A fictional column. All patients are composites. This is reflection, not medical advice. Full disclaimer at the end.
Wednesday. 9:02 AM. Clinic was supposed to start at 8:30.
The second patient of the morning, who is actually the first because the first one has canceled, arrives with a calculator. Not a phone. An actual calculator. It is the size of a small book, with a solar panel on top doing nothing in this fluorescent room. He has it open on the desk before he sits down.
“Doctor, I have done some math.”
I have not had my coffee. I know this because my coffee is in the corridor, in the same cup it has been in for forty minutes, and I keep meaning to go get it.
“What kind of math?”
He shows me a column of numbers. Weights, sugars, step counts, hours of sleep, cups of tea per day, and a column at the end labeled “ratio,” which he has calculated himself. The ratio is 0.74. I do not know what the ratio is the ratio of. He does not fully know either. He has read that 0.74 is concerning.
“Concerning by whose standards?”
“There was a website.”
I look at the column. The numbers are, individually, all fine. The weight is fine. The sugar is fine. The steps are heroic. The sleep is what most adults would describe as a fantasy. He has been doing everything right for eighteen months, and he has come in today because he is worried that the ratio of doing-everything-right has dropped.
I tell him this is a thing his body is allowed to do.
He nods. He does not believe me. He puts the calculator away, slowly, the way someone closes a notebook they had hoped would explain more.
He asks for a follow-up in three months. I write it down. He stands at the door for a moment, his hand on the handle, and asks, “But should I be worried?”
“No.”
“Are you sure?”
“Yes.”
He leaves. The calculator-shaped indentation stays on my desk for the rest of the day. I keep half-expecting it to come back.
11:45 AM. The patient is a man in his sixties who has not spoken in seven minutes. His wife has spoken for both of them. She has, she tells me, brought him in because his sugar is high and he refuses to admit it. He sits beside her with his hands folded in his lap. He looks at the floor. He looks at the ceiling. He looks at me, briefly, and then back at the floor.
I ask him a question directly. He looks at his wife. She answers.
I ask another. She answers again.
I ask the third question while looking only at him. I do not look at her. The silence is so long that I begin to wonder if I have made a mistake, if I have offended someone, if the question itself was somehow wrong.
He says, “I knew.”
His wife stops mid-sentence.
He says it again. “I knew. For a long time. I just did not want anyone to make me do something about it.”
She looks at him as if he has just walked into the room from somewhere else. Maybe he has. He looks tired in a way that has nothing to do with the sugar.
We talk for a while. She talks less. He talks more, slowly, in short pieces, like someone unpacking a suitcase he has not opened in years. He had a brother. The brother had the same diagnosis. The brother did not do well. He has been afraid for, by his own estimate, eleven years.
I write the prescription. I write the follow-up. I do not write the eleven years. There is no field for it.
When they leave, his wife thanks me twice. He does not thank me. He shakes my hand once, looks at me, and walks out.
I sit for a moment. The calculator-shaped indentation is still there. I push my coffee, now thoroughly cold, to the edge of the desk, where it will continue to wait.
At 1 PM I do not eat. There is a sandwich in my bag from yesterday, or possibly the day before. I have begun to think of it less as a sandwich and more as a roommate.
I think about the calculator man. He has a ratio. The ratio is invented. He will, I suspect, keep inventing ratios for years. Each new one will worry him for a few weeks. He will calculate his way through middle age. He will be fine. He will not feel fine, but he will be fine. Those are not always the same thing.
I think about the quiet man. He knew. He always knew. The fear was the prescription he had been writing himself for eleven years, and today, in a room with bad lighting and a tired doctor and a wife who finally stopped talking, he picked up a different one.
The afternoon clinic starts at 2:30 today. I am told this by the receptionist, who is told it by the booking system, which is told it by something none of us has ever seen. I drink the cold coffee. It tastes like a cup of coffee that has spent some time thinking about its life.
The next patient is waiting. I can hear the small sounds of a folder being opened.
Disclaimer
Doctor’s Diary is a work of fiction. All patients, conversations, clinical findings, laboratory values, treatment decisions, and outcomes described in this column are invented composites. They do not depict any real individual, living or deceased. Any resemblance to a specific person, encounter, or institution is coincidental and unintended.
This column is published for reflection and literary purposes only. It is not, and is not intended to be, medical advice, a clinical opinion, a diagnosis, a treatment recommendation, or a substitute for professional medical evaluation, examination, or care. Nothing in this column establishes a doctor-patient relationship between the author and any reader.
Do not start, stop, change, or interpret any medication, test, diet, lifestyle measure, or clinical management on the basis of anything written here. If you have a clinical concern, consult a qualified healthcare professional in person. In an emergency, contact your local emergency services immediately.
The author writes anonymously. The views expressed are personal literary reflections and are not official guidance from any institution, regulatory body, hospital, university, professional society, or government agency. Information may not reflect the most current medical consensus, guidelines, or evidence and is provided “as is” without warranty of accuracy, completeness, or fitness for any particular purpose.
The author, Hormone Insight, and its operators accept no liability for any action taken, or not taken, on the basis of content published in this column. By reading this column you acknowledge and accept these terms.
