THE STORY OF MY DIETETIC COUNSELING -PART 2

Being a dietitian is not all about dietetic consultation. Sometimes its beyond that. Take today’s case as example. I was covering Kak Aishah in Klinik Sekilau. One of the patient today was a 50 yo Science teacher. She was the 8^th pt, the last pt before lunch hour, newly diagnosed with diabetes mellitus.

So same old same, I asked for her 24 hour diet recall, and the food frequency checklist. To cut the story short, she practices a very good, healthy, well and balanced diet (the one that I myself found it hard to do), all that you can find in the textbook. The portion size is very good, no refined sugar in the diet, lots of veggies (organic some more), healthy cooking methods, healthy lifestyle, exercise regularly, regular medical check up, and she also has an ideal body weight. She claimed that she has always been practicing healthy diet, and has become more conscious on diet ever since her husband was diagnosed with cancer in 2004. She knows all about the anti oxidants, omega 3, unsaturated fat and what not, as she claimed that she read about diet more than she study for her Masters. That’s how conscious she is. That being said, she has a strong family hx of DM, as her mother was diabetic.  

Her question is –what have I done wrong?

It’s a very difficult question. Because she asked that not because she didn’t know the answer, but she asked that out of despair, frustrated, and sad. I could sense that she was heartbroken. It is always easy to counsel diabetic pt based on the guidelines that we have –regular meal time, don’t skip meal, avoid refined sugar, carbohydrate counting, increase fiber and less fat. What if your pt already knows all these stuffs, and what more has been practicing it for long? Do I still nag about all these things? Of course I still did the usual diabetic counseling; despite she already knows most of it, but with justification. Each diabetic guideline that I mentioned to her, comes with the ‘why’. Well I hope that helps. But that’s not all.

Remember I mentioned before that diet consultation is very individual? So I told the pt, that diabetic, is hereditary. When your mother has diabetes, the chance that u might also get it is 25%. At the beginning of the discussion (I rather called it a discussion as she knows a lot) she was very skeptical about genetic issue (despite being a Science teacher she is). For her it is not fair, you know, to get the disease simply because your mother has it, because it is in your DNA.

I’ve learned Developmental Psychology during my first year of study. The Kubler-Ross grief cycle. There are 5 stages of grief, upon knowing bed news. They are Denial, Anger, Bargaining, Depression and Acceptance. I believed that the pt has been on the second stage –she she keeps questioning why, and how does she get diabetes, with all the healthy diet and lifestyle. She said that if it is not for the biochem result in her hand, and the repeating test, and the diagnosis by doctor, she will never believe it. And she is somewhat giving up on healthy lifestyle, as she mentioned that why bother when at the end of the day, she still sick. 

The Kubler-Ross Grief Cycle -image googled

At the end of the session, I did tell her something else –to bersabar, and having diabetes doesn’t mean the end of the world. She can always continue practicing healthy lifestyle, take control of the disease, don’t let it ruin you, physiologically and emotionally. And that was not me as a dietitian talking –that was me as a human being, trying to put myself in her shoes. Its difficult, really. I just hope that she will reach the end stage of the grieving process, which is the ACCEPTENCE phase, make peace with the disease, and yeah, control it.

Sometimes its hard to explain things with Science. As a Muslim, we have to have faith in Qada’ and Qadar. When Allah said kun, fayakun. No one can stop it from happening. And we must believe that there is always something in everything. Setiap perkara yang terjadi ada hikmahnya. La yukallifullahu nafsan illa wus’aha. May Allah grant us with good health, amin.