My father reads this blog

But I'm posting this anyway.

He's been taking classes at community college for a few years now, and started taking biology classes a year ago. I'm really proud of him for this. And also, it makes it possible for his to understand parts of what I talk about concerning med school. It's nice to have someone in my family who does.

They seem to be doing interesting labs this block. Last week, they did blood glucose, blood typing, and a blood smear for student volunteers in the class.* My dad came back with a random glucose of 197. First he told me it was "180-something" without looking at the sheet where he'd written the numbers down. I suspect he was subconsciously suppressing the truth.

So..... my dad is 3 points away from having diabetes. And since there is no particular magic about "200," I feel we should be saying that he has it.

And his BMI is only 24.5. Though he has put on 30 lbs in the 10 years since he retired and moved to CT. And though he has been good about exercising his brain, his only physical activity (since he quit participating in Summer Soccer which he runs at his church) has been walking from the house to the car and from the car to the house.

I am really NOT excited about this. Despite his sedentary lifestyle, his low BMI means to me that there is a strong genetic component. Type 2 DM is autosomal dominant. His dad had it too. Which means X marks the spot on little old me 30 years from now whether I get fat or not. If I get fat, it will mean 15 years from now.

F***.

I told him he needed to be more active. That he should think about trying to get back down to 165 (he weighs 171 now). That he could take the dog for a walk, cut out back to one dessert per day, or only one glass of wine. Surely he could do these things. They were small!

He had a colossal shit fit about it. He very indignantly told me that "didn't have time" to do things like take walks. He insinuated that I was asking too much of him and being a rude child. He got passive aggressive and defensive.

Denial anyone?

I ultimately tried to pitch the argument that really he wasn't "sick" now, and the disease was very manageable with MINOR changes in his lifestyle. And that I just wanted to make sure 20 years from now he didn't end up with pain in his legs when he walked or kidney failure.

He finally agreed to ride my mother's dormant exercise bicycle for 15 minutes a day. Last I heard, he's actually been doing it. I hope it's enough. At least it's a good start.

After we got off the phone, I sat on my couch in Philadelphia wondering how this scenario would have played out with a primary care patient. Probably, the same denial would have occurred, but the patient probably wouldn't have played the "bad behavior" card that parents can. They would have probably gone home quietly and continued doing all the things they always did. And they would return to my office 5 lbs fatter. Even if I did all the counseling in all the ways we have been taught to in medical school.

And, that is reason #5,000,001 that I cannot do primary care.



*Interestingly, the smear of one of the students was abnormal. Way too much blue. I think the teacher was concerned about leukemia. The student was 25. Freaky stuff!