Lack of Feeling

In my limited experience as a PA students I've come across many different types of patients presenting with many different problems. These problems have ranged from acute to chronic pain, diabetes, hypertension, hyperlipidemia, mental disorders, fatigue, ingrown toenails, recent traumas requiring suturing, congestive heart failure, dyspnea, and the list goes on. When facing each problem one must take a systematic approach to it's origin and the best, most cost effective approach to treating it. After going through a thorough history and physical (including labs and tests) I offer each patient a list of options, with my opinion of what would give the most desirable results and the most tolerable methods. I emphasize the need for healthy life habits, including the reduction of certain substances and foods, the need for increased physical activity, and the judicious use of certain medications. With that list the patient has the option to chose which treatment regime they would prefer, and financially able to do. Every patient walks out with the understanding of the risks involved with not following through with proper treatment.
In those cases of actual physical pain I see an increased compliance to therapies that I have recommended. Now don't get me wrong, there are many out there who only want to take medicine until the pain goes away and don't want to do anything else, but they at least take their medicine. The instances where I see the least compliance in following treatment is in those cases of diabetes, hypertension, hyperlipidemia, and other similar, chronic disorders that have very little symptoms at the early stages of the disease. If left untreated these diseases can eventually lead to coronary artery disease, diabetic retinopathy/nephropathy/neuropathy, and other serious problems. Eventually the patient will come in desperately looking for relief.
So with these disease states leading to such catastrophic events why is it that someone wouldn't want to nip them in the bud and prevent the progress into such problems by adhering to professionally recommended therapies? Cost is one of them, but I'm convinced that there are two other very important factors: lack of patient education, and lack of feeling. The prior is the easiest to resolve. With a new diagnosis of certain diseases the provider can easily explain the disease process and steps necessary to prevention of progression. Once the patient is informed the rest is up to them.
The lack of "feeling", I believe, is the number one reason for patient non-compliance for three very common diseases; diabetes, hypertension (high blood pressure), hyperlipidemia (high cholesterol). When asking the patient if he/she is taking their medications as prescribed, following and maintaining a healthy diet, and exercising regularly the provider comes across a myriad of responses. "I'm just too tired after work to exercise," "I've just been forge ting to take my medications," "I don't have time to prepare a healthy meal," "es que no me siento malo (I just don't feel bad)". All of those responses can be stripped away of the justifications and translated into "No, I haven't made the effort." And the number one reason for not making the effort is the last answer, "I don't feel bad (or I don't feel any different if I take or not take my medications)." This lack of feeling gives the patient a false hope of comfort and leads them down a slippery slope to an illness which they won't recover from, regardless of if they become compliant at that point.
In my limited experience in the gospel I've noticed similar conditions; lack of feeling leading to complacency and gospel non-compliance. At the time we will say that we don't feel any different if we obey, or don't obey, certain commandments. We feel at times that they are more restrictive then freeing and that sinning a little will not be that bad in the long run. Nephi said it well when he prophesied of the philosophies of our day, "Eat, drink, and be merry for tomorrow we die...there is no harm in this...and if we be guilty, God will punish us with but a few stripes..." (2 Nephi 28:7-8). We let little sins (like diabetes, hypertension, and hyperlipidemia) run free throughout our body without making but a small effort to control and put a stop to them. Sure we might occasionally peruse the scriptures or pray but refuse to make those changes in our lives which will halt our problems in their tracks. Just as occasionally, or only, taking your medication and not making any lifestyle modifications with DM, HTN, or HLD will only partially control those diseases, so will occasionally following God's commandments partially allow you to be truly "healed."
Only when the disease progresses and we are suffering from congestive heart failure, heart attack, blindness, limb amputation, and renal failure do we look to God and ask him to "heal me!" Then we feel the pain of our choices and look to be compliant. By this time, however, it is too late. The disease has run its course, the devil has you bound with his strong cords, and death is inevitable. Unlike these physical illnesses, God's mercy is abounding and salvation is possible but much, much more difficult to attain. Christ's atonement was an infinite one, but as we let time pass without invoking it in our lives the price we must pay increases. That is when we feel the burden of the consequences of our actions, that is when we become gospel compliant.
Oh how much easier it would have been if we would have just listened to that great "Physician" in the first place and followed the recommended therapy program?! How much more cost and time effective would it have been?! How much pain could we have avoided if only we "took our medications and made those lifestyle modifications"?!
Even though we might not feel bad, or any different, at the time let me assure you that there is an underlying problem coursing through each and every one of our bodies that, if not taken care of now, not later, will lead to total system failure and an unpleasant life. Joshua said it well when he commanded Israel "Sanctify yourselves against tomorrow: for thus saith the LORD God of Israel, There is an accursed thing in the midst of thee, O Israel: thou canst not stand before thine enemies, until ye take away the accursed from among you." (Joshua 7:13)
Only through Christ's atonement and strict obedience to his commandments can we take that accursed thing from among us. Let us not wait until we have to lose a foot, or an eye, or even our heart to make that decision. It is far easier now to handle than it will be in the future.

"...becometh as a child...willing to submit to all things...."

Yesterday in the clinic I had a 6 year old patient was brought in who had gotten a piece of glass stuck in her big toe and it had been covered over by a granuloma. There was a noticeable firm bump on the dorsal aspect on her toe that wasn't inflamed much or red to the touch but it was slightly tender and hurt more when she walked. Mom said that earlier in the week she had gotten another piece out and thought that was it, but was now worried that there was more because the toe hadn't healed yet. To be able to probe for this piece of glass and then remove it mom and the girl were told that we would have to numb up her toe with a medication, and that this was going to be through a shot. I was in another room at the time with another patient while this was being explained and you could tell the moment the word "shot" was said...maybe "shot"was the wrong word to say. The girl started screaming and crying and saying that she didn't want to do it and wanted to go home instead. Her cries could be heard through the whole clinic. We finally got her into the procedure room and prepared the needle with the lidocaine. We had her lay down and mom and my preceptor help restrain her while I injected her toe. Just the mere sight of the needle made her shriek in horror. After much squirming and restraining we finally got her toe numb but this didn't get rid of the fear of the sight of a needle. To probe in the granuloma I had to use a larger needle (18 gauge), and even though I know she couldn't feel it, every time she saw the needle she screamed and tried to bring foot back. I found the piece of glass and then tried removing it with some forceps but it was too large and angled wrong to be removed from the tiny whole that I had made in the granuloma. During the procedure every time I switched between the probe needle and the forceps the girl screamed more. Many times during she would say to her mother, through tears and cries, "you said it wouldn't hurt but you lied. It does hurt! Tell them to pull it out." After the procedure was over we sat the little girl back up, cleaned her wound, put some antibiotic cream on it, and then bandaged it up. During that the little girl was quite pleasent and even picked out the color of coban used to wrap it up. She was smiling and happy and didn't resent me, my preceptor, or her mother for the pain, torture, or lies that we put her through. It's like the past 10 minutes didn't even happen.
Now I know that she remembered the pain that she felt and that she knew who put her through it, but after the ordeal that didn't seem to matter. She quickly returned to her happy little self. No resentment, hatred, or betrayal was felt or expressed. As I sat in my room later that night I started thinking about that specific event. How quickly she was to forgive us three who had held her down against her will, repeatedly stabbed sharp objects and burning injections into her skin, and told her "lies" that it wouldn't hurt much. Those didn't seem to matter anymore now that she was feeling better, and no more needles were in sight. How easy it was for her to go back trusting in her mother. How quickly she turned to be able to play with me while bandaging up her toe, even though I was the one poking around in her foot. None of the pain seemed to matter anymore, just 5 minutes later. My mind was then brought to the book of Mosiah, chapter 3, verse 19: "For the natural man is an enemy to God, and has been from the fall of Adam, and will be, forever and ever, unless he yields to the enticings of the Holy Spirit, and putteth off the natural man and becometh a saint through the atonement of Christ the Lord, and becometh as a child, submissive, meek, humble, patient, full of love, willing to submit to all things which the Lord seeth fit to inflict upon him, even as a child doth submit to his father."
How often do we continue to hold grudges, or hatred for those whole have wronged us? How many years do we let go by not forgiving someone for something they did to us? How often do we even remember what that offense was? How long will we let our pride keep us from enjoying those relationships that we once enjoyed? How often do we blame the Lord for our pains? The pain was real, those feelings of mistrust and betrayal existed and affected us, our toe was left with a bloody hole in it, now we're left to make a decision; live in the past and continually feel the pain and mistrust, or become as a child, submissive and meek, willing to submit to all things.
Two principles we can learn from this ordeal and scripture. 1) It is possible to forgive someone for the pain that they intentionally caused us. Just as this child readily forgave me we can forgive others. For her it was easy but for us it's a little more difficult. For us it can only be done if we implement the atonement of Christ in our lives. Only his atonement makes it possible for us to feel comfort and learn to forgive. If we chose to remain in our pride and not forgive then we willingly reject the atonement of Christ in our own lives. 2) The Lord will allow trials and hardships in our lives and will even be there to "hold us down" while the injection takes place. It's not because he wants to inflict pain on us, but he knows the overall outcome of the ordeal and the proper healing that will come from it. He knows what growth can come from such experiences. We can either try to kick against the pricks, or submit to his will "in all things which the Lord seeth fit to inflict upon him." Those times will be painful, we will want to scream and cry and ask the Lord "to make them take it out" but if we have faith in him and His Son's atonement, after the ordeal we will be able to laugh and smile again, quickly forgetting the pain and quickly forgiving the one who inflicted it.
Let us learn from the example of children. Let us strive to take the principles taught to us in the scriptures. There will come times of pain and hardship, but they will be brief. The pain will only last as long as we allow it to. Only through Christ's atonement can we put off our natural man and become receptive to the enticing of the Spirit, which will make the pain go away.