The Case:
Geraldine Williams: Managed Diabetes versus Peace of Mind?
Two weeks ago, Geraldine Williams, a 70-year-old American Indian woman with type two diabetes and obesity, came into the office. She'd just returned from the Southwest, where she'd spent six weeks receiving "traditional" therapy. Dr. Brown remembered his reaction as he heard her story: "What she really needs is much better control of her diet, weight, cholesterol, and blood pressure, and attention to her insulin intake," he thought, fuming. "My gosh, she's already had one leg amputated. You think she'd take this more seriously. What she got were vitamins and yoga, and probably irreversible organ damage in the process. And some fool of a physician let her go, instead of insisting that she get treatment." Even after Dr. Brown used every argument that he could muster, Mrs. Williams still didn't want to pursue the therapies he recommended. After his appointment with Mrs. Williams, Dr. Brown had a lot more compassion for the "fool of a physician" who'd treated her earlier. The best progress Dr. Brown could make was to prescribe medication for her bladder infection and to convince her to make a follow-up appointment.
Dr. Brown walked into the examining room on the day of Mrs. Williams' follow-up appointment. Mrs. Williams' wheelchair was jammed between the wall and the table so that she could only partially face the doctor. "Good morning, Mrs. Williams. How are you feeling?" The patient responded with a shoulder shrug and a forced smile. "Have you thought any more about what we talked about last time you were here? I really think that we need to admit you to the hospital and make sure we know what's going on with your diabetes. We can get your insulin regulated and work on the right meal plan and medications for your weight and heart disease." Mrs. Williams shrugged and winced, while Dr. Brown turned and flipped through her chart. "Again, I'll tell you the gravity of this situation Mrs. Williams. Your diabetes is very serious business. The fact that you've had so many symptoms - dizziness, possible vision impairment, a bladder infection, and pain and burning in your other foot, not to mention your heart disease - is bad news. The sooner we find out what is going on, the faster we can get you the treatment you need."
The Case:
Geraldine Williams: Managed Diabetes versus Peace of Mind?
"But doctor," Mrs. Williams said, "when I was in Arizona, every day the people said that I seemed better, and I do feel better -" Dr. Brown interrupted. "I'm sure that you feel better, but that still does not change the fact that we need to act. Your condition can't be cured with herb teas. Those things might make you feel a bit more relaxed, but they're not going to manage your diabetes or obesity. The people at the hospital know how to treat these types of things. They can do the tests and then we'll know."
Dr. Brown looked up from the chart to see Mrs. Williams' eyes welling with tears. She blurted out while choking back sobs: "I don't want the hospital. I'm not going there. They act like you are not even a person and make you sit and sit, and they only talk to each other. When my husband went in to the hospital, they first talked and talked of illness, then he got sicker and he never came back out. The only time I ever went to the hospital, they took my leg! They don't like us there. I'm not going to die in a closed room that smells like sickness. The people in the desert, they taught me how to take care of myself - how to make myself well - and you just want me to go to the hospital to die! I don't want the hospital. I gathered my herbs, and I made my own tea; I ate traditional food. My family was with me, we prayed, and I wasn't afraid. I was at peace. And now, again, you talk about the hospital. I don't want to die there."
Mrs. Williams stopped speaking. Shocked, Dr. Brown closed the chart and sat down. Mrs. Williams really believed that her traditional medicine would cure her and that the hospital would kill her. How could that be? But, despite her strong feelings, she still had kept her appointment to see him. Dr. Brown knew this was an important moment but was at a loss about what to say next.
What troubles you the most? How could Dr. Brown and Mrs. Williams communicate better?
