Disenchanted

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.