So
I just returned from my quarterly visit to my endocrinologist and I am
frustrated - again! There has to be a better
way!
I
have been a type I diabetic since I was 26 and I wear an insulin pump. I
am a freak of nature, as to my knowledge I am the only one in my large extended
family ( 6 siblings, 16 cousins, and too many second cousins and cousin’s kids
to count) that developed type I. I was working in the ER when it all came
down. Most likely related to something viral I picked up. I had a
weird rash and fever about 6 months before I became symptomatic and the “boom”
there I was doing injections. Diabetes has taught me many lessons and
good lessons. It is not something about
my life I hate. That is a bitter emotion,
so instead I embrace it, hold it close, and care for it as it were another
child. It is my responsibility.
As a registered nurse, I fully
understand the impact of diabetes. In my career, I have worked on a med/surg
floor caring for diabetics, in Medical ICU caring for diabetics at their worst
and in the ER caring for the newly diagnosed, those who poorly managed their illness
and those who had accidents when low blood sugar got the best of them. I have literally seen it all. So I get
it. I go to the endocrinologist every 3 months, get my eyes checked
annually, and do all those other things on the "Check list for Diabetics".
I test my blood sugar 4-6 times a day or more if I feel weird.
While we were trying to conceive, during the pregnancy and while nursing,
I was super careful and checked my sugar every day at 7, 9, 11, 1, 3, 5, 7, 9
and 3 am. My numbers were equivalent to those without diabetes and my
kids had no complications. Yeah! We eat pretty healthy without being
obsessive. I probably could work out a bit more than I do but I have
gotten myself back in the yoga studio the past few months. And I am happy
to say, So far, So good, No complications!!
I hope I am what doctors would label "compliant", one of the
good ones.
So why is it after every visit to
a provider, I feel so beat up and defeated?
I leave feeling like I am failing at my diabetes management, that I must
be the worst patient ever and I am doomed to suffer all the complications that
are just waiting to pounce on me.
It
starts with the waiting. In my corporate
world, if I had an 8:30 meeting, it started at least by 8:40. It would
not be acceptable to be 60 minutes late.
I feel devalued when I am made to sit for no good reason. I was the first appointment! How could you be that far behind? Nevertheless, in healthcare it is the norm. Patients wait.
I
eventually get back to the exam room and answer the required screening questions
(Thank you Meaningful Use). Today they added Ebola risk along with
verification that I haven't started smoking in the 3 months since my last visit (LOL!), my flu shot is up to date, my
BMI is recorded and many other important tidbits that have no bearing on how I
feel or what I need, but they are required.
Meanwhile, the clock is ticking, I have a list of things that I need from
my provider and I have to make sure we cover it in my allotted time. 1) My
insurance no longer covers the brand of insulin I have used for the past 20
years - need a new Rx. 2) My insulin
pump is out of warranty and I need a new one - curious about new pumps on the
market. 3) I need some labs drawn for
another doctor - any way we could do it together? 4) Anything new on the diabetes front I
should know about?
But first, we do the obligatory
review of all my blood sugar readings that have been downloaded from my pump.
"What happened 2 weeks ago on Thursday - your number was a little
high?" Hmmmm, I really can't remember. (Can you?
What were you doing 2 weeks ago on Thursday? Who knows
this?!!!) When I say I am not sure, they
eyebrow of my NP goes up as if to say, "Aha! We caught you! And you
have nothing to say for yourself". It proceeds as she points out all
the "wrongness" in my numbers. Never mind that most of them are
good and my overall average says I am within target range, only those out of
range are addressed! On my last visit, I
created a log of everything I ate, activity, mood, glucose readings, carb
intake etc for 2 weeks, so I could answer her questions. She still only circled the numbers she didn't
like and commented she “Didn’t know what to make of all this information".
Sigh.......
So we complete the review she
asks me if I want to change my pump settings. "Sure" I say,
"what do you suggest?” She counters with "What do you
think?" In my head I say “What I think is that I am here for your opinion
and advice. You help me!” We end up doing nothing and when I get to the
parking lot - I adjust them based on what I think will work. Frustration
#1.
So on to my list of stuff! She hands me my new prescription.
"What should I know about this?" I say. "It is
just the same," she says, "Nothing new". Well to me
it is new as I have been on the other brand for a long time. So I will google it when I get home and see if
I can find others who have switched and noticed a difference. Frustration
#2.
Now to new insulin pump.
She hands me a packet of literature from the manufacturer (same as what I
have already read on their webpage) and tells me to read it and call the
company rep who can answer my questions. I ask for her opinion about her
other patient's experiences and she says she isn't allowed to share that, as it
would be unfair to the pump companies to promote one over the other.
Really? Being fair to the pump
company is more important than sharing real life experiences among your
patients? She tells me not to worry, as the pump reps will be fair.
Yeah - right and I have some swampland you might be interested in!
I told her I would try to find some info from other pumpers online.
Her advice "Don't believe everything you read online". Once
again, I am left to my own devices to figure this out. Frustration #3
Finally my lab work. I have
several specialists in my medical arsenal and my wellness doctor likes to have
my labs done in advance so we can discuss during my visit. (Brilliant
idea BTW!). I need to get them done this
week, so let's get two providers tests done with one needle stick - right? No such luck, My NP wasn’t willing to
add the wellness labs to her lab slip and wanted me to move some of the
duplicate labs to her lab slip (which would require me to contact my wellness
doctor for a new order sheet). Suffice to say I had 2 separate lab draws
45 minutes apart at labs that were 2 miles apart. Frustration #4
As far as anything new in the
world of diabetes management, she had nothing. I go every 3 months, it is
always the same, and nothing is new. Sigh...........I
will keep checking online.
I leave somewhat dejected, defeated and very frustrated. When I could have used a cheerleader or an
advocate, I get a critic. If you look for a person's missteps, they are easy
to find, especially if you have a chronic illness. I really want someone
to tell me, "Keep on going! You are doing great! There is
hope!” But not today. So, as I
have done many times in the past, I try to shake it off, take matters back into
my own hands and be my own cheerleader. Take a deep breath and try to
rise above my frustration and disappointment.
Because at the end of the day it is my responsibility, my “child” to
care for, and I will do what I can.
But what about all those people
out there who haven’t really accepted their situation, who don’t have 30 years
of nursing under their belt and aren’t comfortable enough to take matters in
their own hands when it is necessary? It
seems our system has become broken, fractured, siloed and frustrating. Even though we have the best medical care in
the world, it has become less and less about helping a patient to live their
best life and to be well. It is now about data collection, checklists,
finding physical symptoms that can be treated and billed among a sea of
specialists. There is little concern
about the overall quality of a patient’s life, their ability to deal with the
emotional toll that is paid, or the how the nuances of their life affects their
ability to manage illness (or wellness).
The body is assessed for symptoms of brokenness and disease and thusly prescribed
treatments, but the mind and the soul are not included. So many people walk around "Band-Aided", but really
not whole. Struggling, when they shouldn't need to.
There
has to be a better way! Could it be
possible, that there is a way to coordinate a plan that includes not only
medicine , lab tests, and traditional western health practices, but addresses emotional
health, nutrition, family considerations, work/life balance, discovery of inner strength so
you can do what needs to be done, and peace in your spirit to minimize the ever
present effects of stress in our lives?
I am not sure of the exact recipe to make this happen but I think it is
a quest worth pursuing. And it doesn't start with education. If so, smokers wouldn't smoke, no one would be overweight and we would all exercise 30 minutes every day. We all have been educated about these things. So why don't we do it? Personally, I
know having someone cheering you on who thinks you are "worth it" is far better medicine than having someone
pushing you down and making you feel "less than".
I
am interested in connecting with anyone who has interest or expertise on this
topic. I think it is a service that people need. Feel free to share my blog or send them
my way!
Patricia
No comments:
Post a Comment