Diabetes Doesn’t Have to Give You the Blues

The world lost a friend last Friday when bluesman B.B. King passed away. Since being diagnosed with type II diabetes 25 years ago, B.B. showed his love to the Church Health Center’s home city of Memphis and was vocal about his type II diabetes, urging others to check their blood sugar levels often. I’m grateful for the many years of enjoyment that he gave people with his guitar “Lucille.”  I only briefly met him once, but I could tell he was full of energy and loved life.

Source

Source: travelsouthusa.com

During that meeting, he joked about the soft drink and fried foods he was eating. “I know this isn’t good for my diabetes, Doc”. It’s funny how people become hyper-aware of their health habits when I come around! But as I see it, King was like all too many men who view their diabetes as, simply, “the hand they were dealt.” In his view, there was little he could do about his diabetes, and he represented a disconnect between knowledge, fatalism and personal empowerment I see all too often among my own patients.

Source: travelsouthusa.com

The problem begins with the patient not fully understanding what diabetes is all about. “I have sugar” is how it is often expressed to me, and I have never fully understood what those words mean to people. It usually implies “I eat too many sweets,” but it is rarely connected to the effect of the microvascular disease consequences of diabetes.

I usually describe adult-onset diabetes like this. Everything you eat, no matter what it is, is churned up in your stomach and turned into sugar. That sugar then goes into your bloodstream and is carried to all of the cells of your body. For the healthy patient, the body makes insulin that then grabs ahold of the sugar and pushes it into the cells. Once inside, the cells turn the sugar into energy, which is how we live.

Diabetes is a disease where there is something wrong with your body’s insulin. We know this because when we prick your finger to measure how much sugar is in your blood, your sugar is staying in your blood rather than getting into the cells.

I often use this analogy:

Say I am trying to dig a hole and I hire a man to do the job. Only, it turns out he is lazy and just piddles around. What can I do to get the job done? One option is to hire several lazy men. Although their work ethic leaves much to be desired, if I hire enough of them they will eventually get the job done.

This is effectively how most of our drugs work. Even though your own body’s insulin is “lazy”, the drugs tell it to make more insulin and if we get enough of it in the blood we can cause the insulin to push the sugar into the cells of your body. This is helped by eating the right foods and exercising.

Most people seem to understand this analogy. What they don’t always appreciate is that the consequences of diabetes over time are permanent and devastating. Blindness, stroke, dialysis, and amputation are all-too-common outcomes.

B.B. King was actually very lucky to live 25 years without these more serious consequences affecting him until late in his life. Others aren’t so lucky. Part of the tragedy of diabetes is that it affects the poor in more devastating ways because the lack of knowledge and access to medicine and healthy foods. Even after his legs were amputated, my father’s best friend drank chocolate Yoo-hoos several times a day because “no one was going to tell him what he could do”. He died from a stroke when he was 63 years old.

The good news is that for most people, diabetes is either preventable or manageable through diet, exercise, and the right medication. In the last 20 years, our knowledge of the disease has progressed tremendously. We now have dozens of effective treatment options, and we know much more about the role of diet in the prevention of the progression of the disease. Key to living with diabetes is an internal motivation to live a healthy life and avoid the foods and lifestyle choices we know are unhealthy. Yet in a world where we are surrounded by soft drinks, fried foods, and healthcare that isn’t focused on prevention, this is simply easier said than done.

Diabetes is more than “a hand you were dealt.” It’s something that you can control and live beyond. Honor the memory of B.B. King by taking control of your diabetes today.

No Impediments

No Impediments

I walked into the exam room to a familiar scene. Two men sat before me looking worn and tired. Their interpreter stood alert, ready to help me give them the care they needed.

One was 18, the other in his mid-30s. The younger man was clean-shaven and well-dressed. He complained of a persistent cough and a sprained ankle.

I asked as I always do to immigrants, “How long have you been in the U.S.?”

“Two days.”

Through their interpreter, a longtime patient of mine, I learned that both men had entered the U.S. from Mexico through Laredo. The 18-year-old was forthcoming with answers to all my questions.

“How much did you have to pay the coyote to get you here?”

“$3100.”

At that point, the interpreter broke in. “He is my nephew. His mother saved up the money for him to come be with me because he cannot find work in Mexico. He’s worried about the cough because someone else on the crossing was very sick. He’s worried it might be TB.”

The other man was in pain too. “He is my brother,” the woman said. His lower leg was red, swollen and very tender, and I was worried he might have a compartment syndrome which would require surgery. I took an x-ray and luckily one of the retired orthopedists was there to examine him with me. He thought it was just a very bad bruise, but I still scheduled a follow-up appointment for the next week.

While waiting for his x-ray, the patient began talking to Claudia, one of our other interpreters.

She told me, “There is more to his story than he told you.”

When it comes to these cases, there always is.

As he told me his story, tears began rolling down his cheeks. Married with four children, he had resorted to begging to pay his bills because he could not find work in Mexico. To pay the coyote to help him cross into the U.S. where he could most certainly find work, he made the decision to sell his car, the only thing of value he had. That got him $3100, but then the coyote demanded that he pay another $1000 for security. Obviously, he didn’t have it. The coyote threatened to leave him in the desert or turn him over to a drug cartel at the border. Miraculously, his sister found a way to wire him the money.

She said, “I had to do it. He is my brother.”

I assured him that I could help him with his leg. After all he had been through, I was glad to deliver him a sliver of good news. It would take some time for his leg to fully recover, but I knew he would be alright within a couple of weeks provided he stayed off his leg at work and rely on crutches to get around.

His face fell again.

“I cannot pay for the crutches.”

I assured him that we would give him the crutches.

As for not working, I knew there would be no way to stop him so I just tried to lay out some parameters so the problem wouldn’t worsen.

As they were leaving, everyone was smiling. I knew that both men would heal soon and that for a time they would find a bit of security knowing that as long as they worked, the Church Health Center would provide them with medical care.

Still, I just feel so sick to my stomach that this is what happens every day on the border of my own country, in order to come to my city, in order to become my patient. All this money and all this fear is put on the line just for the chance to have a better life.

A life where you can work freely and provide for your family.

A life where you do not have to beg to feed your children.

A life where you do not have to pay a bribe to a drug cartel in order to work honestly.

A life where you are willing to work hard and are not breaking a law when you step into the Rio Grande River.

It was in the Jordan River that Jesus felt God’s presence. On this issue of caring for immigrants is the one place where I’m clear as to God’s will for me.

Each month at the Church Health Center, we hold an All-Staff Meeting. New employees introduce themselves to the entire organization and share an interesting fact about themselves. At our last staff meeting, every single new employee said that they speak Spanish. Some even speak multiple languages.

I have no excuse for not learning Spanish myself, but there will never be a time that a person’s country of origin will be a barrier to our care. When it comes to caring for the working uninsured, we have no impediments, both literally and spiritually.

An Unexpected Lesson in Generosity

As a not-for-profit organization, the Church Health Center has relied on the support of our community from Day One. It’s simple, but it’s true: we cannot do what we do without relying on charitable contributions. Read: we need money to keep our doors open. Whether those gifts come from the young or the old, they all make a difference.

But money is more than just cash. Behind every dollar we receive is a story and an opportunity to learn about the nature of generosity. This past Christmas, I met a little boy who elected to give the Church Health Center the money he otherwise would have received from his grandmother. This reminded me that generosity and kindness are not limited to a certain age group.

Last Christmas, Noel told his grandmother that instead of presents, he wanted her to give the money that she would have spent on him to someone who could really need it. He selected the Church Health Center as the recipient of his gift. I am floored by the selflessness of this young man and thank him for helping us make Memphis healthier.

Last Christmas, Noel told his grandmother that instead of presents, he wanted her to give the money that she would have spent on him to someone who could really need it. He selected the Church Health Center as the recipient of his gift. I am floored by the selflessness of this young man and thank him for helping us make Memphis healthier.

Early in our ministry’s history, I learned a fundamental lesson about generosity that I’ve carried with me ever since.

It was late in the day on December 23. I was our only doctor on duty that day, but since everyone wanted to be well for Christmas, the waiting room was bursting at the seams. I had already seen over 40 patients that day when our front desk receptionist, Kim, called me with an urgent request. She told me that there was a homeless man at the front desk who was insisting on seeing “Scott.”

I asked Kim, “Does he have an appointment?”

“No, I don’t remember him from before, and his name is not in the computer. He just keeps saying he needs to see you.”

This impromptu visit could not have occurred at a worse time, but rather than going to the next patient, I went out to see him. He was standing at the front desk hovering over Kim. If nothing else, I needed to get him away from her, or so I thought. He was wearing old blue jeans and a plaid shirt. He had not shaven in several days. When he saw my white coat he turned to me and said abruptly, “Are you Scott?”

“Yes, sir, I am. How can I help you?”

“Can we go in the back?”

I had no idea what he wanted, but I did not think he was dangerous. I led him into the lab, the only room that didn’t have patients at the time. He told me his name. It meant nothing to me. He then handed me an envelope.

“I hear you do good work. If I ever hear my name associated with you, you will never hear from me again. Understand?”

“Yes, sir.”

I was bewildered: what was he talking about? He reached to shake hands again and turning to leave said, “Merry Christmas.”

That was it.

When he walked out, the nurse gave me the look of “Don’t you know there are patients waiting?” The whole encounter had taken less than five minutes, so I thought I had time to look at the envelope he handed me.

I found enclosed a personal check for $100,000. At that point, it was almost one-third of the Church Health Center’s budget. I hurried to Kim and asked her if she had learned anything more about our mysterious visitor.

“No, he just wanted to see you, so I treated him like another patient. I was as nice as I knew to be. He seemed like a lot of our homeless guys, so I tried to be a little gentler.”

Of course she did; that was Kim.

That night, I could only think of Kim treating the man like another homeless man. For all she still knew, that was what he was.

The next day, after a few phone calls, I learned that our Christmas visitor was not Howard Hughes, but he had a reputation for eccentricity in Memphis almost the same as the famed aviator. I was also told that he had made other anonymous gifts and he was serious about things staying that way.

Over the next ten years, either he or one of his sons would always show up to drop off the check the week before Christmas. These exchanges were always without fanfare or conversation. One year, I drove to his house with a small present and I tried to tell him about everything happening in our ministry. If he cared, it wasn’t obvious.

Then one Christmas, the check didn’t come. And that was it. I reached out to him in a variety of ways to thank him for his gifts, but he has never responded. I am confident I did not break the trust we had.

But I do know that his unexpected generosity made it crystal clear that every homeless man is to be treated like he is about to hand us a check. Not because of the money, but because of the lesson his generosity taught me. What if Kim had told him that I was too busy to see him? Or if she just told him to take a seat? Or if I had just responded that it was too much to talk to him right then?

Everyone who walks through our front door should be treated as though their value is greater than we could ever imagine. We begin with that assumption, and then from there we do the best we can.