A Tale of 2 Patients

I had a couple of DKA (diabetic ketoacidosis) admissions this last week while oncall.

The first was a 27 year old woman, a professional in a large firm here in town. Presented with DKA and newly diagnosed diabetes, fairly classic for type 1. She was visibly upset at the diagnosis, but after a day of grief, decided to take charge as what she is used to doing at work, do research and was keen at learning how to administer insulin and how to adjust. I discharged her after 2 days and expect her to do very well.

The 2nd case, a lady I've seen 9 out of the 10 call weeks I've been oncall. A 31 year old with diabetes so poorly controlled she's already on hemodialysis and has had 2 coronary stents. She literally comes in with DKA once every month; spends a day being unconscious in the ICU, then when she recovers, becomes one of the meanest and most demanding patients I've known here, screaming at nurses and doctors for not letting her eat a cheeseburger or go out to smoke, while she was still in DKA. She smokes, does drugs and binge drinks. These have been factors in her usual DKA admissions. I saw her sick like stink in the ICU a few hours ago, barely conscious, with an anion gap of 30. I told her a couple of admissions ago, that DKA carries a mortality of 2-4%- if she tries hard enough eventually she's not going to make it. That's 1 in 25 admissions. Tonight, I fear she might be really testing things.

As a physician, you try to be objective and heal. You try to not be judgmental; after all you know no one is perfect. You try to be patient, to not get mad at the patient. But at times like this, you sometimes can't help it but to think that sometimes some patients just don't try enough.

And yet, you know that even if the patient doesn't want to try, you have to try your darnest to help heal the patient. And you pray that God has enough mercy to let your patient get through this, if only just one more time.

Perhaps she'll learn this time.