See What You Cannot See

DU. A national study of chronic disease prevalence and access to care in uninsured U. Engelgau MM. Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control. The health status of patients of a student-run free medical clinic in inner-city Buffalo, NY. Insuring the uninsured: A student-run initiative to improve access to care in an urban community. Odin, chief of the Norse gods, came down from Asgard to seek the ability to see all. To do this, he knew he must drink from the well of a mortal, Mimir, the wisest man on earth. He knew he would be required to pay a heavy price to drink from the well. When Odin arrived, Mimir told him that if he wanted the gift of sight, he must tear out his right eye. In his quest for knowledge, Odin obliged. I recently saw a patient who was fired from her job because she was always late. Often she would get to work after nine o'clock. Even though her performance was satisfactory, she regularly missed morning meetings, and her schedule was unpredictable. Despite repeated warnings, she did not change her behavior. So she was fired. Her pulmonologist thought she should be evaluated for depression, and this is where I met her—at the outpatient psychiatry clinic. In our first meeting, we spoke for an hour. After conferring with my attending physician, she was prescribed an antidepressant and referred to a therapist. We didn't talk much about why she was chronically late for work. I assumed it was because she was overwhelmed. Being a single mother was challenging, and her six-year-old daughter was often difficult to get out the door in the mornings. During our fourth meeting, I finally asked why. She was doing better on the medication, but something was still missing. She had found a new job, but she still was not arriving on time. She mentioned that her daughter had stayed at her mother's house a few times during this adjustment period. So what was preventing her from being punctual? Almost as if she did not realize it was unusual, she let it slip. Every day she got in her car, started driving to work, then returned home to be sure the door was locked. She would do this once, twice, sometimes 10 times each morning. Then she arrived at work, late. Depression was only part …