diabetic ketoacidosis<\/a> (DKA) and could I come get the kids? <\/p>\nThere went that travel schedule.<\/p>\n
I headed off to the emergency room to pick up the kids \u2013 8, 6 and 3 months – and find out what was up with Kate. Jon said Kate\u2019s blood sugar had been almost at 400 when she woke up and shot up soon thereafter to 567 and was unresponsive to insulin, which sort of rapidly escalating blood sugar, unresponsive to insulin, usually means DKA, a deadly condition that can be very hard to arrest and can lead to sudden death, and which Kate, a Type I diabetic, has suffered from before \u2013 usually when she has an infection of some sort.<\/p>\n
I was reluctant to leave the hospital, as Jon has far less experience with Kate\u2019s medical problems than I do, but clearly the kids couldn\u2019t stay, and clearly it would be unreasonable to suggest he take them away and leave his wife\u2019s side, so I took them home, got them settled down and went on-line trying to change my travel plans. Worst part of changing my travel plans for me was the necessity to get there in time to see my son before they put him under \u2013 since I\u2019d promised him I\u2019d be there \u2013 combined with the utter impossibility of warning him that I\u2019d been delayed (I\u2019ll get to why he was beyond my ability to contact later on).<\/p>\n
Kate called me about two hours later to say that they\u2019d given her a bolus of insulin and had rehydrated her with a saline drip and told her to go home, but she didn\u2019t think she should because her blood sugar was still over 400 and what did I think? For those of you who are not aware of the effects of very high blood sugar, well, those effects are exactly why Kate was asking me what I thought \u2013 having a blood sugar of 410 is rather like just having done six shots of tequila \u2013 your judgment is really that impaired. So Kate was well aware that she wasn\u2019t thinking straight, but also her fuzzy-mind was insisting to her that you don\u2019t leave the hospital with a blood sugar over 400, because it\u2019s immediately, pressingly, life-threatening.<\/p>\n
I told her she was not fuzzy-thinking, she was right, and should continue to refuse to leave, then asked her to put Jon on the phone, and repeated to him that he should not take Kate away until her blood sugar was down to 200. He said the nurse practitioner was insisting Kate had to go, I said call Kate\u2019s endocrinologist, but by no means let her leave the emergency room until her blood sugar is down to 200 (about twice normal) even if you have to stay in the emergency waiting room with her testing it yourself.<\/p>\n
Kate called me back about an hour later to say her blood sugar was still around 400 and the nurse practitioner was still insisting she had to leave, she was still in the emergency room, not checked in, and had not seen a doctor, though the nurse practitioner said she had spoken to Kate\u2019s endocrinologist. The nurse practitioner said Kate\u2019s blood sugar was coming down, but slowly, and she was not in DKA and was now hydrated, so she should go. I say again: do not leave. Kate says, I know, I have been in several hospitals \u2013 including this one \u2013 with very high blood sugars before and that is the rule I remember they use: 200 before you can leave, right? She says she knows she is not thinking straight, but is pretty sure about this as she hates hospitals and is usually the one fighting to get out. I tell her, correct, 200. Stay.<\/p>\n
About five or six hours later, well into the evening, Kate comes home, says her blood sugar is down to 240 and she just got sick of arguing with them only to be able to stay where she doesn\u2019t want to be, so came home. Plus, she\u2019s remembered that I was supposed to be on my way to her brother\u2019s surgery and was distressed for his sake. No problem, I said, I can get out tonight and still make it. And since Jon was there and she was on her way to normal, I left. But less than two hours later, just before I could leave town, I got another phone call from Jon: \u201cCome over and watch kids? Kate\u2019s blood sugar is back over 400 and I have to take her back to the emergency room.\u201d<\/p>\n
There went that (newly revised) travel schedule.<\/p>\n
When I got to Kate\u2019s she was on the phone talking to her endocrinologist and giving herself an insulin injection – a surprise since she has an insulin pump. She got off the phone and said to me: \u201cGo, my endocrinologist just figured out in ten minutes over the phone that my insulin pump is broken \u2013 and the alarm bells aren\u2019t even going off to warn me it\u2019s delivering nothing. I\u2019ll be fine now \u2013 go, go.\u201d<\/p>\n
So I go. On my way to my son\u2019s surgery I got a call from Kate, to thank me and make sure I\u2019ll make it in time and to say she\u2019s really better \u2013 blood sugar rock solid at 100 \u2013 but really concerned and thinking about calling the patient advocate at our local hospital.<\/p>\n
\u201cYou know,\u201d she said, \u201cI\u2019m fine now, but I was pretty much in the hospital from dawn to well after dark and I never saw a doctor once, just that nurse practitioner. Jon keeps saying there must have been a doctor overseeing her treatment of me, but there was no doctor\u2019s name on my chart at all and she just kept telling me to go home when my blood sugar was still so high.\u201d<\/p>\n
\u201cDidn\u2019t she talk to your endocrinologist?\u201d I asked.<\/p>\n
\u201cYeah,\u201d she said. \u201cShe told her not to come down, that I was responding well and not in DKA and rehydrated, but she didn\u2019t tell her they wanted to release me \u2013 or so my endocrinologist said.\u201d<\/p>\n
Then Kate said \u201cIt\u2019s one thing if they tell someone like me who has been diabetic for years and coped with episodes of this before and is relatively healthy otherwise, so better able to withstand high blood sugars, but what happens when they tell the parents of some newly-diagnosed ten-year-old, who don\u2019t understand how rapidly this can deteriorate, to take him home with a blood sugar like that?\u201d<\/p>\n
\u201cDead kid?\u201d I asked.<\/p>\n
\u201cYeah, seriously. They\u2019ll take him home and it\u2019s not unlikely at all that the kid will die before they can get him back to the emergency room. Dead kid. So I think I need to call the patient advocate, because this is just so wrong on so many levels. Someone\u2019s going to die.\u201d<\/p>\n
She called me back before I got to my son\u2019s hospital to tell me all the patient advocate did was take the info and say something vague about the need to rely on well-trained nurse practitioners for \u201ccost containment\u201d purposes and the probable barrier which her (supposedly excellent) insurance might have represented to keeping her around or checking her in. But mostly, she said, the patient advocate just sounded bored.<\/p>\n
Anyway, I got to my son\u2019s bedside just in time to see him for about five minutes before they put him under. The surgeon, an expert in this type of procedure, talked to both of us and explained the procedure in detail, pointing out that they knew going in that they would have to sever the nerve to his left ear, but would spare no effort to save the facial nerve itself as otherwise he would go through life with one side of his face paralyzed. The anesthesiologist, who had already interviewed my son, heard I was there and came back to interview me about whether I could recall any allergies he might have, or knew of any adverse reactions to anesthetics in the family.<\/p>\n
I discovered from one of the nurses that they had flown in a second surgeon, also expert in this particular type of procedure, just to be there for back-up purposes, which kind of amazed me, but they said it was a tricky and intricate surgery and they had no one else on staff qualified if something went wrong, so they had to get backup from elsewhere. Then I sat in a waiting room for six hours \u2013 three hours longer than it was supposed to take \u2013 and found it not hard at all to stay awake, despite the fact that I hadn\u2019t slept in more than 48 hours. I was just too tense. <\/p>\n
The surgeon came to find me when surgery was over, said it went very well, my son\u2019s ear is paralyzed for life, but though he\u2019ll never wiggle it again, I\u2019m pretty sure he couldn\u2019t before so that\u2019s no loss – and he can still hear out of it. They had to stretch his facial nerve to the breaking point, so one side of his face is paralyzed, but they didn\u2019t break the nerve, so it\u2019s not a permanent paralysis. <\/p>\n
I spent the rest of that day in my son\u2019s hospital room watching the meticulously professional and sympathetic care bestowed on him by the staff there \u2013 despite the fact that it didn\u2019t take much observation to note that the facility itself was dated and well-worn. I couldn\u2019t help comparing it to the relatively new and well-decorated and well-equipped local hospital where my daughter\u2019s life had been so recently in the balance. And I couldn\u2019t help finding our local upscale hospital wanting \u2013 for decisions about care in this one seemed to be dictated by medical necessity, and I couldn\u2019t feel the same criteria was at play in our local hospital.<\/p>\n
And here\u2019s where the whole thing goes back to my Twitter Follower. Because late that night I went and checked into my hotel and, restless and still keyed up, I started going through e-mails and discovered one from Twitter informing me of my new Twitter Follower. I\u2019d never heard of her, and I have so few followers \u2013 less than a dozen at that point – so I looked at her profile. Turns out Twitter Follower is a licensed health and life insurance professional, who delights in having a job where she can \u201chelp people.\u201d <\/p>\n
Oddly enough, Twitter Follower is also based in Springfield, the capitol of Illinois. You know, where we keep our legislature. Maybe I\u2019m just the cynical and suspicious type, but it did cross my mind that perhaps Twitter Follower has chosen this moment in time to follow an obscure blogger, in an obscure Illinois town, on Twitter, precisely because said blogger has been known to blog about healthcare, now and then, and is most adamantly in support of single-payer. <\/p>\n
And perhaps Twitter Follower is even being paid to be an on-line advocate for the Death by Spreadsheet industry? But no \u2013 surely not? We are talking about a very obscure blogger, with no following to speak of, in a very obscure town, in the middle of the country \u2013 surely the insurance industry is not so very worried about a public option that they are meticulously following the every online move of every obscure blogger like me who is out there?<\/p>\n
Well, I don\u2019t know what the rest of you think, but suspicious and cynical me thinks it\u2019s the most likely explanation. We have a very determined enemy of public health and well-being out there, boys and girls. But regardless of whether Twitter Follower is following obscure bloggers \u2013 who very occasionally blog about healthcare \u2013 because she is being directly paid to do it, or merely because the Death by Spreadsheet industry is her bread and butter, I just have a couple of things to add about the Two Hospitals in question.<\/p>\n
Dear Twitter Follower, observe if you will that back in the day when my daughter was uninsured and flat broke and walked into emergency rooms with sky-high blood sugars she got checked in and seen by doctors and treated until she was well enough, and lucid enough, to leave in a condition where she could reasonably take care of herself. <\/p>\n
Yet now, merely a year or so after her emergence from the ranks of the uninsured, now that she has that \u201creally good\u201d coverage, she is all of a sudden \u201cwell enough\u201d to leave the hospital when she has pretty much identically high and lethally dangerous blood sugar levels. Nor is she any longer given the benefit of any doctor at all to \u201cmake medical decisions in her best interest.\u201d Odd that, because I could swear I\u2019ve heard your industry rely rather heavily on repeatedly thrusting the \u201cyour doctor should make the decision\u201d talking point down the collective throat of the American public as a standard we should strive for. <\/p>\n
Yet this is the \u201chealthcare system\u201d (in scare quotes precisely because it does scare me) most Americans are the beneficiaries of: one in which cost containment and the profit motive pervade every healthcare decision. And your industry would have us believe that the very last thing we want is the government making our health care decisions for us.<\/p>\n
Like, say, the health care decision that the doctor \u2013 let\u2019s just call him Major Surgeon – made for my son. <\/p>\n
See, my son\u2019s surgery was at a military hospital, because my ridiculously hard-working college-educated son finally acquired real healthcare by the simple expedient of entering military service. I can\u2019t say getting healthcare was his reason (though it did weigh in) or that I was very happy with his decision, but there it is: he does have government-provided, government-paid, healthcare.<\/p>\n
Under which healthcare plan it is apparently possible for the medical professional in question to not only make decisions based on the medical best interest of his patient, but to tell the entire government \u2013 and the patient himself, who was not thrilled about the risk of having to restart basic training – to essentially \u201cfuck off\u201d because he was not going to let this medical condition slide until the patient was at his permanent duty station. <\/p>\n
Although, ok, I suppose Major Doctor probably did not literally tell either my son or the entire government to \u201cfuck off\u201d \u2013 but then I don\u2019t recall hearing that anyone tried to stop Major Doctor from acting in his patient\u2019s best interest: there was no death-dealing accountant standing by with a spreadsheet to interfere with his decision to set aside the needs of military recruitment quotas and divert my son\u2019s time instead to a surgery he needed to avoid a potential risk of malignancy that might take twenty years to develop, nor even to question the expense of his decision to fly in another surgeon to stand by while he operated on some random Private in basic training because he felt they needed another expert rather than just one of the other surgeons there on staff, in order to ensure the random Private\u2019s face didn\u2019t end up looking kinda-sorta funny.<\/p>\n
So I am left here, home again, pondering the ironic fact that although I am not looking forward to where my son will most likely be living for the next year, I am reluctantly forced to conclude that there are definite scenarios under which he might well be safer in Kabul or Baghdad than his sister is in the Fox Valley here in Illinois.<\/p>\n
But in the end, Twitter Follower, I must thank you. Despite the fact that I have no more time to deal with blogging now than I did last month, your effort to follow me reminds me why I made the time before and will do so again. Continue with your tweets about how much you enjoy \u201chelping people\u201d by all means. I look forward to the opportunity to respond. <\/p>\n
For now I am following you.<\/p>\n","protected":false},"excerpt":{"rendered":"
First, an apology \u2013 I\u2019ve been incredibly busy since this blog launched, mostly living as a road warrior for work, but also providing necessary grandmotherly support for the birth of not one, but two, new grandchildren. Jane Danger, who arrived in this world at about the same time this blog did, and Joseph (aka \u201cJoe-normous\u201d) […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[78],"tags":[20,2869,330,331,145],"_links":{"self":[{"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=\/wp\/v2\/posts\/447"}],"collection":[{"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=447"}],"version-history":[{"count":2,"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=\/wp\/v2\/posts\/447\/revisions"}],"predecessor-version":[{"id":1322,"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=\/wp\/v2\/posts\/447\/revisions\/1322"}],"wp:attachment":[{"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=447"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=447"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.progressivefox.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=447"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}