Sam and Joan were sitting in my office at the hospital outpatient diabetes center. Sam seemed a little bored, and Joan appeared to be anxious. Sam had recently been diagnosed with type 2 diabetes by his internist, who suggested that he come to our center for specialized treatment and education. Because I use the family approach to diabetes care, Joan was there, too.
I started the session off by asking both Sam and Joan how they felt about the diagnosis. Sam said he was upset but that he "would manage." It was Joan who had the more emotional response. Although making a desperate attempt to be "brave" and not break down, she began to cry.
Sam looked like this outpouring of emotion upset him, but eventually he also had a tear in his eye. Something that he hadn’t planned for had "cracked open." As I was reaching for the Kleenex, I noticed him moving closer to his wife. As he put his arm around her, he tried to console her and said, "Don’t worry, everything will be okay. I’ll be fine."
And that was what we worked on for the rest of the session—making sure that Sam and Joan would be okay and would handle living with diabetes. Though we covered the highest-priority "survival skills," like blood-glucose self-testing, medications and basic meal planning, the focus was on the emotional issues of dealing with the newly diagnosed diabetes.
My sessions are informal, and I encourage patients and their families to ask questions or bring up feelings as they arise so we can talk about them, put them in the proper perspective and move on to the business of living their lives. This is important, as was apparent with Sam and Joan, because if you’re scared, angry, sad or confused and you don’t talk about it, it will come back to bite both of you later.
Freedom of Expression
Throughout the session, Joan kept saying how grateful she was to have been included in the visit. She said she had been worried sick since Sam had been diagnosed, but she had been afraid of talking about it with him because he seemed so moody and irritable lately.
Sam had become much more animated than he had been at the beginning of the session. He was asking more questions and even admitting to having felt a little depressed lately. Both of them expressed relief that the pressure of the unspoken fear both of them had been feeling was now out in the open. Although this fear hadn’t disappeared, the openness had, remarkably, helped both of them begin to believe that the situation —living with diabetes—was manageable.
We established that Sam did want Joan to help—just not all the time. And there would be times when he would be committing "dietary indiscretions" and would be upset if Joan reminded him in a finger-pointing way. Joan said she understood and asked Sam if he really understood and appreciated how she felt. That although the diabetes was in his body, it was like she had it, too, because she loved and cared for him so much. And, she added with a wink: "I have an investment in him and he’s gotta stick around. We have a lot of things we want to do. He has to take care of himself. I need my traveling partner!"
Sam said he understood that this wasn’t just about him, and he agreed to keep Joan informed about his management. They both agreed that it wasn’t necessary for them both to come to all the clinic visits together all the time, but that it was important for both of them to feel like they were always working on it together.
Involve Your Loved Ones
Patients need to have their loved ones be part of the treatment and education process for two main reasons: One, it makes managing their diabetes easier because they can get knowledgeable help and support right at home. And two, the joint educational sessions provide a forum where questions and feelings can be brought up in a neutral and professional atmosphere.
Working with a diabetes nurse educator who is comfortable working with couples and families can make living with diabetes much easier as opposed to it being a "life sentence."