When my mother was diagnosed with diabetes in her early 70s, I was working in home health as a clinician providing counseling services. I'd evaluated hundreds of patients my mother's age, many of them with diabetes.
Their level of compliance with (or defiance of) a diabetic (or any) treatment plan could sometimes be predicted by examining a person's medical record. Did he or she follow doctor's orders? Take medication as prescribed? Attend follow-up appointments? It's totally unscientific, but from this perspective, my mother was, in general, a good, obedient patient. She never questioned her doctors and healthcare professionals loved her.
The first thing my mother did upon receiving the diagnosis was go out and buy two AccuCheck machines in case one broke. But I knew in my heart it was likely that my mother wouldn't be able to control her blood sugar. Long before the official diagnosis my mother couldn't control her eating. Before that, she couldn't control her smoking.
I was correct, and it saddened me. In addition to being unable to control her blood sugar, her blood sugar monitoring became unwieldy. Over time she was testing herself so often—fifteen or twenty times per day—her fingertips shriveled and toughened with scars. But while her blood sugar level or weight might be within normal limits on paper, the numbers did not reflect the actual disease process—mental, emotional, spiritual, physical.
To test, my mother pricked her finger with a needled stick, squeezed two drops of blood onto the test strip and slid it into the machine. "I hope I get a number I can live with," she'd say, applying a Band-Aid to her fresh wound. Then she'd fold her hands in her lap and wait.
When the machine beeped, she crossed her fingers. Either she "hit a winner" or "got a loser," she said. A loser-any number higher than her endocrinologist suggested was healthy-prompted more tests and a strict diet of peanut butter sandwiches to stabilize her blood sugar. A winner necessitated celebration, complete with any food she felt deprived of that, naturally, made her sugars spike.
This was a reincarnation of how my mother used to smoke, puffing through four hard packs a day. She attempted to quit many times, but always came back smoking more. As a child I drew circles around the tips of her cigarettes, as public service announcements on television back in the 1960s implored kids to do. In theory, when the smoker hit the red line-which you strategically placed far from the filter-the smoker would extinguish and actually thank you for the gentle reminder. But Mom felt controlled by my attempts, policed by my fears that she might die and, literally, blew past every red line I drew. "Thanks," she said, "But don't waste your red markers." She quit years later, but only when X-rays proved her lungs were black and the threat of cancer loomed. Within two sessions with a hypnotist, Mom threw her leftover cigarettes into the garbage and announced,
"I'm free!"
Then she started to eat.
It started with healthy snacks, peanut butter on apples, toast, a clear chicken broth, but soon progressed to fried chicken. McDonald's French fries and A&W root beer floats. She gained weight, as ex-smokers sometimes do, when one compulsion is traded for another. Her struggle with food led to her late-onset diabetes. Her compulsive behavior, I believe, was the real disease. The diabetes, in this case, was secondary, almost like referred pain.
I understood that compulsions progress (worsen) over time, and can be exchanged for other compulsions (food for smoking, for example). I understood-but my clinical training had nothing to do with it. Our family was filled with compulsions. In my late teens and early twenties I was that person who ate erratically—binging, starving—then climbed on the scale to "get a number I could live with." My compulsion was the underlying disease, the root. And realizing this in myself finally scared me enough to take action and get help. It's definitely not the same struggle today for me around food. (But my mind can still find something to obsess about.)
It hurts to be an out-of-control person and it hurts to love one. You feel not only powerless but impotent to make them stop hurting themselves and, by proxy, you. As a caregiver it can be tough to see that, especially through the veil of our own, ahem, issues. Out-of-controll-ness—compulsivity—sometimes runs in families. Letting go, balanced with selective action and evaluating whether more help is needed and whether the actions underscore a deeper problems, becomes the higher form of love or compassion. Because anything else-which is, in reality, only worry, veiled attempts at control and manipulation-isn't love at all and doesn't work.
It was a mixed blessing, then, when my mother's memory began to weaken a few years later, requiring she move to an assisted living facility and finally a nursing home where her blood sugar was tested for her at normal intervals. Even then, some behaviors don't go away. Whenever I visited her, even in the later years before her death, she often had a little smudge of peanut butter at the side of her rouged lips. When I hugged her, I felt the crumbs of bread on her cheek, like I always had.
This essay appeared in a different format in A Sweet Life.
Photo credit: Jenya Cambell
