About Daniel

Recently a friend, a diabetic for years, sent me a note saying that she had started taking insulin injections three times a day. After being so sick with diabetes, she says she feels reborn. I am pleased because her struggle with diabetes has really been difficult. Now insulin is giving her a whole new life.

*   *   *   *   *

Her note reminded me of a young man I knew years ago. I was one of his nurses. His name was Daniel and he was a "brittle diabetic." We used the word brittle, because his diabetes would swing from high to low blood sugars very quickly. However, he would not accept his diagnosis, was totally noncompliant, and from the time he was told he was a diabetic at the age of 15, up to the age of 25, he refused insulin, even though the oral medications proved ineffective. He was terrified of needles, he said, so consequently he arrived in our Emergency Department regularly in severe diabetic coma.

It was all so senseless. But Daniel was adamant. He fought us all, and he was going downhill quickly. All he had now was his aggression toward doctors and nurses who, in our small hospital, had all felt the sting of Daniel's verbal abuse. Stressing him more would be pointless.

On one of his hospital stays, we thought we had him receptive to the idea of once a day, long-acting insulin. But it was not to be. One evening during that time, I arrived at the nurses' station, only to find Daniel standing there. My heart sank. Ten minutes previous to this, I had tested his blood sugar and he had been, while still sullen, fairly cooperative, and listened when I told him his blood sugar was still extremely high. But, in a short time after I had left his room, he decided he was leaving.

The tall, emaciated figure with the sunken eyes, looking far older than his 25 years – his body showing muscle wasting, his skin a sickly gray color, with noticeable hair loss, and an extremely high blood sugar reading – was playing his game of Defeat Death once again. He signed the AMA (Against Medical Advice) form and shuffled his way toward the exit like a very infirm, elderly man. There seemed to be no way to manage Daniel, his offensive attitude, or his diabetes. The effects of high blood sugars were taking their toll, and this once smiling young man was dying needlessly. Daniel, who was an accomplished musician, who worked as a laborer to earn much-needed extra money, was well aware of all of this, but refused help.

This was the worse case of denial any of us had ever witnessed. He was atrociously uncooperative, and his paranoia, disdain, and hostility toward the very same medical personnel who worked hard to save him were unbelievable. He was so disgusted with the world that he would risk his life, and horrify his family, who could not bear to watch him slowly die. His talent was being wasted, his mother was distraught, and his brothers were powerless.

We knew he would be back, because his condition was worsening. Such was his pattern as he endured diabetic comas that left him weakened and disoriented. The oral medications, when he did take them, were not effective, and still he refused insulin. He hated needles, he raved, and no amount of persuasion, pleas from his family, or the numerous audiovisual aids we used, would change his mind. "I would rather die than take insulin injections!" he said. His doctor told him he was dying, but Daniel stood his ground on the insulin issue. We felt helpless and defeated as we watched a young man slowly let his life slide away.

In a week, Daniel was back. He had been found in a car, unresponsive, filthy, and covered in sores and cuts, and had been rushed to the ER once again. In an hour the doctors had him sitting up and were busy fending off his fists. He would never let anyone remove his clothes, or have an IV drip put in his arm, it was always his hand. His blood sugar was the highest they had ever seen, so he was receiving insulin by IV drip. After some control was achieved over his alarming high blood sugar, he removed his IV drip and promptly left! The ER nurses said they felt then that they would not see him alive again.

Their instincts were right.

Two weeks after that hospital visit, Daniel was found lying in the street, unresponsive, dirty, and wasted, with no signs of life. He was pronounced dead upon his arrival at the hospital. Daniel's fight with diabetes was over. It was heartbreaking in the ER that day.

Then the ER nurses noticed something peculiar. Daniel's body was covered with needle punctures.

He could overcome his fear of injections to use street drugs, but would not take an insulin shot. In the end, diabetes had not claimed the life of the sullen young man who "hated needles"; the toxicology testing showed that an overdose of heroin had. When he injected his street drugs, he found the euphoria he craved. Insulin could not give him that, even though it could save his life.

Losing Daniel haunted us. We studied the dynamics of drug addictions and, through this process, we learned that addictions destroy reason, negate fear, push aside scruples, and steal life. This analysis helped us deal with our sense of failure.

Daniel's life was terminated at the age of 25, lying in the street, with garbage blowing around him, alone except for his "friend," the bag of drugs in his pocket. That he was fearful of a tiny insulin shot, yet covered with needle punctures, for us, was inconceivable. Now we knew why he always needed money! It was so sad.

My friend chooses to feel better with insulin, Daniel chose to feel better with heroin.

How many more Daniels do we have out there, I wonder?

Be at peace, Daniel. Your battles are over.

Discuss This Article

Have something you'd like to say? Tell us what you think! Read and post comments for this article.

Find a Job

Choose your career:

MedHunters is the world's biggest healthcare job board. Our job directory has 16,443 jobs with 2,364 hospitals and other direct employers.

We want you to find your next job on MedHunters. Need Help? Call us at 1-888-884-8242, email us at info@medhunters.com or sign up now.