Mr. A. was a frequent flier who called 9-1-1 on a regular basis—at least once a day, if not multiple times. But, he wasn't the one doing the calling. It was a buddy or his girlfriend calling for the same thing: "He don' take his sugar shot," or, "He take his sugar shot, but he didn't eat, so he done fell out."
Each and every time we went, it was the same routine. We'd check his sugar, find out his BGM was higher than the Gross National Product of China or so low that the first four numbers after the decimal point would've been zero followed by a 1...if we were that lucky that day.
We would play our favorite game of Poke-and-Hope, trying to find one sliver of vein that wasn't covered in scar tissue so we could give him D50 and allow him to wake up in a manner that wasn't unlike a bull after being Tasered. He'd wake up swinging and kicking, ripping out his line, cussing us out for waking him up from his nap. If his sugar was high that day, he'd sit obstinantly in his bed, refusing to go to the hospital. The speech was the same every time: "Mr. A, if you don't go to the hospital with us, you know what's going to happen. By tomorrow or the next day, if you don't take your insulin or keep up on your sugar, we'll be back, because you'll be unresponsive. Do you want to go through that again?"
Mr. A would sit, sullenly staring at the wall, the ceiling, his belly-button...whatever he could to keep from making eye-contact. The results were always the same: a refusal. The times we'd arrive to find him unresponsive, we'd take him to the ED, but once he was awake, he'd sign himself or have his girlfriend sign him out against medical advice.
We tried everything we could to get him the medical care he desperately needed. It seemed as if he were absolutely unable to care for himself, and his roommates were not able to take care of him. It looked as though the only outcome for him was going to be transport to the local cemetery.
One evening when we were eating at a local restaurant, Mr. A and his family walked in with a few people we didn't recognize. We had been at his home so many times, we thought we knew all of the people who lived there by name and face. They waved politely at us, and Mr. A seemed as if he was doing pretty well. As they sat down, we watched him pull out a glucometer and a vial of insulin. Right before our eyes, we watched him check his blood sugar, jot something down, then, while looking at a piece of paper, he gave himself an insulin injection.
We were stunned. The man who could never even find his glucometer, was testing his sugar and taking his medication! From the looks of it, he was even recording his numbers. We shrugged our shoulders thinking that, finally, someone got through to him.
We didn't hear from Mr. A for almost a week. We started to pass by his house on the way back to the station after calls to make sure there were lights on and movement in the house. We'd wave when we saw him sitting on the front porch and he'd wave back.
Unfortunately, like clockwork, it started up again. After one particularly frustrating encounter, a woman who identified herself as his cousin pulled me off to the side: "Child," she started in a very motherly tone, "you're wastin' your breath. He ain't gonna listen to you. He does this. He's had the sugar these past 15 years, and he's making the choice not to do what he needs to do. Some days, for appearances, he'll choose to watch the sugar...if not, he gets lazy. He'll eat what he wants to eat, then give himself his medicine to fix it, or he won't. It's that simple."
I furrowed my brow, "But why..."
"Because he can act like he don't have it."
The message hit home. We all knew what he needed to do to keep these repeat visits from happening. He had to take care of himself, but when the cure is sometimes more frustrating than the disease, patients may ask themselves if it's worth it.