Tuesday, February 7, 2012

Immunity to Change

I cried twice in my Medical Nutrition class, yesterday. Once because I took a quiz on medical terminology and felt as if I studied the wrong things. I don't ever remember reading about a "plastic" artery, or the root word for bone marrow.
I wasn't the only one. When the Professor called, "Time!" ...yeah, I know, when was the last time you heard a Professor ever say that's it 'TIME'. Everyone around me all had the same look on their faces - like they just crapped themselves! Then, this young boy raised his hand and asked, "Are you sure you took those words from the book you told us to study from?" Nervous giggles everywhere ...and then the realization ....
This class is freakin' HARD!
The lecture followed for about an hour and then we took a break. After the break, one of students gave a presentation on Type II Diabetes. For this class,we each have to choose a different medical condition, assess the condition based on someone who will allow us to have access to their medical records, prescribe a Nutrition Therapy Program and then evaluate and monitor the plan to determine if the Nutrition Therapy is helping.

The student presenting on Type II Diabetes stated that her patient was morbidly obese, a single mom (she had one young son), drove a delivery truck for a living and was currently taking medicine for her diabetes, but refused to take insulin. The student worked for a Podiatrist, which is where she met her patient. This patient comes in with foot ulcers, which are a common complaint when someone is suffering from uncontrolled diabetes. According to the patient's medical records, the medicine that she took for the diabetes was not working and her blood sugar levels were very high. As a result, this patient was now suffering from the early stages of kidney failure.

Then, my classmate presented what her patient ate on any one particular day. For breakfast, the diabetic patient would go to Dunkin Donuts, every day, and get a bacon egg and cheese sandwich and a large coffee with four sugars and milk. For lunch, she would go to Subway and order a sandwich full of salami, pepperoni and provolone cheese with a medium Coke. For dinner, she and her son would go to McDonald's and ordered a Whopper Jr. with a medium fries and a medium Coke.

That's when I lost it. I just sat there and cried. This poor woman, she was killing herself, on so many levels. Then, I just pictured her, eating dinner, with her son - maybe at McDonald's, maybe in their kitchen. I wondered if they had heat. So many thoughts and scenarios ran through my head about this person.

She didn't want to change her diet. She didn't want to take the insulin. Why? Why didn't she want to make the effort - even if it were just for her son?

There is a disconnect somewhere. I see it even with people who have the best intentions. Their ability to "make meaning" or "sense" is missing.

Like with people who make some kind of resolution and say, "I wanna start an exercise routine" or "I wanna quit smoking" or "I wanna lose 10pounds". But they don't ...there is an immunity to change.

With my classmate's patient, the immunity to change was huge. It was beyond not having any motivation, confidence or desire to change. Kegan & Lahey, in Immunity to Change,  say this immunity is based on hidden commitments that drive our behavior and grip our thoughts. The only thing I could think of for my classmate's patient was that the foods she chose to eat were the only things in her life that gave her pleasure. It was the only thing that she used to treat herself. These are what Kegan & Lahey call "Hidden Commitments."

To move passed our immunity to change we need to address our hidden commitments so we can make our goals and visions possible. My classmate came up with a great Nutrition Therapy Program that altered her patient's foods a little - she replaced the Coke with Diet Coke and replaced the fattening deli meat with lean turkey. These small alterations don't threaten her current food choices that much, but the real change will come when my classmate's patient recognizes her immunity to change and her hidden commitments. I pray this happens for her.


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