I was a 26 year old ER nurse and thought I must have
contracted chronic fatigue syndrome from one of the many patients I treated in
Baylor ER in downtown Dallas. I was just so darn tired. I remember
working nights and struggling to stay awake - well who isn't sleepy working
nights? I had to pee all the time - again what nurse doesn't put off
"taking care of her own business" to take care of patients? We all have to pee all the time - nothing new
there. Yeah, I had dropped a few pounds
and just thanked the "fat Gods" for finally adjusting my metabolism
to match my food intake! I had been a nurse for 6 years and treated
patients on med/surg units with diabetes, in ICU with diabetes and DKA, and
countless in the ER who were new onset, in the midst of a hypoglycemic episode
that caused injuries, or just dealing with some of the many complications
that diabetes may inflict. Never in a million years did I think it was
happening to me!
I remember working
one night and the Bat Phone rang (our ER slang for the red phone that alerted
us to incoming ambulances). I had the sickest thought in my head -
"please be a GSW to the head". GSW was gunshot wound and when
it occurs in the head, the outcome is usually quick and usually fatal.
Horrible, I know. But I was so
tired, the thought of having to care for someone intensely for a few hours
seemed more than I could bear. It wasn't
a GSW and even though I didn't have the strength, but I trudged on. Not
too much later, I saw my primary care physician during a shift when he had come
to see another patient. "John, something is up with me. I
think I have Epstein Barr or chronic fatigue or something. I am just
always exhausted!” He asked what I had been up to lately and my answer
was my typical busy life, "Well I am in the midst of buying a house, I
have a new boyfriend, I am working extra shifts and partying with friends when
I have an open evening”. He raised an eyebrow, "What's your diet like?” Hmmmmm, I had to think. When was the last time I ate a meal?
With all the running around I was doing and working nights, my top meals,
were candy bars, take out and cafeteria food (yuck!). And of course, I was too tired to exercise so
my basic pillars of health: food, sleep, exercise were basically non-existent.
No wonder I was tired. His advice: get some sleep, eat a few
square meals, and come see me next week.
He wanted to run some
fasting lab work, so I had to go without food all night during my shift (that
is HARD to do!). Looking back, I am pretty sure he knew what was up, but
I was clueless. My fasting glucose was 140! He asked, "Sure
you didn't sneak Snickers on the way over?” "Nope - nothing". He didn't diagnose me then, but suggested I
do some fingersticks at work after a meal.
I was horrified when the meter read > 300.
There had to be a mistake. My nurse brain knew what it meant, but
searched for anything that might explain the number other than the dreaded DM.
In the weeks to follow, I was started on oral hypoglycemics and sent to
an endocrinologist. He confirmed I had insulin antibodies and that even
though I wasn't insulin dependent yet. I would be. Honeymoon phase
they called it. Great! Who did I
just get married to?
So I exercised and
starved myself to make the numbers on my meter tell the story I wanted to hear.
I worked side by side with a dear friend who was type I (love you
Debbie!). She shared her story and tried to help me along, but I wasn't
having any of it! I was just fine with my little pills and I would NOT be
crossing the line to needles. No way.
No how. I was a nurse! An
ER nurse at that! We are the ones who take care of poor diabetics.
We are on the other side of the triage desk. We are there to
provide empathy to those poor souls who have this affliction. I am not, cannot
be one of "them". They call this stage denial - I did it
perfectly!
 |
| Party Time! No worries |
 |
| Rocking the bikini! |
 |
| Dehydrated and worn out! |
Eventually the pills were no longer doing the trick. I was still losing weight and I was oh so tired. I remember driving to an endocrinology appt. I was on the freeway, doing 65 or 70 mph and I just wanted to close my eyes, just rest a bit, so I had more energy. The fact that it would be a lethal decision was lurking somewhere in my consciousness, but the idea of sleep was so enticing. I didn't succumb, but it took all the will power I had not to nod off driving down I30. It was at that point that I asked for insulin. I didn't care anymore about the needle. I just wanted to feel better. My endo wanted me to wait until I could go to diabetes education. I pointed out that if our discussion been about any random patient in the ER the day before, he would have no problem giving me an order to administer insulin. I didn't need to practice on oranges and learn what insulin did. I had those skills. I wanted to feel better NOW! So that was it. On July 5th, 1991, I took my first injection of insulin that day alone in my kitchen. I became insulin dependent the day after Independence Day - ha!
The needles and
injections were fairly easy to adapt to - just had to get used to the patient
being me, but I had the skills. Hypoglycemia, however (low blood sugar)
was an aspect of the disease I wasn't prepared for - but it is part of the gig. It happens. Sometimes your food intake,
activity, and medication don't match up and your blood sugar plummets.
This has to be one of the WORST feelings in the world. I still
can't stand it and it scares me. The first time it hit, I was home alone
and became dizzy and diaphoretic (sweaty) like no patient I had seen before.
Fluids were literally pouring out of my skin and puddling on the floor as
my body attempted to correct my blood sugar levels by concentrating my blood.
I had a hunger like I had never known. I only knew I had to eat. And eat I did - much more than the 15 grams of
carbohydrates that is recommended but there was no way you could have stopped me.
A cup of orange juice, are you kidding? I am dying here! I
need food! And lots of it! In a
few minutes the fog cleared and my blood sugar came back up (most likely a
little too much). Mr. Hypoglycemia, meet
Patricia. Your free gift with
purchase. He comes with your husband Mr.
Diabetes
My second date with
Mr. Hypo was in a Walgreens and I started noticing the dizzy, sweating feeling
come on. I knew I needed to get some carbs so I head over to the snack
aisle. There are hundreds of cookies and
candies in front of me, but I was so fuzzy I couldn't make a decision. I
just stood there looking at all the options, swaying back and forth, and trying
to focus my blurry vision. Anyone watching would have thought I was high
on something (irony - I was low on something!) I finally selected a bag
of Pepperidge Farm Chocolate Chip cookies, sat down Indian style right in the
middle of aisle and chowed down. Cue the
Bob Marley music!
So life moved on. I kept my game face on and tried to
make sure I didn't worry anyone. My Mom’s
advice "If it's not a big deal to you. It won't be a big deal to
everyone else". So I was very open
and didn't try to hide it from the world or cover it up. I think almost
every Firefighter in the Dallas Fire Department saw me inject in the ER break
room. I wore diabetes like a badge of honor, proving I was tougher than
it was and I could control this thing that had taken over my body. I ate
pretty much what I wanted and did multiple injections to cover what I ate, I
altered my long acting insulin according to my work schedule - sometimes I
needed the insulin to peak at night when I was working, but on days off it
needed to kick in during the daytime. It was a constant roller coaster
but I was doing what I wanted. I was "winning"; I was doing
diabetes on my terms. Or so I thought.
God teaches us
lessons in many ways. I learned one from a man who presented to the ER
when I was working triage. He was a black male, probably mid 50s who had
suffered nearly every insult uncontrolled diabetes can inflict. He was
blind, partially paralyzed from a stroke, with limbs partially amputated, his
dialysis shunt was in his thigh because the vessels in his arms (the typical place
for a dialysis shunt) were shot and he was disoriented. I looked at him
and fear racked my body. Real terror.
This shit is real, it is dangerous, and I have it. I wept. His memory still brings tears to my eyes.
I didn't (and still don't) want to end up like that.
So I swung the
pendulum to the other direction. I stayed in, weighed, and measured
everything I ate, exercised diligently, changed my work schedule, and just
"did" diabetes. Textbook. To my disappointment, I still
had numbers that weren't perfect. Every finger stick became a judgment of
my character and my worth. "Bad"
blood sugars = "bad" Patricia.
I wasn't doing it good enough. My type A personality and
perfectionist tendencies did not serve me well. I was really hard on
myself as I “failed" daily to control this thing that had killed off my
pancreas. I wanted off this crazy ride! I couldn’t do it
perfectly. It was too much and it had
beaten me down. Life was not fun. Diabetes
was not fun. I was frustrated and
couldn't see a way out of the dark place that consumed me.
God sent another
angel to rescue me. Another nurse friend was in the midst of a divorce
and had been seeing a counselor to help her cope with the situation. She
encouraged me to make an appt. I did and it changed everything.
What I came to learn about myself was that diabetes wasn't my problem.
It was how I handled problems. I was an avoider and a pleaser. My pattern was to power through uncomfortable
situations, get busy, stuff my emotions, act like everything was ok, avoid
conflict, try to live up to what people expected of me, please people, and put
other's needs above my own, all so I wouldn't have to deal with my own
"stuff". We nurses love to fix
others so we don’t have to fix ourselves.
For many aspects of my life, it worked, but diabetes couldn't be ignored
or pleased or avoided. Sort of like a two year old, it demanded attention.
I did a lot of
soul work, inner exploration, and crying. My counselor was the first
person who said, "It is really awful that this happened to you" and
when she did the flood of tears poured forth. No one else had acknowledged my tragedy or
could sit with my tears. My friends and
family just wanted to cheer me up. No
one wanted to be negative. Tears are uncomfortable.
She helped me to see the truth. I wasn’t OK.
I wasn’t dealing with it. I wasn’t
strong. A strong person has to face the
situation and deal with it. Not hide, ignore,
and act like nothing happened.
Her compassion and insistence on the truth helped me
to accept my situation. I had diabetes
and my life would never be the same. Ever. I had to grieve my
non-diabetic life so I could accept this new one. I was in the throes of
most of the stages of grief: anger, denial, bargaining, and depression. She
helped me with the most important stage: acceptance. I had to face that I
couldn't run from this situation, but I could turn and embrace it. I saw that my life would never be without
diabetes as a part of it, but it didn't have to define me and it didn’t have to
be a bad life. As I changed my
viewpoint, my life got better and I became happier. I worked through some
demons from my past and let them go. I
learned that my blood sugar readings were just bits of information to help me
better understand my insulin needs, not something to be done perfectly, or a
reflection of my worth as a human. I
came to appreciate that you cannot control diabetes, but you can care for it
every day. I accepted that I wasn’t being punished for past mistakes. I learned to be nicer to myself.
A lot has happened in the nearly 24 years since that time;
insulin pump, husband, kids, career changes – the stuff of life, with a little
diabetes sprinkled in. And I am grateful
for all of it.
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