Monthly Archives: February 2008

family, health, Juvenile Diabetes

Good night nurse

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I learned of Trudeau’s death when taking a few minutes to grab a coffee in the parents’ lounge on the Pediatric Ward. It was my third day there – I’d been sleeping on the floor by R.’s bed each night until, finally, one of the nurses suggested I see if a bed was available in the parents’ quarters just down the hall. I suppose they’d hoped I’d go home each night but that wasn’t going to happen until I was sure she was out of the woods.

It was something I had to do. The thought of her waking up in the night – and she was being woken up two or three times a night for blood work at this point – surrounded by strangers was not a good one. After all she’d been through, the least I could do was be there when the nurse came around to take a little blood.

Once R stabilized on the insulin and her fluids were back up, they took out the IV. It had been very handy for all the blood tests needed to keep up on her metabolic state of affairs but IV sites are notorious for infections. So, for some blood work they could get enough by warming up her fingers and using a large lancet, milking the blood into small vials. For most of it, though, the quantity needed really called for getting it from the arm. The inside of her elbows were getting pretty chewed up from all the needles the blood work required.

On the third night it was a new nurse who came around with the tray. She seemed a bit put out at having to come to the ward – maybe she’d planned a nice quiest night, maybe she’d been held over on her shift, I don’t know but there was an attitude I hadn’t seen in any of the other blood-letters.

She grabbed R.’s arm, looked at it, snuffed. Went to the other side and grabbed that arm, snuffed again. With a heavy sigh she took up her needle and started the tie-off. She inserted the needle, muttered – she’d missed, pulled it back a bit and pushed again, muttered, pulled it back and angled another way. By now R was getting distinctly uncomfortable and was whimpering. I was appalled at what I was seeing and gripped the bed rail to keep from leaping across the bed to grab the woman by her throat.

She clumped over to the other arm and started again. Same thing, pulling back and angling another way, pulling back, angling. R was in tears now. The nurse just tossed her gear on the tray and said someone else would have to give it a try, she wasn’t getting anywhere and off she went. I was shaking by this point, followed her out and went to the nurse station.

“I don’t ever want that woman to touch my child again.” The nurses looked up in total surprise. They had grown used to my being there, sleepy at times, encouraging always and making little humorous comments to keep spirits up but this time I was white. “If she comes near R., I will put her through the wall.” One of the nurses came with me and took a look at my dear’s little arms which were actually swollen to the point she couldn’t bend them anymore. I described what I had seen. The nurse said that I could have told her to stop at anytime and that protocol is if the needle misses on the first try, it is to be removed completely and the other arm used.

She called up another phlebotomist – a sweet, obviously gay male nurse. He took a look and was shaking his head. They’d have to use finger vials because there was no way any of her arm veins could be used with all the swelling there. He apologized profusely and said he would make sure to take care of R. himself from now on for any night time blood work.

The ward nurse confided to me that the other leech, the night butcher, as I took to calling her, had a reputation for being impatient with children. She wasn’t usually called out to the ped’s ward. All I knew is she wasn’t going to be allowed within sight of me for a very long time.

family

Kinda like rodeo round-up in the spring

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The triage nurse at emerg directed me to take my limp child to the waiting room, even after I said Dr, Sidhu was supposed to have phoned ahead. I went back, filled out the paperwork and suddenly,  a couple of nurses materialized to whisk my baby into the trauma room. I guess someone finally got the message from the doctor.

M. had parked the car and came in to find us in a big bright room. At first it was a matter of waiting for the I.V. nurse to show up and put a line in. M.’s aunt actually was an I.V. nurse at the hospital but not on that shift. Besides, she always made it pretty clear none of the nurses liked ‘doing’ kids because of the tiny veins they had to work with. Bricklayers and weightlifters, nice big veins are the preferred patients for the intravenous needle specialists.

M. and I stood at the side of the bed looking at our little girl, a pale bundle of love in the middle of a great big hospital bed. She wasn’t aware of us anymore, finally able to slide in to the pool of unconsciousness. Then the party began. A nurse took us aside and sort of kept us herded into one corner of the room. She kept us pinned against the wall and softly explained everything that was happening. There was a bit of a cry and both of us looked over – ‘our’ nurse put her hands out to make sure we weren’t going to charge the bed.

“They’ve just put in the i.v. needle – it’s okay, it’s a good sign, actually, that she’s reacting…We’ve got to get some fluids into her and, once the doctor approves the order, we’ll start her on insulin. First we need to get a base reading in order to see what we need to do. ”

At least that’s the gist of what she said. We really did try to focus on nurse but there’s a gut instinct, part of the lizard-early -mammal brain that kicks in when your child is in jeopardy. Another part of my brain, the savior, that sense of humour that keeps everything in perspective when the floor has fallen out from under foot, had a sudden snapshot of us in one small circle and everyone else over there.

Ever watched films about branding time in the spring? When the cattle get herded in from winter grazing and the new calves are cut out for branding and the yearling males also get the honour of providing prairie oysters for the round-up crew’s dinner. There’s usually a couple of guys on horse back cutting out and herding the calves and keeping the adult cattle away. Then there’s a large group of men gathered around each calf as it comes their way, roping, throwing, branding and, ah, cutting, as required. A honkin big vaccination for good measure and the poor wee thing is released.

The point here is that while this is going on, the cows are continually milling around, nosing the air and calling to their calves. When one of the wee critters comes trotting back to the herd, the mother knows it’s her baby, she calls to it, sniffs it all over then pushes it back into the main herd with her nose. M and I were like those cows, milling about, sniffing the air and making worried parent sounds in the direction of a very large group of people huddled over our child. Without the dust, the heat and the smell of cow poop but otherwise, operating at much the same basic level.

A side note:  in Victoria the road to the Vic General winds around the far side of the parking lot and the main building. As we drove past the back of the hospital, we saw a medi-vac helicoptor flight taking off. It’s kinda hard to miss it as the heli-pad is fairly close to the road. Later we learned it was a child who had been brought in after three days of being in diabetic coma. The parents thought it was the flu.

A nurse told me this to explain why there were so many people working on R. and why the tension seemed so high. It is a serious condition, of course but by the time boy was brought in, he had no body fat left – the nurse kept talking about how big his joints seemed because there was so little muscle left. He was medi-vac’d to Sick Kids in Vancouver but didn’t survive the day.

What’s the difference between a diabetic coma and insulin shock? Well, the first one takes longer to kill you. Diabetic coma is the result of too much sugar in the blood – no insulin or too low insulin levels means the glucose stays in circulation and your brain can’t use it and begins to shut down. Insulin shock means the no sugar in the blood because the insulin levels are too high and all glucose has been metabolized. The brain has no sugar to use and begins to shut down – rapidly.

Ah, all the technical stuff we got to learn. Once things calmed down to the point where we were just waiting for the pediatrician to issue orders, the nurse took both of us by the hand, looked us in the eyes and said, “you’ve got a steep learning curve ahead of you, guys. You’re going to learn more in the next week then you ever thought possible.”

family, health, Juvenile Diabetes

You know it’s bad when the doctor looks scared

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I’ve never dragged my children anywhere but when the cab arrived, I had to physically drag R. outside. She didn’t want to move and was barely conscious. Even at 10 and having lost weight overnight, she was too heavy for me to actually hoist over my shoulder or anything as heroic looking as that. I suppose that’s what the made for tv movie would have for directions…

Maureen:

come on, sweetie, you’ve got to get up, the cab is here

(pulls child to sitting position, turns to get shoes as child flops back on couch)….

no, sweetheart don’t lie down again…here, let’s get your shoes on…

(takes deep breath, grits teeth, steely glint appear in eyes)

Oh, the hell with it,

(reaches down, puts arms under child’s arms)

come to momma!

(grunts and in one swift move pulls child up and then over left shoulder)

if the doctor wants you to wear shoes, she can damn well put them on you herself…

(grabs coat, purse and in one swift motion pulls the door open and then slams it behind her. scene shift: pov: through a car window – background sound, car engine idling, cab dispatch radio and a local country music station weave together – camera focuses on front door of house as woman emerges with child slung over shoulder. The door slams and she runs down the steps towards the cab)

I see either Jodie Foster or Sigourney Weaver playing me.

Anyway, repeat process of dragging, sweet talking and coaxing the semi-comatose child out of the cab, into the elevator and into the doctor’s office. At this point the hard edged receptionist didn’t even wait till we sat down – she grabbed the other arm and helped me guide my baby into an examining room.

There are two things Dr. Sidhu can be counted on: if you have the first appointment in the morning, she will be there at least 10 minutes after you arrive. The other thing is that once she is in the examining room with you, you have her total attention. No one ever complains about waiting an extra half hour or more past the scheduled appointment time before finally seeing her because you know when you need that extra time, she’ll be there for you.

So, in comes the good doctor, smiling and apologizing for being late. She stops in mid-sentence, takes one look at the patient, then at me and asks, “how long has she been like this?” I start with the camping trip and she stops me before I get more than a few words out…”No, I mean like this…” I’ve never heard her use that voice before, no nonsense, give me straight information right now and only the vital details type of George Clooney on ER voice.

She grabs a glucose meter, and a lancet, takes R.’s hand and pokes a finger to get a drop of blood (this is the first time I’ve seen this done anywhere outside of a blood donor clinic; now it is a four/five times a day routine sort of thing). We look at each other in surprise when the test strip fails to soak up the drop of blood. Dr. Sidhu looks closer… it can’t take a reading, she says, because the blood is too thick to be absorbed. I look closer. It’s like syrup. Suddenly the doctor is holding out a sample bottle and pulling us both down the hall to the private bathroom.

So there I squated, attempting to hold my daughter upright on the toilet with one arm and holding the sample jar between her legs, patiently cooing like when she was much younger, still in toilet training. “Can you pee a bit for me, sweetie?…come on, just a bit…thats a good girl. Do you want a drink of water? will that help? Here, let me put a warm cloth on your hand…finally she manages a dribble and fortunately I’m able to catch it in the jar. It’s amazing what constitutes a victory some days.

As I pull her clothes back on and drag her back to the examining room, the doctor takes the jar, stirs it with a stick.

You need to get her to the hospital right now. I’ll call an ambulance if you don’t have a car here.

Mark just gets to the waiting room as we are discussing this – he couldn’t concentrate at work and drove to the doctor’s office.

The doctor stressed the importance of going directly to the hospital. She will phone ahead but don’t wait. If for any reason the emerg desk hasn’t gotten the message tell them this is not a fuck around situation and get her inside. Okay, that’s the screen play version, I don’t think the good doctor would drop the f-bomb regardless of the situation. (Dr. Sidhu would be played by Archie Panjabi – the older sister in “Bend it Like Beckham” because she’s the only Indian actress I can think of who is anywhere near as tall as my doctor – she’s a big girl…like a lot of Indian women, actually)

 

 

family, health, Juvenile Diabetes

And now a word from our Sponsor

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Frederick Banting

This is the man who saved millions of lives, including my daughter’s. Sir Frederick Banting didn’t create insulin. He did take a look at what others had discovered about the pancreas, it’s role in digestion and what might work in bringing about an effective extract from it. Insulin was a shadow substance at that time, it’s existence postulated by others before and even at the same time Banting was doing his research.

This is the part my friends in PETA will protest strongly about. You see what Banting and his partner Best, did was use 10 dogs to isolate the substance being produced by a certain part of the pancreas by means of shutting down all it’s other functions…then making an extract and injecting it into another dog from which they had deliberately removed the pancreas. The result was the liquid from the one dog kept the other dog alive.

It took a few more dogs and pancreas from other animals to fine tune the process. The University of Toronto professor who was sponsoring Dr. Banting’s experiments went from sceptical to quite interested once it was apparent the good doctor was actually on to something. Finally James Macleod was to actually walk off with half of a Nobel prize for his role in being somewhere else while the work was done. Banting actually protested that Macleod recieved fully half the credit while Charles Best was not mentioned. Banting decided to share his half of the prize with Charles Best.

Speaking of PETA, one of the true ironies of all this is that while the organization protests any form of animal testing, the senior Vice President of the organization, MaryBeth Sweetland, is a Type 1 diabetic. She justifies her use of insulin, which does contain some elements of animal product and was developed through extensive animal testing, by saying “I need my life to fight for the rights of animals”.

And Hitler was a vegetarian – he couldn’t bear to think of an animal being harmed or killed when there were perfectly decent vegetable alternatives. Jews, Romanies, political dissidents, Catholics and Catholic priests, homosexuals and Poles, however…