Unit 3 Section 2Exercise 6Living with chronic illness: diabetes
Clinical correlate 5: Diabetes:Insulin use/patient-centered care
Read the poem below. For clinical information on insulin use, review the clinical correlate. See study question 5 for reflection on patient-centered care. See also Annotation
James McManus, "Spike Logic"
Since my smeared blood has registered beep beep beep
a half-decent 166, I download 34 units of Regular Humulin, 52 units
of Lente (S166 34R + 52L / 900 calories and 45 minutes
of Stairmaster) then snap my coked index fingernail to dropkick
sideways from the top of the syringe the stubborn little bubble
that other wise might, Allah forbid, introduce a fatal embolism
into my maculate cardiovascular system. Dr. Michael Halle,
my most recent endocrinologist, he of the grizzled jaw and wheels
of fire flaming round his eyes, has been on my case hard
for the past several weeks to go from two to shit three
shots a day, this to all the more tightly control my sugar
levels, and as soon as I don’t find this stuff amusing anymore
I stop mumbling and humming and cackling viciously hyeah to
myself
about how I never did anything, I never did anything, that caused me
to get diabetes, how I’d like to add that to the hemisphere’s
burgeoning reservoir of ribbonworthy causes and T-shirtiana...
just as the perfectly ripe, six-percent-brown-splotches Chiquita
I’ll anally slice into uniform three-eighths-inch-deep cylinders
for subsequent layered dispersal amongst 1 oz. Wheati and Equal
reminds me all over again I’m not quite intact and I want to be perfect
but so
could certainly have done without having to prick just don’t let me
get started my fingertip before insulating my blood this warm morning
and evening and every last morning and evening and pretty soon
morning
noon and night, especially now that my faux Proustian, already
sizzling brain
is retrieving with hypermnemonic precision and velocity voices and
mugshots
of persons convince they’ve got health problems the minute they
come down with liverspots,
strep throat, insomnia, root-canal-caliber cavities,
gingivitis (another advantage of having diabetes:
you don’t have to floss), ulcers, acne, the wrong-sized cotton ball
for applying fresh witch hazel, nearsightedness, migraine, one testicle,
torn anterior cruciate or ulnar collateral ligaments, corns, ague,
distemper, alcohol or narcotic dependency, gas, cellulitis,
fractured tibia, psoriasis, hairiness, hairlessness, old
skin and bones, folks who will genially curse
as they recount, mucus-voiced, the history of their cold…
Because our sickness must grow worse
Because I do not want
Because I don’t have my health
Because I don’t want to have to be fitted, sweet ladies, for none
of these big-time wowzer breakthrough prostheses, have krypton
lasers focused on the backs of my eyeballs to cauterize capillaries
in order to inhibit, though not to reverse, retinopathy. Because I do
not want
my kidneys to deteriorate to the point where I need my blood
cleansed by
dialysis, assuming I meet my then HMO’s criteria, assuming I have
one, assuming
my fucked up circulation hasn’t crunched my nerves’ capacity
to produce nitric oxide so I can’t even fill out the HMO’s forms, see,
get a
hardon, track the moist grain of a nipple or gnawed pen or vulva.
Because as the blond guy from the Shrimp Boat has lazily drawled, I
wasn’t feeling
that fine . On, literally, the other hand, the first president ever I walking
pre-existing condition that I am voted for has signed an executive order
making it legal again to use fetal tissue in research enhancing
the possibility of implanting functional, way less rejectionprone
islets of Langerhans into my gall bladder, kidney or liver. Wherever.
Because
I want to be cured of this thing as of Monday. Because I want
to have never had it. Because
I do not want
Because what part of this last do you not understand, Dr. Mike
and Camillo Ricordi and colleagues at research facilities in Tokyo,
Rochester , Pittsburgh, Dublin, St. Louis, Los Angeles yo!?
as I stab my left thigh with the hollow and glistening spike.
from Salmagundi
Study questions
1. This is a great example of how patient experience can teach clinical medicine. Use the clinical correlate to study insulin dosage and monitoring. What technical understanding of his condition does the patient have?
2. Use the following key words to write a summary of the patient’s experience.
a) perfection
b) HMO
c) Resistance
3. What is the patient’s relationship with his physician(s)? Describe the contrasting perspectives of patient and physician in this case.
4 . What do you think the writer is saying about all the other diseases he lists? Is he being fair? What have you learned from this poem about the different experience of acute versus chronic disease?
5 . The clinical correlate links you to an article on patient-centered care. Discuss this poem in relation to the chronic care model discussed in the article.
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