseling though I’ve never been trained in the field. I easily ask about nicotine, alcohol, caffeine, bedroom set up and coping mechanisms but I don’t have a Human Resources degree so I give disclaimers and advice. The advice comes from my personal experience and I hope my sound reasoning. The bottom line: taper down the caffeine, take this Rozerem and this buspirone (the gentlest tranquilizer on the market), stop the lorazepam, and after a good night’s sleep talk to HR at your firm.
The stuff I’ve never seen before is never boring, and the run of the mill stuff is pretty interesting, too.