Saturday, December 08, 2007

Why did no one tell me?

Been a while since the last nurse post. I teach new diabetics in my current job- the down and dirt survival skills like using a glucometer to check your own blood sugar, drawing up insulin and giving the shot, how to tell if you are too high or low and what that could do to you. Then I strongly encourage them to take some of the classes offered by the hospital- they have a crack team of diabetic educators- the neurosurgeons to my meatball surgery to put it in MASH parlance.

I get the privilege of hearing their whole story- how they first didn't feel well, how they have had no energy and have been buying stronger and stronger reading glasses, but they just don't see well anyway. I hear about their mothers, fathers, sister, aunts struggle with diabetes . I hear their fears about becoming blind, losing toes and then feet and then legs to amputation, about having to go on dialysis. Most of the time, I get the supreme pleasure of being able to offer solid, evidence based reassurance.

It is rare for me lately to be able to assure people that they will get well. Things are complicated, microbes are resistant, multiple diagnosis are colliding and interacting in ways we never dreamed possible. Part of working at a teaching hospital is that we get the sickest, the strangest, the most hopeless after their community hospital has give there best shot. ( Remind me to tell you why you WANT to be at a teaching hospital if you ever get sick.)

But the new diabetic, well, they can get well. Sure, they have to take insulin, four times a day, at least. Yep, gotta check the blood sugar four, six, eight times a day. May at some point actually get a small pump that the wear at all times on their body, pumping insulin in all the time, and more before they eat. Lot of work. Lot of trouble. But, in return, they get to live. Not only do they get to live with their disease, they get to live past it. They can literally have no long term effects of their diabetes if they can manage tight blood sugar control, watch their diet, exercise, all the good stuff. They can keep their vision, their kidney function, their toes, avoid the searing pain of neuropathy, heal well, feel well, live well.

Many times I have had the pleasure of seeing a patient after their hospitalization, asking how they are, and having them whip out their blood sugar log to show me the solid hard work they have done to save their own life. Before insulin was first extracted ( from animal pancreas's) in the mid 1920's, diabetes was a swift and sure death sentence. Now, it is a dangerous dance partner, but one that can be mastered and made to let you dance your own life. I applaud those folks who chose there own life every stinking day.

Then, there is the patient from today. When the Doc called in a teaching referral-a diabetic who needed "a little update" as he was now going to go on insulin, I should have heard that Jaws music. When he said the name, my head sank to the desk. I knew, that no matter what I said and how I said it, that this guy will not care, will not listen, and will not change. I have given him the compliance cheer four times in the last two years, but he always refuses to acknowledge that he has ever had any teaching. He has lost six toes in four separate surgeries. He will most likely lose more on this trip, and he has a bone infection in his hand that is worrisome. He cannot really see well enough to draw up insulin, but that is a common enough problem that I can order him a doohickey that will help him out. He denies having ever owned a glucometer, although I personally have dispensed two into his hands. Whenever I tell him the slightest fact about diabetes, he says, "Well, why did no one tell me that before?" When I mention that I did, he shakes his head, nope, never knew it was the sugar making his toes black. Nope, never knew that was why he had so much trouble seeing that he cut his hand on a saw at work. Nope, never knew any of it, but young lady, I'm going to get a hold of this, this time. First few times he told me that, I believed him It took all my work ethic to go see him today, and it will tomorrow, too. I phoned it in, a little, but I'll badger him until he is able to draw up insulin and jab it into his massive gut. I'll hand out the foot care info, the class info, the food info, all of it, and when he leaves, I will find the intact folder of info right where I put it on the over bed table. (Unfortunately, it will all have to be thrown away because of his habit of taking only one antibiotic a day- no matter how many are prescribed- and he is filled with resistant organisms. Gets him a private room. too) He wonders why all these doctors and nurses get so mad at him- we are all slipping our mask a bit- and this is why: We offer him the miracle of life and health, and he spits out a candy wrapper on it.


Helen said...

There's just been a case in the UK where a diabetic killed a woman with his car because he hadn't paid any attention to the signs, and hadn't monitored himself for ages anyway. It's beyond my comprehension why anyone should behave like this; it must be a very special sort of stupidity.

Alison said...

Wow. I guess some people don't want to be Bothered. Sounds to me like he truly needs someone to lose their temper and scream at him, because there's no other way that kind of person is going to realize that anybody else cares, so he should, too.

--AlisonH at