Rhonda came into the emergency room with a blood sugar of 450. She had been drinking too much, pissing too much, eating too much, ravenously hungry. She knew these were all symptoms of diabetes.

Rhonda had refused to check her sugars or go to the doctor. Finally, on a recent Thursday afternoon she was so blurry eyed she was sure she was having a stroke. Her husband mercifully forced her out of work when he had received her troublesome call, amplifying the worry in her voice about losing her vision and her mind.

When I saw Rhonda, she was already beaten. She knew she was dying and she expected to be pulverized into the floor. Her eyes cowered when she saw me, except she was so tired that she never actually flinched.

What has befallen her, I thought to myself, that she has already seen the future, immutable?

I met her eyes. I sat at her bedside. And I started to share myself.

What you say to yourself in this situation impacts your own life and the lives of everyone around you at this moment. When you profess the worst possible outcomes, everyone around you quietly leaves. When you are animated, everyone works with you to make that possible.

What if we changed he conversation to what we could do, instead of what has befallen you?

Rhonda, you have a life-threatening disease I remember saying, but the story isn’t written yet!

From empowerment stems action. From action stems the possibility of change. From the possibility of change stems hope itself.

Rhonda and I spoke. We spoke of how her daughter could walk her to school and how her husband could make less tortillas and more chicken. We laughed at how bad the soy burgers tasted and how easy it was to forget the metformin at night.

But we also spoke of choice. Of investigating exercise and a high protein low carb diet. Of reading up on GLP-1 agonists and their effect on diabetes. Of understanding the long-term effects of sulfonylureas and insulin on diabetes. She understood risk and benefit, and that she had choice. Choice to forgive, choice to forget, and choice to act. More than anything else, she told me clearly that inaction was a choice, one she did not want to make.

Rhonda’s blurry vision had brought her to me, but Rhonda came up with a plan for her blood sugars with me. She understood what was ahead of her. She was empowered. In a less than 30 minute ED visit, her husband, daughter and Rhonda were all aligned with the power of understanding, with information, and against the tortillas and ice cream that were poisoning her vision. Rhonda was determined to keep her vision for as long as possible.

How many nights could I feel this satisfied, empowering people with information and options to act on?

From empowerment stems action. From action stems the possibility of change. From the possibility of change stems hope itself.

Rhonda went home with hope. For that, I am Blessed.

-Dr. Naresh Ramarajan

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