LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Sunday, June 13, 2010

The Red Chair Chronicles

After 30 days, I really didn’t want to go back to work.

I wasn’t ready.

Not in mind. Not in body. Not in spirit.

But I’m also realistic. We do need to eat. To pay for electricity, propane.

And I do need health insurance.

And this is not the time nor the economy to try and find new work.

So… So really I had no choice. But at least I could look forward to sitting in the Red Chair of Courage.

It all started three days before I returned to work last Monday, and it started with batteries. Lots and lots of batteries. I have the TENS unit on for 12-14 hours per day and it is a battery sucking hog, gulping a 9-volt dry every three days.

Unlike AAA cells which can be bought in 20-pound bricks for dirt cheap, the blocky 9-volt generally comes in 4-packs and most definitely are not cheap. Clearly it was time for a battery charger.

After physical therapy, Rio and I headed for Best Buy, but all the parking spots were all taken, and we ended up parked next-door at Staples. Hmmmmmmm… well, Staples might have a battery charger.

The staff, who we must recall are not rocket scientists, directed us to a battery display near the front of the store and told us that was all they had. Later, a check of their web site shows all Staples stores have a good variety of what we were looking for. At the display, there was nothing for 9-volts; but there was a clear line of sight down the aisle that lead to the back of the store.

And from all the way across the store, the bright-red chair caught Rio’s eye. It was a large, modern, executive office chair. Burnished aluminum and red leather. Really, really, really red leather.

Rio just had to sit in it.

So to the back of the store we went. After giving it a test spin or two, he urged me to try it out. I sat down and it was… comfortable.

Damn comfortable.

Now my physical therapist has been on my case to stop “slumping.” I didn’t know I was a slumper, but apparently I am. Still, beats being a slacker. And my super-comfy chair at work is a slumper’s chair. Think bean-bag on wheels. I needed to get something with more back support. Something that would force me to sit up more straight.

The red chair did just that. Plus it made me sit up straight while still being comfortable.

I held my breath and checked the price tag, which was blank. This was clearly a several hundred dollar chair. Or more. I scan the nearby shelves, but don’t see any in boxes. I should just walk away.

But instead we walked to the front of the store. Ummm, hi. There’s this red chair in the back of the store that I’m interested in, but there’s no price tag on it.

“Yeah,” replied a kid who didn’t look old enough to have a job, “it’s thirty-two bucks.”

There must be a red canvas chair or one of those no-better-than-a-stool “student chairs” in the back of the store I didn’t see….. I… I don’t think we’re talking about the same red chair. The one I was looking at is a full sized executive chair. Leather and all.

“Yeah, it’s the display model. We’re clearing it out for thirty-two dollars. Or maybe it’s thirty three. Are you interested in it?

We’ll be taking it home with us.

It turned out to be $32.50, at the cash register the clerk asked how it felt to save three-hundred and twenty five dollars. It feels very good, I told her.

Getting the red chair into the car took some work, but in the dead of night, on the way home, Rio and I dropped it off at my clinic office. He stuck his fingers in his ears because he was sure I’d set off the alarm. Geez, you enter your ATM code into an alarm system one time, and no one ever lets you forget.

Driving to work for the first time this last Monday, my stomach was full of butterflies. One of two things can happen when you’ve been away from your job for a full month. Either people really, really miss you… or they realize that they really didn’t need you around after all.

It turns out I was missed. By patients and by staff (well, all but two staff). My first week back was a blur of 30 minute appointments, half of the time spent trying to explain why I had been gone, reassuring that I wasn’t leaving, and talking about the red chair—which turns out to be a universal hit. People love the red chair.

Different people have added different significance to the red chair. My Mother took it to be God’s way of telling me to stay put. One of my peer educator gang (who are in the know on the real cause of my troubles) views it as a battle flag, a declaration of war, a statement of “I’m staying, just try and make me leave.” Historically, flying a red flag means you’ll “take no quarter.” A pirate ship hoisting a red flag sent a clear message: surrender at once or we’ll kill you to the last man. Santa Anna hoisted a red flag at the Alamo.

Another peer educator weighed in with a different view. She saw it as the red cape a toreador would use in a bull fight. My wife dryly remarked that if I had to resort to slitting a certain person’s throat, at least her blood wouldn’t mar my chair.

Over all, I think the fact that there is a bold new chair in my office signaled to my patients and the staff that I wasn’t going anywhere soon. Why would you buy a new chair if you were leaving?

An interesting collection of rumors had circulated in my absence about why I was absent. Some were obvious: they heard I had quit. They heard I’d been fired. They heard I was really sick.

One person heard I had taken a bunch of things home from my office that didn’t belong to me and that I had been fired. That one was half true. I did take a bunch of stuff, but it was all mine.

I’ve paid for 95% of my visual aids out of my own pocket. I’ve had three offices in five years, each a smaller home at a better address. I’m now in the heart of the action, but it was time to reduce the amount of stuff I have. It is too crowded in my little postage stamp. I took home the stuff I don’t use as often. Like my anatomical model of a Roswell alien (in the three years he’s been lurking with the legitimate anatomical models—a human torso, a pancreas, eye, heart, kidney, and the like—only five people have noticed him).

For the most part, I just used my absence as a teachable moment. I picked up an awesome 3B lower spine model on eBay to help me understand what had gone wrong in my own body. I took it to work, I showed it to people, talked about back pain, and talked about non-medication treatment options for pain like my TENS unit.

Of course some people I couldn’t resist kidding with. About mid-week I was working side-by-side with one of my crew with a particularly gullible patient who I have a good long-standing relationship with. “What happened? Where were you?” asked the patient.

Oh, I got stabbed by a Peruvian Prostitute, I replied.

“Really?” slightly shocked, but not too surprised.

Without missing a beat, my assistant shot back, “No, not really. She was from Bolivia.”

But the apprehension I had driving in that first day back was quickly enveloped in and by the work. The feeling of helping. Of realizing that you are the caretaker of knowledge and insight that others need. That others have no other source for.

I got hugs and “don’t ever leave us agains” from both staff and patients. In addition to the folks crammed into my schedule, patients at the clinic for other reasons on seeing my car in the parking lot, or seeing my long-darkened office now had a closed door, came knocking, just to say hello.

As it so happens, this first week, I only had to interact with the human tumor twice. Both times it went OK, and now she’s gone on vacation for next week.

The paperwork of prior authorizations, insurance denials, and related nonsense was epic. The voice mail and email weren’t too bad. Both systems had filled up in the first week, so they were all old news and everything that came in for the next three weeks was lost so I don’t have to worry about it. I also had to zip out for physical therapy every-other-day for a couple of hours.

The week flew by, and it ended with my favorite activity: solving a medical mystery. Studying a collection of medical evidence that has everyone baffled. Putting together all the pieces, figuring out what is going on, and taking action to solve it.

It started when the patient handed me his meter sheepishly, “I’m glad you like mysteries,” he told me.

Damn straight. At least diabetes mysteries.

I plug his meter into my desktop and download it. And I study the insane menagerie of dots. Looking for patterns or constellations in the night sky of his blood sugar testing.

At first there is nothing. I ask questions. I probe. I let my eyes wander over the graphs, trying to find a clue, a thread, a key to the mystery. If he’s taking his basal at 8am… and the peak excursion is at mid-day, but the morning fasting is way above target even though the hour of sleep number is in range… so why the fuck does…

Then, like double vision, geometric shapes form ghost-like traces, shapes, curves—all overlying the data in my mind’s eye.

Synapses fire deep in my brain, tapping in to the mental data base of all I know and have learned. From nowhere, it seems, the answer flickers for a moment then crystallizes in my mind. In a flash of insight, all the little clues, all the seemingly unconnected bits of information come together.

Suddenly, I know what’s happening. Eureka! Guod Erat Demonstrandum!

The mystery is the perfect storm of unusually short basal insulin half-life in this patient, the timing of his injections, and the over-lapping action curves. It was great. I felt jazzed. Alive.

I lean back in my blood-red chair and smile.

It’s good to be back.

6 Comments:

Blogger meanderings said...

LOVE the chair.
LOVE that you're back!

4:34 PM  
Blogger Molly said...

You know, red is the color of power.
:-)

7:14 PM  
Blogger Scott K. Johnson said...

The red chair is perfect. And for $32.50?! Incredible! I need to wander around Staples more often I think!

I'm glad to hear that you're feeling alright, and are back at work. Of course we all knew you were missed terribly. :-)

11:06 AM  
Blogger Bernard said...

Wil, clearly the chair was waiting for you. It was so much fun to meet up with you again last week, let me know if you need anything and I'll keep an eye out for spare supplies.

12:39 PM  
Anonymous Rabbi Hirsch Meisels said...

where can we read up on that concept of the short half-flife of basal?
Thanks

2:13 PM  
Blogger Wil said...

Rabbi--

Basal half-life varies from person to person. Same is true of fast-acting too. Basal runs 18-26 hours; and fast from 3-6. As with anything in diabetes, your miliage may vary!

12:36 PM  

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