Wednesday, December 24, 2008


Tuesday, December 23, 2008
Work 6p-8a--155.5#
A year or so ago, I met a young lady in her mid-teens in the ER shortly after she had been diagnosed with type 2 diabetes, what not so long ago was known as adult onset diabetes. Since then, I have seen her several times, almost always because her blood sugar is out of control. Here lately, it has been more out of control than in, often running in the 400's to 500's. Someone's initial response to this might be to blame her, accuse her of eating poorly and not caring for herself. Someone's initial response would be wrong.
This little gal is smart and kind, and, I believe, good. She's a senior in high school, works at Wal-mart and pretty much takes care of herself, all the while aspiring to go to college next year. And she truly wants to know how to care for this disease that is trying so desperately to defeat her. When she comes in, I try to talk to her to see what her primary care doc and her endocrinologist are doing to try to fix the problems she is having. Most of the time, the answer is nothing. Most of the time, it seems they just tell her to take more insulin when her sugar is up. At no point has anyone really sat down and taught her how to care for herself including how to eat and how to exercise or what to do when presented with a diabetes related problem. It's not that she doesn't listen or that she doesn't ask questions. She does. Her questions are intelligent and appropriate, but they are met with a deaf ear and apathy, and she leaves the visit with her doctors knowing no more than she did when she got there. Even her visit to the dietician was fruitless. On the surface, this would seem like the common denominator is the girl, but I know without a shadow of a doubt she is not the weak link in this chain. I know because when we interact she listens to what I suggest and asks questions and listens to what I say in answer. I know because last night she came to see me at one in the morning to ask more questions and show me her food journal to see what feedback I could give her.
This whole experience has left me even further disenchanted with my colleagues. I often find myself frustrated with either their lack of knowledge or their poor bedside manner or their apathy. Occasionally I'm disappointed by all of the above. But seeing this girl so neglected leaves me embarassed to be even remotely associated with the profession. I just want to throttle her doctors for not taking or having the time to help teach her what she needs to know and her mother who is a nurse for not placing more focus on her child who needs her. And I'm embarassed because I know this is the rule in healthcare rather than the exception, a fact that is driven by a broken healthcare system and a public who by-and-large just wants a pill or a quick-fix.
This young lady gives me hope, though. She reminds me why I went into medicine. She brought me a card (that's it in the picture) and a gift when she came last night. She thanked me for taking the time to try to help. She'll never know how so often I limp along in this ER feeling like I'm just throwing band-aids over situations that I have little power to fix because the patients choose not to work to help themselves or how much that card means to me and how it'll join the short little stack of notes or cards I've gotten over the years that I go back to time and again to remind myself that sometimes I might make just a teeny bit of a difference to someone.
WORKOUT: Today was my first day back after 8 off. It was going to be yesterday, but I jacked up the alarm and would have missed work if the hubbie hadn't realized something was awry. I had hoped I would go bounding into this workout blowing the top off of everything, but I didn't. Honestly, it was a weak workout. I just didn't feel strong, or coordinated for that matter. As I pondered the situation during my breaks, I think at lease some of that might have been a factor of dehydration. I think I probably was drinking about a liter less water per day over that last week because I wasn't working out.
5 rounds of the following:
30 sec of green band assisted pull-ups
30 sec of pushups
30 sec of box jumps--I just did this on the first round and changed it to burpees with a knee to chest jump on the subsequent rounds because I think my wierd modified box jumps might be part of my knee problem. There is NOWHERE to do real box jumps, so I've been flat-footed jumping over some stuff as my box jumps.
30 sec of plank
assisted pistol 1/1 x 2
rest 1 min
20kg TGU 1/1 x 2
20kg Tabata swing.


  1. Jen, I'm assuming you're the one that got her started on her food journal.

    She's come to ask you questions and get advice. You're now also a certified personal trainer not just a doctor.

    You really are in a unique situation to help this young lady in so many ways. If I remember right, you said you were going to have some space you could use at your friend's martial arts school. Have her meet you there and work out with her. Show her some of your pictures from before you got in the shape you are now. In the processes, she might even join the martial arts school and learn self defense too.

  2. Jen, I have more than one physician as a client. Several of them have suggested expanding and re-working the Medicare system and down sizing the influence of HMO's or eliminating HMO's altogether to create a real, quality, universal national health care system. Your thoughts?
    If it is a viable idea, maybe we should petition Senator Kennedy and President-elect Obama to consider it.
    p.s. I have no idea how to get the HMO's out of the business of healthcare.

  3. Jen, you have described a deplorable situation and a humongous problem. Don't the health care professionals on the whole give a shit?

    If she came to me, I'd say eat only whole foods and lots of vegetables every day. Also, exercise in a meaningful way every day. See if that improves things.

    But I'm not a health-care guy, WTF do I know? Why the hell do we pay for health insurance every month and never use it when this is the treatment people get?

  4. Jen,
    You are a Saint... I have been disenchanted for years!

  5. hang in there kiddo. you can't fix them all. remember, i know. keep looking at your stack of cards. i didn't keep one and im out of the business. i tapped out. the world would be sad if you did that.

    ps- there HAS to be something around you can do box jumps on. how high are you jumping now a days on those? you could use a chair if your up to that point yet. ona side note though, you are really giving the pull ups the whatfore, pretty soon you will be out-pull-upping me.

  6. Here is a suggestion for box jumps:

    It's 20" high. If that's not enough, it's easy to attach 2"*4"s to the bottom to lift it.

    Jen, I could use your thoughts: I'm 51, and now one of many many laid off technical managers. I don't want to go back to tech, even if a job surfaces.

    I am thinking about nursing, or respiratory therapy. I want to work with people, not computer screens, and software. There are good programs in this area.

    I think I am aware of the downsides, yet, it would all be new to me. I think we will all be working into our late 60's, or later, and I'd like to spend those years doing something that matters?

    Any thoughts?

  7. Bryan, That actually looks great. Have you found it to be sturdy enough? The only negative I see right now is that I wouldn't be able to get that many in. Remember jumping is one of my nemeses and I haven't been box jumping but about 12 inches or so--yes, I know that's incredibly wimpy but there's a long history there.
    I'm really sorry to hear about the job, but I think you're looking in a good field. I would definitely choose nursing over RT because those jobs are infinitely plentiful. RT jobs are sometimes a little more difficult to come by.Nurses also make significantly more per hour, have more potential for advancement, and have more patient contact. Nurses also definitely make or break a hospitalization for a patient--make a huge difference in their illness, their communication with their physician and their understanding of a frightening process. If you have the chance, travel nursing can even be very lucrative. My brother sometimes made twice what local nurses were making when he was traveling. The down side is that it is a physically and emotionally demanding job that can drain a person in a hurry if they don't find good balance. Walking concrete floors for 12 hours a day can really beat a person up--especially over the years, and watching people die takes its toll as well. Please let me know whatever I can do to help answer questions. My direct email is if you don't want to post here. My brother is 52 years old and a neuro intensive care nurse. He is a wonderful person who started nursing later in life--after a career in the military. He would be a great person to ask questions of and his blog is the "greentigerRN" that you see on the sidebar. Go over and check it out.

  8. Jen

    No surprise that you took your time and really thought about your response. I will likely look your brother up...

    RE: the jump,they may make these sprinkler valve boxes in lower heights; google around.

    They are plenty strong. I outweigh you by agood bit, and mine has held up great. They are light weight too!

  9. AARON, No most docs don't give a shit. Once upon a time, most of them did, but the world has beat it out of them. All the crazy patients have sucked the compassion right out of them until they don't even have the energy to do right by the patients who are trying.
    STEPHEN, I don't know what the solution is. Undoubtedly, though, the system is busted. TN was actually a test case for socialized medicine starting back about 10 or 12 years ago. That system went broke in about 8 or 10 years--didn't take long. It was a failure in every way, and its remnants continue to fail those who need it. Honestly, I think it could have worked if they had had the right people running things. The right people would have been practicing primary care docs, not politicians. And they would have placed a $5 charge on any office or ER visit instead of allowing them to be completely free. There would also be a graduated number of ER visits available for each member based on what their diagnoses were. If you have no known health problems, you get 2/year. If you have diabetes, hypertension and heart disease, you get more, and so on. Instead it was a healthcare free-for-all. Get whatever the hell you need, all on the tab of the TN taxpayer. WTF?! And there was no accountability on the patients' part. If you have COPD, and you continue to smoke, you should be cut the fuck off. Obese? If you don't lose 2 pounds per month, cut off. IF...okay, I'll end my rant here.

  10. Bryan,
    Thanks again. I'm gonna see if tractor supply has anything like this, then I'll go looking online.

  11. Tractor Supply - my wife's favorite store!

    Try Lowes and Home Depot too.