Morning Prayers

It was a couple of years ago, but I remember it like it was yesterday. I was up in the cold dark of pre-dawn. I had shaved and showered, and I was looking at my clothes laid out on the bed. I had carefully centered my name tag on my scrub top the night before. Putting it on, taking it off again, then putting it on again. Trying to get it just right. My stethoscope was polished and ready. I had two black ink pens and a brand-new pair of white shoes and I was scared to death.

It was the day of my first “clinical” at the regional medical center. All the classroom and lab fun was behind me. Now it was sink or swim. Time to do the job for real. The two Tums left a chalky taste in my mouth and didn’t do much to settle my stomach.

Above the closet hung a retablo that my Hispanic/Catholic wife had bought for me when I went back to school. It is St. Agatha, patron of nurses. A retablo is a hand-painted image of a saint on a flat board. It is a folk-art tradition as old as New Mexico. I think the gift was her way of signaling me that she thought I was on the right path.

Actually, like most Catholic saints, Santa Agatha is a multi-tasker. She’s also the patron of women with breast cancer and she’s in-charge of volcanoes. The story is a bit murky, but as I recall she was a virtuous early Christian woman who refused to marry a powerful pagan Roman Senator. He did various horrible things to her with no effect, such as cutting off her breasts and throwing her into a volcano. My little retablo shows her calmly holding her breasts in her hands and looking saintly.

I pulled on my scrub top. Laced my white shoes. Draped my stethoscope around my neck, shiny metal name plate out wards. The stethoscope name plate was a gift from my fellow students. It read: “William, NTD.” NTD stands for Not The Doctor. A problem that faces me to this day. I always get mistaken for a doctor. Well what can you do? A six-foot middle aged white guy with a beard and a stethoscope working in a rural New Mexico clinic…..????

Anyway, back to the cold dark morning. I’m a spiritual guy, but not a church going type, and I rarely pray in an organized way. But on this morning I kissed my finger tips New-Mexico-Catholic-style, brushed my fingers lightly across the face of the retablo and prayed:

Santa Agatha--
guide my heart,
my head,
and my hands.

I don’t know where the prayer came from. It just came. And the day went well. I was compassionate, smart, and capable. St. A now hangs above my desk at the clinic and I say the same prayer every morning when I get to work.

Santa Agatha--
guide my heart,
my head,
and my hands.

And she does.

“V” isn’t always for Victory

One cherry slice.

Fifteen minutes. It is dark and cold. The wind is howling outside. It is a little after two in the morning.

Second cherry slice, plus a half left over. My emergency jar on the bed stand is now empty.

Fifteen minutes. The girl woke me up thirty minutes ago to warn me that the correction bolus had gone awry. The damn cookie buffet at the church concert had parked me at 400 BGL at bed time. It was now three hours later and I still have 3.95 units in play.

The fifteen minutes are up and I do a finger stick. I’m at 50. And dropping.

I’ve long believed that IQ and BLG are linked on the low end. The cave-man panic sets in as I make my bleary eyed way through the dark house to the kitchen.

Three spoonfuls of honey. Then I spy the white-chocolate covered Oreos. After two of those I drink a glass of milk. I know that on some level I am over-compensating, but in the heat of the fear all I want to do is stop this hypo in it’s tracks and get all the evil insulin out of my blood. I’ll trade the re-bound high for the comfort of knowing I’ll wake in the morning.

Next comes a packet of Rio’s Scooby Snacks, followed by a bowl of cereal. And another glass of milk. I throw a few more units of insulin on the fire for the hell of it and crawl pack into bed.

The high alarm isn’t long in coming.

In the morning I down-load the girl to look at the curve. A beautiful, perfect “V.” A terrify one hour drop from 400 to hypo; and a perfectly symmetrical mirror image curve shooting back up to 400 again. Looks like a steep valley caved by an ancient flood. Not all Vs stand for Victory.

Guinea pig a.k.a. Exhubera Party

Floutas. (First cousin to the Taco). Check.

Salsa. Check.

Sour Cream. Check.

Guacamole. Check.

Glucagon Kit. Check.

Inhaler. Check.

Powdered insulin packets. Check. A 3mg packet and a 1mg packet; based on my weight.

So…Time to rock. Shuuuuunk! Snap! Poof! Ahhhhhhhhh….Tastes like chicken. Not really. Just kidding. I just tried Exhubera. On my self. What the hell. Why not?

We’re having a party of sorts in my office. A small party, but aren’t those the best kind? I’ve got my pharmacy tech (perky blonde about 12 years old….or so she seems from my side of the hill), the out-reach coordinator (and my right-hand-woman in the diabetes program), and my Pfizer Rep (who brought cookies from the Chocolate Maven).

Pfizer is really trying to push their Exhubera, with varying results. I’m keen to have any arrow in my quiver, but this is far enough out there on the ledge that I’m not going to recommend putting a patient on it until I’ve tried it for myself. Eager to please, Pfizer has provided me with some samples.

So the clock is ticking. We’ve got ten minutes to wait before we start chowing down. I check the Girl. My blood sugar is stable at 116.

By the way, the inhaler was a heck of a lot easier to use than I had imagined. I thought the multiple dosing would be a pain, but it was fast and easy. The inhaler telescopes inside itself to make it more compact. It has a finger ring you can use to pull it out to its full length, but a quick snap of the wrist will “unfold” the device. Makes you look cool and sophisticated in a James Diabetic Bond kind of way. That’s the Shuuuuuuuunk!

You slip a blister pack into the mouth of the device, cock the handle to pressurize the system, and pull the trigger. All of the training devices have empty packets, leaving me very curious to see how the insulin cloud would really look. Snap! I pull the trigger and Poof! The clear chamber is instantly filled with fog.

Three sets of eyes are riveted on me, unblinking. I exhale, turn the mouth piece around and breath in deeply. I briefly consider grasping my throat and collapsing to the floor, just to freak everyone out, but we only have a one-bay ER, and only one defibrillator, so we really aren’t well equipped to handle three simultaneous heart attacks.

I expect a slight burning sensation, like when I used to smoke. But it is no different than any other deep breath. I feel…..nothing. No taste. No tickle. No cough. I exhale, expecting to blow a smoke ring. Again, nothing. So simple and uneventful as to be almost disappointing.

WhatdiditfeellikeWhatdiditfeellikeAreyouOK? Don’t you hate it when three people talk at once? I de-brief the crew and take the second hit.

Ahh. Ten minutes have passed. Time to chow down. We eat, chat, check the girl, and chat some more. Continuous monitoring offers not only the ultimate in safety and control, but it allows you to safely play with new meds like this.

My BGL drifts downward, then levels out. It stays that way for nearly an hour. I begin thinking a hypo may be in my future. Then, in the space of half and hour it shoots up from 110 to 192, which is the peak for the day. For the next three hours my BG stays bizarrely flat between 190 and 184. It is like looking at the cardiac monitor of a dead person. Flattest, longest, BG graph I’ve ever seen on a bolus. After three hours after spiking (four hours into the experiment) it begins a gentle drift downwards and bottoms out at 136 five-and-one-half hours after taking the hit. By the way, I want you all to know that for the sake of science, I sacrificed the opportunity to have a Starbucks Iced Latte. I didn’t want to add in any carbs until the Exhubera ran it’s course. See how much I love you guys?

Now a gentle drift upwards begins. The insulin has run its course. Looks like we could have used a bit more powder or a few less carbs. It is promising enough that we all agree to have to have another party soon and try again with a little more insulin. Hey, that’s not an excuse for a taco party, this is serious science here! Really. I swear. Have I ever lied to you guys?

That loud thump was me falling off of the control wagon

It started with an espresso brownie from Starbucks. I spend waaaaaaaaay to much time in my car shuttling around the northern part of my state. I’ve given up smoking, wild women, and song. My last vice that I can’t afford is my love affair with Starbucks coffee. I have a little stainless brewer at home, and I buy ground Starbucks beans from my favorite location in Santa Fe….but it never comes out quite the same. I’ve endlessly tinkered with water and coffee ratios. I make a pretty good cup of coffee, but they make a MEAN cup of coffee. And I can’t quite master it.

But I digress.

So whenever I drop in for my Starbucks fix (or later in the day a Venti Iced Latte) I am forced to walk past the glass case that holds an awe-inspiring assortment of pastries. And mocking me every week for months was the espresso brownie. Now I have a well-documented weakness for brownies. Especially if they are smothered in vanilla ice cream and hot fudge sauce. But that’s a story for another day.

I resisted for months. But one evening I was down in Albuquerque. I go down twice per month to spend the day with a hospital endo group. It’s three-hundred miles on the road and a full day of mind-expanding experiences. Wipes me out in a joyful kind of way. I was getting a Latte to keep me awake to make it home alive and the devil on my shoulder suggested: “you know, Wil, that espresso brownie’s sugar would only mess up your BG a little bit and give you lots of energy to keep you awake to get home to your family.”

OK. Let me state for the record that they are every bit as good as they look. Better in fact. I’ve never believed that nonsense that if a kid takes one toke on a joint it will lead straight to heroin and crack within two months. Now I need to reevaluate that…..

The brownie lead to the orange-cranberry scone which lead to the chocolate mint cake which lead to the apple fritter which lead to the triple chocolate bunt cakes at Trader Joe’s which lead to the….well you get the idea. I’ve become a desert junkie. I’ve lost all control.

Now, my system doesn’t take well to sweets. No way to match the insulin curve. Even with the Girl to watch over me, (for those of you new to the blog, that’s my nickname for my CGM unit) things went to hell in a hand-basket.

My latest A1C: 7.2

Much to my professional and personal shame my ICD9 code was changed. I’ve been branded for the entire medical world to see as an UNCONTROLLED TYPE 1. Well, crap. I guess I am out-of-control. You’d think that I, of all people, would know better. My patient base are one big train wreck. Not really their faults, actually. There has been no quality diabetes education in this part of the state before I got here. Ever.

Serious complications are common place. Diabetes is a leading cause of death here. I see horrible stuff every day. Maybe that has put me into some sort of diss-associative state? Am I clinically depressed? Aren’t we all? Our councilor once told me to be sure to refer any “depressed diabetics” to her. I laughed in her face and told her to clear off her schedule. “We’re all depressed.”

I use to eat a modest breakfast. I drank a low-carb diet shake for lunch; or two during a crazy day. And a nice chef’s salad with cottage cheese and grilled chicken for dinner. A couple of sugar-free chocolate almonds and I was good to go. My sugar’s were “flat line.”

I gotta get back to that. My new Doc gave me a stern gaze over the top of her glasses and told me: “you can’t take care of your patients if you don’t take care of yourself.”

So I’m going cold turkey. No more sweets. Until Christmas. Right after I finish that last triple chocolate bunt cake…..