Patient encounter 1: The Mirror Image

I was on call and had just admitted an unfortunate young man:

30 years old with Chronic kidney failure, Hypertension, Diabetes Mellitus type 1, h/o Stroke with neurological deficits and left eye blindness. He also gave a history of having a "small" heart attack in the past. Had been admitted countless number of times for diabetes. He had been diagnosed being diabetic at the age of 7 and been on isulin since then but had been very non-compliant to meds and follow-up appointments. His primary care had been Emergency rooms and he spent more time in the hospitals than he was in school, hence did not graduate from high school.

2hrs later, I admitted a 17 year old boy in a diabetic crisis (DKA), he also had issues of non-compliance and had not been taking his medication. He did not even want to have a primary care doctor to follow him up. He thought since he was young, he could get by most days without his insulin. It did not help matters that he was already emancipated.

The following morning I was struck by an idea that I discussed with the Medical social worker on my service. After confirming that I was in the clear I went for it.

I went to the 17 y/o whom I will call Eric. I did the usual counselling about complaince to medication and bla bla bla... about complications of Uncontrolled diabetes. One could tell that he had heard this several times over and over and he was not paying much attention anymore.
I still went on and on.

Then I went to the 30 y/o whom I will call James. He had learnt his lessons by now and was very compliant to meds and all. He was admitted this time around for Hemodialysis. I asked him If he could be willing to tell his story to someone who unfortunately was already going his path but luckily was still intact-organ systems-wise. I did not have to ask twice or even convince him
at all. He was more than willing to talk to anybody that was willing to listen and who would hopefully be changed by his experiences.

I now had to convince Eric to listen to One last person before he was discharged. I found his father in his ward room and It helped. Once I explained to them what I wanted to happen, He agreed. We organised for the two to meet. It also helped that they had similar backgrounds.

I did not have to wait for long.

His father came and told me that Eric wanted to speak to me.

Eric wanted me to arrange his folow-up care. Get him an outpatient doctor close to his home. He would have wished to come to my clinic but its downtown and he could not keep appointments.
He wanted to take control of his life now. He wanted to know all the resources at his disposal.
He sounded more like a man that had been newly diagnosed!

I was ecstatic!

It worked.

I checked the records one month later and he had been to his doctor. That was a good start. I can only hope that he is doing well.

My mum always sys "seeing is believing"

Chite.