Then my cell phone decides for me. By ringing.
There’s static on the other end. Then a rapid fire female voice, tinged with panic, disjointedly careening from English to Spanish to English again. I try to get my brain firing on all four cylinders.
What? Who? Where? When? How? Those were the key questions in the old days of journalism, now conveniently replaced with the more succinct and all-encompassing What-the-fuck?
I’m not clear what’s going on. But something about vomit, ketones, and blood sugar. So it can’t be good. The fading in-and-out of the phone is a good sign that the caller is barreling down the interstate towards the ER.
As the signal clears and my brain wakes up, it’s finally clear who I’m talking to.
Shirley Temple is on her way to the Emergency Room.
OK, so the real Shirley Temple isn’t my patient. But one of the little T-1s under my care is the spitting image of Ms. Temple back in the day. This child even has a penchant for pink.
Job One, in cases like this, is to calm mom the fuck down. Job Two is to get the what-the-fuck-facts. In this case it seems the kiddo was running on the high side most of the night. They had been taking corrections via the pump. First thing this morning, the kiddo complained of stomach pain, then promptly threw up.
“I checked her blood ketones when she threw up and the meter said 4.3” the mother told me. “I thought ‘that can’t be right’ so I washed her hands and checked again and it read 4.1. That’s when I threw up.”
So a super-quick blood ketone refresher for you readers. For those of us with Type-1 Diabetes, when you run out of insulin your cells can’t get the sugar they need to live from your blood, no matter how much sugar that there might be in your blood. Your body’s cells turn into a pack of savage cannibals. Rather than starve, they chop up your body fat and throw it into big iron kettles. Can you hear the African drums in the back ground? Thump-thump-thump. Thump-thump-thump. Thump-thump-thump.
The smoke from the cannibal’s cooking fires darkens the jungle’s sky. In your body, the smoke from cells eating fat is called ketones. Too many ketones in your blood will kill you. They are the cause of the “diabetic coma.”
Historically, we checked for ketones in the urine with little dip-sticks that turn pretty colors. You then had to try and match the color of the stick to the color chart on the side of the bottle. But don’t wait too long or check to early.
Nowadays, thanks for our friends at Abbott, we actually have a way to test ketones in the blood itself with special strips that work in the Precision Xtra® meter. Under normal circumstances if I check mine, they will always be at zero, but I’m told that below 0.6 mmd/L is considered “in the green,” or normal. Between 0.6 and 1.5 mmd/L is the “yellow zone,” which translates into you need medical attention. Right now. Above 1.5 is “red lined.” You are now in a world of hurt. You are going DKA. Your blood is turning to acid. By now your breath will be fruity. You will be throwing up. Atropos is sharpening her scissors. I actually never knew how high above 1.5 you can go. But now I know that it’s possible to clock a reading in the fours and live to tell the tale.
Meanwhile, back on the phone, I confirm the kid’s breath is fruity. How’s her breathing? I ask.
“I don’t really know… once I totally freaked out, she totally freaked out.”
It’s OK, I think you are doing great.
Job Three is a pro-active guilt-ectomy. No matter how bad you may think it is to have diabetes, it’s nothing, nothing, nothing even 1% as bad as being the mother of a Type-1 kiddo. The level of responsibility and guilt they carry over things they cannot control is astounding.
I acertain that the mom has givien the little one a 5 unit intramuscualar shot in the arm. Super. Awesome. I’m soooooo proud of you. You’re doing everything perfectly.
“I need to live closer to the hospital.”
Oh, nonsense. Your house is beautiful and you own it free and clear. Why would you want to move to Santa Fe and pay rent just to save time when going to the ER a couple of times per year? Diabetes is fast, but not that fast. You have plenty of time with these highs, and if she were to go really low and go lights-out the ER would just use the exact same glucagon kit you have to bring her back.
“What if I can’t find the kit? What if it’s in my purse? Damn! I should keep the house cleaner!”
Hey, don’t worry about it. Don’t worry about it. I’ll give you a second kit on Monday. You can double-sticky tape it to the wall above her bed.
A relaxed exhaling of breath, and a little laugh come through the static. “Right next to her Virgin Mary, huh?”
Yeah, our Lady of Low Blood Sugar.
“Best to keep the whole team together, we need all the help we can get.”
“Oh… ah… did I remember to say ‘good morning?’”
I hit the bathroom for a speed shower, get dressed and call the mom back again. They’re now at the ER. Shirley Temple’s CGM is showing a drop. She’s drinking water. Her skin color is normalizing. The emergency shot in the arm her mother gave her is kicking in.
Do you want me to come over to the hospital?
“No. No need. But thanks for offering. And thanks for being there for us.”
“It’s been a pretty crappy year, huh?”
Yeah, but it’s almost in the rearview mirror now.
So speaking of the end of the year, Deb, Rio, and I have been invited to a “kick the old year in the ass” party tonight (as opposed to a “happy new year” party). I, for one, am looking forwards to seeing 2010 behind me.
That said, just the other day, one of my spiritually well-grounded friends made me focus on the GOOD things that happened over the last year, rather than the crap. Paraphrasing quite a bit, she basically said if you spend all year in the outhouse, of course you are going to see a lot of crap.
Like a police detective she interrogated me on good things. “How's your diabetes? You don't seem to be in the ICU at the moment.”
“How is your beautiful child? Oh, and I see you still have a house, and a car, and a job.”
And so on.
I think the whole world has been through such a bad time lately that many of us are chronically tense and waiting for the other shoe to drop.
So for the new year, my dear friends, let's all try to change what we focus on. What we dwell on. There is sunlight and shadows out there, and we can choose to sit in the sun or sit in the shadows.
Damn cold here today.
A patch of sunlight sounds lovely.