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

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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!).

Saturday, February 01, 2014

Hospital Horrors



The bullet hit me just below my rib cage, punching out a huge section of my liver and collapsing my right lung. Waves of pain rippled round my chest like a stone thrown in a still pond or echoes reverberating off sandstone cliffs.

I gasped for breath but could find none. I tried to scream but had no voice.

I rolled onto my back, clutching the entry wound with both hands, felt the wet, blood-soaked T-shirt beneath my fingers, sodden and cold.

Wait… A bizarre fact flickered across my consciousness. The temperature of the human body is 98.6 degrees Fahrenheit. The blood spilling from my torn abdomen should be warm—not cold.

I blink upwards in the near-dark room. Where am I? What happened? Who shot me? Why?

Wait a minute… Who am I?

An angry buzz, like a pissed-off cockroach. A light. What the fuck? I turn my head to the side. A glowing screen on a box. It says, “High-200.”

Wait. I know what that is. It’s a CGM. It’s telling me my blood sugar is high. The blood spilling from me? No… It’s cold, it can’t be blood.

Chilly blue light spills from a bedside clock. Fighting waves of pain, I sit up, reach for the reading light and turn it on. My T-shirt is soaked and dark. But not with blood. With sweat.

I yank it up over my head. My chest and stomach glisten with a thousand dewdrops of sweat, but the skin is intact. I have not been shot.

Was it a crazy dream?

Another wave of pain ripples through my body. Not shot. But not a dream. Something is wrong. Desperately wrong.

I’m supposed to be healing, they tell me. Give it time, they tell me. But every day the pressure in my gut and the clouds in my mind get worse.

I struggle to the living room. It’s 2 a.m. Rio and Debs have fallen asleep on the couch, the room illuminated by the DISH TV screen saver.

I rest my hand on my wife’s chest and give her a gentle shake, “Wake up, baby,” I whisper hoarsely, “You need to take me to the ER.”

She barely stirs. Rio sits bolt upright like a Jack in the Box. “What’s wrong?!”

The night is dark and the drive seems to take forever, and as the stars wheel overhead the pain subsides. As we pull into the mercury-vapor lit parking lot of the Regional Medical Center, an hour from our home, I wonder if I’ve dragged my wife on a fool’s errand in the wee hours of the morning.

But we are here now, might as well see this through.

The night, well, morning, is cold. Aggressively cold. The kind of cold that worms its way through many layers of clothing to nip at your skin. The walk from the parking lot to the front of the hospital is a long one. All of the close spaces are reserved for doctors and overweight security guards.

The rotating door at the front of the medical center is locked at this hour, but the side entrance at the ER is open 24-7-365. The glass doors slide aside, Star Trek style. At this point I’m just back to feeling the odd pressure that runs down the base of my ribcage on both sides. I feel a bit silly and try to decide what to say to the night clerk.

Ahead of me is a young girl with a tear-streaked face and puffy eyes. The night clerk waves her in. Then he turns to me. He is a giant of a man. And not a happy one. Clearly, it has not been a good night for him. His ID badge says he’s a RN. He locks his cold eyes on me and demands to know my businesses.

Ummmm… abdominal pain. I say meekly. Ummmm, bad enough to make my wife drive me over here from Vegas in the middle of the night.

He curtly demands my name and birthdate, finds me in the computer, and tells me he’ll get to me as soon as he can. He gestures to the waiting room the way one might point a dog to the door. As the night wears on, I find he uses these curt hand signals more than words. He does, however, address me as “Sir.”

He does not prove to be so respectful with one of the other nocturnal visitors to the ER.

As we leave the reception desk, I survey my options. There are only a handful of people in the waiting room, all keeping as much distance as possible from each other. In one corner a homeless person is passed out on three chairs. In the middle of the room a sharply-dressed MILF with faux-fur topped boots is holding a very sick child. His cough suggests severe pneumonia or perhaps even pertussis to me. The child is maybe seven, and he’s having a hard time getting enough oxygen. His mother’s hair and make up are perfect.

In another corner a very obese woman in rumpled pajamas, wearing an N-95 surgical mask, is holding a whimpering baby. N-95’s are what we give to people we think have influenza. Across from her is another woman who is talking to herself. She does not have a cell phone.

All things being equal, the woman talking to herself seems the least threat to my fragile health and we grab a pair of chairs midway between her and the woman with the mask.

How do I describe the woman who’s talking to herself? Well, skanky-looking would truly be a fair description. And not in a hot way. Her hair is long, dirty, and stringy. She’s in a filthy stained sweatshirt and shorts. She has tennis shoes, but no socks. Her knees are drawn up to her chest, and she rocks rhythmically back and forth. She alternates between talking to herself, or maybe God, some invisible people around her, and the nurse-bouncer running the desk. She wants a blanket. He tells her he has none. She asks again. Several times. The nurse finally tells her to shut the fuck up.

Debbie turns towards me, shocked. “What’s wrong with him,” she hisses. Then she looks at Skank Woman, “What do you think is wrong with her?” Debbie works at the clinic now, and also spent several years in the private practice environment, but she’s never worked an ER, so I realize she doesn’t understand what’s going on.

Withdrawal, I whisper.

“Huh?”

She’s a junkie… sorry, I should say addict. She’s in withdrawal.

Deb’s brow furrows, “Are you sure?”

Hey, I thought Bill Clinton visited me last week, I’m not sure of anything. But that’s what it looks like to me.

“Still… for God’s sake, she’s a human being. Why is he treating her so badly?”

Nurses are like that with addicts sometimes, I tell her. They can be very judgmental about substance abuse. Which is fucked up on so many levels I hardly know where to start. But beyond the whole nursing charter of caring for the sick, the fact of the matter is that a great number of addicts got started down their rocky roads by being put on powerful prescription painkillers by us. “Us” being the medical community at large. When you can’t get Percocets or Lortabs anymore, you turn to heroin.

My view is that the circumstances of life that separate the guy sleeping under the bridge from the guy in the corner office on the 33rd floor are razor-thin. We are all human, I try never to forget that in life in general, but especially in my clinical practice. Only a small degree of luck, good or bad, separates the corner office from the shelter of the bridge. I do have a couple of patients I think are despicable people. I groan to myself when I see them on my schedule, but they have diabetes, and by God I will not let diabetes win, and I try my damnedist to treat them with equal respect and care.

Sorry, I got off track again. My focus is still fucked. Anyway, when it comes to junkies… sorry, addicts, I think we in medicine need to take the opposite track from the one I see so commonly. I believe we need to take ownership. Odds are we caused their mess; we need to fix it. Of course, I also remember what it felt like when several years ago in this same ER when they mistook me for a junkie and treated me like they were treating this lady.

But of course, there are two sides to every coin.

And, I added in a low whisper to Debbie, because while I didn’t know for sure, but I was dead certain of it in my heart, She’s probably one of his frequent flyers. She probably comes in two or three times a week when she gets strung out.

“Can’t they help her?”

Probably not. She probably doesn’t want help. She wants some painkillers, which, really, is the last thing she should have.

Finally, Skank Woman stops asking for a blanket and starts screaming for one, “For God’s sake I’m fucking freezing my ass off out here you asshole! Why can’t you give me a God-dammed fucking blanket?!”

Instead of giving her a God-dammed fucking blanket, security is called. Her tiny body is surrounded by two men and one woman in black uniforms. Collectively, the three of them have the biggest butts I’ve even seen, at least in one place. Clearly, the “A-Team” is not in place on graveyard on weeknights. The male nurse joins them. I don’t hear it, but Debbie later tells me she overheard the nurse tell her, “I’m your worst nightmare.”

Way to show you care, Mr. Healthcare Worker.

For the moment, the show of force scares the addict into submission. I know what’s going on. They can’t turn her away, not by law, but they are under no obligation to be nice. If they make her visits uncomfortable enough, maybe she’ll give up and go somewhere else in the future. And, truth be told, there probably isn’t much they can do for her. And, hey, for all I know, this bully of a nurse moved heaven and earth to get her into treatment at some point in the past only to have her leave after one day.

Still, if I had been at the ER desk, I would have given her a God-damned fucking blanket.

The gasping child is taken back. The obese mother with the mask gets sick of waiting and leaves with no word to anyone.

Finally, with a “come here, dog” gesture, I am admitted. Then I’m appalled to discover that not only is the giant nurse the night receptionist, he’s also the triage nurse. He’s doing two jobs. In fact, I’m to discover that budget cuts have left the ER at the only major medical center in the northern part of my state manned with only two nurses and one doctor at night. It will prove to be a long night, and the better part of the next day, before I leave the building.


 I’ve not read it, but someone once told me that James Michener filled dozens of pages of his epic Pacific tale with the word “wave,” over and over again, to depict the monotony of an ocean crossing. If I wanted you to really get the feel of our ER visit, I’d say:

We wait. And wait. And wait. Hours pass.
We wait. And wait. And wait. Hours pass.
We wait. And wait. And wait. Hours pass.
We wait. And wait. And wait. Hours pass.
We wait. And wait. And wait. Hours pass.
We wait. And wait. And wait. Hours pass.

But if I repeated that for 18 more inches of blog column you’d all fall asleep. I did. Deb didn’t. But being increasing pissed-off really gets her fueled up.

When we were eventually parked in a bay, the attending nurse ordered me to strip and put on a paper-thin gown, then she put an IV in my arm, drew many tubes of blood, promised to get me a blanket (which I did get much later, so they weren’t out), and sent me half-naked across the basketball court-sized ER to give a urine sample. The single unisex bathroom was filthy. There was urine on the floor and bloody gauze piled up on the sink. I’m barefoot.

When I get back, she asks if I want some pain meds. Thinking of the junkie in the lobby, I decline. I don’t mind pain, particularly. I mind mystery pain. If I know I’m not suffering a necrotic gallbladder (my latest freak-out in thinking after mentally reviewing all the various bad things that have happened to my own patients who had mystery gut pain), then I can tough out pain. It’s the runaway imagination worrying about what’s causing the pain that’s my real enemy, not the pain itself.

Then the real waiting began. Do you remember watching the clock on the wall in elementary school? The one in the front of the classroom, above the blackboard? The one that seemed to crawl with an eternal slowness, or even run backwards before recess? Yeah. I could see that clock from my hospital bed.

Finally the first of the several doctors who saw me came in. Tall and thin with piecing blue eyes, he was wearing a blue turban. I glanced over his shoulder to make sure Bill Clinton wasn’t standing outside waiting to see me. The doctor poked, prodded, asked questions. I filled him in on the illness, with Deb supplying the majority of the details I could not recall, I told him about the pain today, and about the cognitive troubles I was having, to which he responded that I seemed pretty sharp to him. Not being sure he was actually real, I didn’t know how to respond to that. I certainly wasn’t feeling even the least bit sharp.

He asks if I want some pain meds. Thinking of the junkie in the lobby, I decline.

He decides, what the hell? And orders a CT scan. I am elated. Now we can find out what the fuck is going on inside of me.

I spend the next 45 minutes trying to get my wedding ring off my finger. Deb pops the transmitter off the Dex. Years ago, I had an MRI and the tech made me pull the sensor. After the scan was done he was kind enough to take the dead sensor back in and see if it would stick to the outside of the machine. It didn’t, so I know it’s safe to leave it in my arm. Besides, it’s only one day old and I only have three left and no insurance coverage for them, going forward ,so I can ill afford to waste it; but the transmitter needs to come off.

Then for some reason, I actually remember my basal insulin. Oh. Wait. No I didn’t. My iPod remembered it for me and then reminded me. Of course I didn’t bring any basal with me, partly because it’s the last thing you think of at two in the morning when you are going to the ER, and partly because even if I had thought of it, I would have assumed I’d be long home (or admitted to the hospital) before it could become an issue. My Go-Bag has back up fast-acting, but no basal. This is partly from ex-pumper habit and partly because how often do you really need back up basal for God’s sake?

I press the call button for the nurse and ask her for a whiskey with a chaser of 10 units of basal insulin. She says she’ll see what she can do. Ten minutes later she reports that as my blood glucose is 137, the doctor doesn’t want me to have any insulin. She leaves before Debbie and I can get our heads around what we were just told. We probably sit there for 15 minutes with our mouths agape before Deb snaps out of it and has a hissy fit, demanding, among other things, that I educate these incompetent nurses and doctors about the facts of diabetes life and basal insulin.

But I am too tired to save the universe tonight. I request basal insulin numerous times over the next few hours with no success. After half a day at the hospital, they never re-check my blood sugar, and despite sneaking a unit of fast-acting insulin myself every half hour I leave their “care” at 285 mg/dL at the end of this epic.

Meanwhile, the other nurse on duty cheerfully brings me two bottles of contrast dye. “Drink up!” she says, throwing the two bottles onto my bed. “The sooner you down these, the sooner we can take pictures.” She tells me once I drink the last drop it will be 90 minutes until the CT scan.

The contrast dye is better than I remember. Last time I had some it was thick, like a Slimfast shake. This is clear. The label says it’s tropical fruit flavor. The bottle boldly displays colorful graphics of virtually every fruit known to man: pineapples, kiwis, bananas, cherries, apples, strawberries, and more. On the back of the bottle, in small print, it says: “Contains no fruit juice.”

Huh.

It tastes like weak Crystal Lite with a funky after-taste. At least it’s sugar free.

Then we wait.
And wait. And wait.
And wait. And wait.
And wait. And wait.

Shift change comes and goes, but the day shift is short-staffed, too. My part of the hospital is actually closed and I am relocated. A new doc comes in to tell me turban doc has left for the day. I go over the story again. Doc Two, who I decide in my head to call Doc Too, adds a CT of my head to the already ordered one of my gut.

The he asks if I want some pain meds. Thinking of the junkie in the lobby, I decline. Then I wonder if she is still out there. Maybe I should have taken her my blanket.

Eventually, I’m transported to the rad-room for my CTs. On the way back the guy pushing my rolling bed tells me how tired he is, and how much his job sucks. I don’t know what to say, but I don’t ask him for any insulin.

We wait. And wait. And wait. Hours pass.
We wait. And wait. And wait. Hours pass.
We wait. And wait. And wait. Hours pass.
We wait. And wait. And wait. Hours pass.

Again, I try to score some basal insulin and am told that I can take some when I get home if I am high then. I am reminded that I was at 137 on admittance. Of course, that was over six hours ago. No other BGL checks are done the entire time I’m at the hospital.

Finally the new doc comes back. There are bags under his eyes. He has the results of the blood work, urinalysis and the CT scans. And they reveal… Nothing. Well, nothing unexpected in someone my age. Spleen a bit enlarged, no surprise on the backside of a major illness, a hint of a hiatal hernia, junk like that. But no smoking gun. No lodged bullets.

Debbie is thrilled. Perversely, I am disappointed. At that point, I would rather have been full of tumors than full of mystery. It sounds sick, looking back on it, but in the moment, worrying that I’ve completely lost my mind, I wanted something broken to be found so it could be fixed. After all, I wake up thinking I’ve been gunned down and then find out there’s not one fucking thing wrong with me. How can that be?

Are dreams and reality merging to the point I can no longer tell the difference? Was the pain real or was it a dream?

I feel fine, damn it. But I do need to pee.

And as soon as I swing my feet to the floor to get up out of bed, another bullet tears through my abdomen with a clap of thunder.

Pain. OK. That’s real. But as there’s no clear cause, it’s not addressed. Doc Too thinks my primary care doc is probably right: Internal organ chickenpox has left me a mess. When I asked Doc Too why it would suddenly get worse, he just shrugged. “Abdominal pain is funny that way,” he says. Great.

In the fullness of time, and I do mean that literally, my insurance cards are Xeroxed and I’m discharged. I’m told to get dressed and I may leave. Once again I’m offered pain meds that I decline.

On the minor victory front, as I was signing the discharge papers, my latest insulin-withholding nurse noticed my CGM transmitter and asked if it was a pump. I told her no, it was a CGM and I was rewarded with a blank look. So I gave her my CGM elevator speech and then showed her the receiver.

Her mouth dropped open, “You’re blood glucose is almost 300!”

Yes, that’s what happens when you deny type 1s their basal insulin.

I could see her trying to process how my sugar could be so high when all I had been allowed was ice chips (despite the radiology tech’s insistence I should be drinking “lots” of water as the contrast dye is hard on the kidneys and I’d had both oral and IV contrast dye). I suppose I should have educated her on how the liver works and the need for insulin to suppress the neoglucogenesis, but I was too tired and to be honest, I still wasn’t sure what clinical facts in my head were real and which were grounded airplanes and ex-presidents, plus I just wanted to get the fuck out of that place.

As we leave I’m surprised to see the sun is up. It’s fully daylight and now the ER lobby is packed. The junkie, however, is not among the throng.

My girl is hungry, and I need water, so Deb points her sporty little Juke towards downtown and roars out of the hospital parking lot. I sit in the passenger seat dazed and confused, trying to understand how the day can be so beautiful after such an awful night.

As I look out the window, I see the Abominable Snow Man.

Whatthefuck?

Yep. Plain as day. He’s standing right there on the sidewalk. He’s waving at me with his right paw and waving some sort of ring-shaped pillow over this head with his left paw. Shocked, I glace at my wife to ask her if she sees the strange aberration, and I find she’s cheerfully waving back at the great white ape.

Did you see that? I gasp.

“See what?”

Ummmm… the Abominable Snow Man. Uh, selling, butt pillows. I think.

“Sure.”

The Abominable Snow Man selling pillows on a sidewalk in Santa Fe, New Mexico, is real. The ER staff of the Regional Hospital refusing to give insulin to a type-1 diabeticis real. Bill Clinton visiting me while sick wasn’t real.

Is it any wonder I’m losing my mind?



5 Comments:

Blogger Laddie said...

Without a doubt that is the most powerful piece of writing that I have read in a long time. But then I remember it is a true story and I'm appalled at the treatment (or lack thereof) that you received. And then. I'm even more shocked knowing that your experience is happening to thousands of people every day. And then as a Type 1, I'm terrified for all of us when we get into a hospital setting.

I do hope you get some answers soon, or at least stop feeling so horrible. I have no advice for you, but please know that you are in my prayers.

11:23 AM  
Blogger Lisa (aka Mollie's mom) said...

Just wait until nine years from now when you need another CT scan and you find out that they found a nodular mass that the turbaned doctor didn't consider important and that it hasn't changed. Fun times!

12:19 PM  
Blogger Scott E said...

My goodness, hospitals sure are a scary place! It's unbelievable that people actually go there to get well...

4:18 PM  
Anonymous StephenS said...

Wow... really sorry you had to go through this. I'm sorrier still that this is just one of many stories I've read and heard like this. Hope you're on the mend very soon. Like yesterday.

12:54 PM  
Blogger Scott K. Johnson said...

Wow. What a story, Wil. I'm sorry it wasn't a piece of fiction!

6:04 PM  

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