I tried to walk into the exam room with a smile. To give the impression I was glad to see him.
I knew I had not succeeded.
I did wonder why he continued to return.
Every three months he came back for his scheduled appointments to check his A1C. And, at regular intervals we checked off the quality measures programmed into my clinic’s EMR. His urine microalbumin was creeping up. The ophthalmologist reported mild diabetic retinopathy.
I wasn’t surprised. As long as I had known him his A1C had never been below 8. More often it was over 9. Microvascular complications of long-standing, undertreated diabetes could not be held off.
Not untreated diabetes. I had prescribed metformin and refill requests came from his pharmacy at intervals that convinced me he was taking it. But metformin alone wasn’t doing it. I had recommended adding a sulfonylurea. No, he didn’t want that. He had read about those medications on the internet, having searched Google, and had even printed out pages for me to read. It was at best pseudoscience — completely unrelated to evidence-based medicine. Did he really think I was going to acknowledge the validity of his “research”?
He had insurance. So I could offer him other options, GLP-1 receptor agonists and DPP-4 inhibitors. He agreed to consider those – and again came back with website pages printed out to share with me. No, not those either. “But thank you,” he said. He was always appreciative.
Insulin? No again. He had read it would cause weight gain – now that was true! – and I had told him that losing weight would improve his A1C. So he reasoned insulin would worsen his glucose levels. I tried to explain – to no avail.
He said the same thing at every appointment. “I need to work on my diet and start exercising. I promise I will do it. You’ll see a difference next time.”
But there was no difference.
I was dumbfounded. Yes, he was smart enough. He knew enough to use technology – but only to his detriment, I thought. I was the one with four years of medical studies at a prestigious academic center, graduating in the honor society, three years of training in internal medicine, board certification, ten years of experience in practice, fellowship in my professional organization.
He didn’t have any of that. He needed to admit that I knew more than he did about the appropriate treatment of diabetes – but he wouldn’t do it. He continued on in his stubborn pride thinking he knew what was best. He was paying me to provide medical care but then wouldn’t let me do it.
Medical care – as in I cared about him! I had seen other patients like him – losing their kidney function, their sight, their limbs. Sometimes those consequences would finally convince them – and sometimes not even then.
Mercy requires humility, I had heard. I was trying to offer mercy – one of the corporal works of mercy, caring for the sick. But his lack of humility wouldn’t let me do it! Without his humility, he couldn’t accept mercy.
So it is with us and the Lord. Without our humility, without our willingness to admit that we need help, that we need forgiveness, that we need redemption, His mercy can’t reach us. I have to admit that I can’t save myself. Mercy requires humility.
And I couldn’t do anything to save this man from the ravages of diabetes without him. Without his humility.
But perhaps there was another way.
Maybe I was the one who needed the humility in order for him to receive the mercy of my medical care.
Maybe I needed to admit that I had not yet found the right way to help him. Perhaps I needed to understand him better, to learn what his concerns were, to explore what he knew about diabetes. Maybe I had to admit that my threats of diabetic complications were never going to win him over. I was so sure that I had all the facts, all the data, all the answers.
But unless I was humble enough, unless I accepted my lack, my inability, my inadequacies, I would never be able to help him. To give him mercy.
And wasn’t this, too, the lesson God taught us about His mercy?
For to give us mercy, Jesus, the Son of God, humbled Himself, emptied Himself. He took on the form of a slave, made in the likeness of men. God took on humility. The Word was made flesh, and dwelt among us, and worked among us, and taught us, and healed us, and ultimately suffered and died for us. That we could receive His mercy.
For me to bring mercy to my patients then, in the light of Jesus the Divine Physician, I was the one who needed to approach them with humility. Yes, using the knowledge I have – yet emptying myself dying to self, humbling myself before another made in the image and likeness of God.
Next time – I would walk into the exam room with a genuine smile. I would be glad to see him again.