Cured . . . by Definition.
A friend posted this image and I couldn’t help but think about this little cartoon throughout the day. In the 15 years that I have been in medical practice, it was re-emphasized to me that my definition of cure and the patient’s definition of cure may at times be notably different or even in opposition.
I am reminded of a sweet a patient in her early nineties that was brought in by her three well meaning and very caring daughters. This patient was a type II diabetic and, for the most part, her blood sugar was in pretty good control. To put it in medical terms, her morning blood sugars were in the 120 range and her Hemoglobin A1c (HbA1c) was a 6.4%. She was obese by the standards of her body mass index (BMI) and her cholesterol was elevated.
The concern of her three daughters, “there to rat her out,” as the patient put it, was that she was eating donuts for breakfast each morning for the last few months. I noted that her HbA1c had gone up from 5.9% at the last visit. We discussed the fact that the change in her dietary intake appeared to have caused the rise in her blood sugar and her cholesterol.
With my affirmation of the cause as ammunition, the patient’s daughters began to individually take shots at her choice of meals over the last year. They did it, I could see because they loved and cared for heir mother. But I noticed the patient’s demeanor change suddenly, and a bit of trust between me and my patient began to slip.
This sweet centenarian turned and looked at me, square in the eye, and then proceeded to give me an education.
“Dr. Nally, do you know how old I am?” she asked.
“Why, yes, you are 93 years old,” I replied.
“And do you know how much longer I am going to be alive on this earth?” she inquired.
“Well, no. I do not know how much longer you will be alive, but I can tell you that you have out lived most of your peers and the average age of most Americans.”
“Then, why the hell are you, and my daughters, worried about me eating a damn do-nut?” she yelled. “My blood sugar is still pretty good and I figure that if I have to be around on this earth any longer, then by stars, I am going to enjoy my favorite breakfast. If it kills me, then so be it. I am going to enjoy it.”
Well, that was that. The cure was to enjoy her last few years upon this earth.
She did just that.