Prescription for Success: Caring
When pharmacist Steve Chen first saw him, Mike Metcalfe was straight out of a hospital ward following an eight-day diabetic coma. He was 50, homeless, weighed 300 pounds, and his doctor had given up on him.
“His physician said ‘he doesn’t want to take insulin. His blood sugar is out of control,’” recalled Chen, who was working at the Center for Community Health on Los Angeles’ Skid Row at the time. “Basically, he said, ‘ do what you can with him, good luck. And by the way, he’s very difficult.’”
That was 10 years ago. Today Metcalfe is a preeminent example of how pharmacists who expand out of their traditional role can help patients control diabetes.
Metcalf, a Los Angeles native, attended California State Fresno in the 1970s and was a point guard on the school’s freshman basketball team. But family tragedies, employment setbacks and drugs and alcohol became the backdrop for a slide to Skid Row in the 1990s.
Chen sensed that Metcalfe—who had stayed sober since 1997–was not a lost cause if enough attention could be paid. Chen was not simply a dispenser of medication, he became Metcalfe’s de facto primary care provider, and a dispenser of tough love.
First up was food. Metcalfe’s binges were sending his blood sugar levels soaring, threatening his eyes, kidneys, heart, and life.
“I’d been eating two large pizzas, hamburger, French fries. I’d go through a loaf of bread with peanut butter and two liters of soda,” said Metcalfe. “I was just crazy about eating.”
Chen put him on a strict, do-it-or-die diet.
“He taught me how to count carbs, watch what I eat — eat to live, don’t live to eat,” Metcalfe said. “He told me to substitute water for soda. He was amazing.”
“I listened to him because I liked him and he seemed to care. That really touched my heart.”
Then came the insulin, which must be injected and is critical to controlling blood sugar in many patients.
Metcalfe resisted. “I didn’t like it,” he said. “I’m scared of needles. It hurt. But he said if I didn’t take this, I’d die.” Chen didn’t mince words and told Metcalfe he would likely be on insulin forever.
Then came the exercise, and purpose in life.
“I started gardening because he told me I needed to sweat,” Metcalfe said.
He found work as a property manager in an apartment complex in 2004, where he lives. He also cleans a massive church housed in a former warehouse twice weekly. He occasionally lectures Chen’s students at the USC School of Pharmacy about how to deal with difficult diabetics like he used to be.
And all that gardening means he gets to eat fresh vegetables, which has helped him shed the pounds. He now weighs in at a lanky 190.
“I’m telling you between my work here,” he said, pointing to the church, “and my work in the garden, my waist is so skinny, I can hula hoop through a cheerio.”
And maybe best of all, he no longer needs insulin.
“Mike showed me that the sky’s the limit in terms of what patients are capable of doing,” says Chen. No matter how “difficult” a patient is, he adds, you can always find the right treatment. “You just need to listen.”