Wednesday, September 20, 2017

Dr Meanie Pants & the sick girl

Being a teenager is hard. Being a teenager with a life long chronic illness is even harder. I was diagnosed at age 9, and was pretty much on auto pilot with my disease management for several years. My parents were always supportive and helpful, taking me to my Endo appointments and making sure my teachers always knew that I was "special" haha. They never let me feel sorry for myself, and were always so matter of fact about my disease, so I mirrored that attitude. I needed no ones pity or to be constantly promised that a cure was "just 5 years away".

Enter the tumultuous teenage years. Puberty, hormones and everything had to have a drama level of at least epic proportions. I began to blossom socially, and loved running around with my friends...and pretending I wasn't chronically ill. I placed my type 1 on the burner at the back of the very back one. I wouldn't test, I'd miss insulin injections and I ate what I wanted, when I wanted, without making adjustments to my regimen. I was always tired, had headaches and dealt with random infections as a result. My mom was frustrated and sad that I was ignoring my health. She would demand to see my meter once a week, and we would fight constantly. At the time I had no idea how much the yo yo that was my blood sugar was affecting my mood.

Every 3 months, like clockwork, we would travel to Temple or Round Rock, TX from our home in Lakeway, to visit Dr. Stephen Ponder. Yes. The Buddha of Sugar Surfing, the Sultan of Sugar, the Deputy of Diabetesville, Ghandi of Glucose and the Colossus of Camp. Dr Ponder and I never saw eye to eye. I was a teen that knew it all and didn't need some adult telling me how things should be in MY life. I dreaded my appointments, because I knew I would be called out for how irresponsible and wreckless I was acting when it came to my diabetes.

Being a woman, and a teenager, I was proficient in the art of deception and talking my way out of things. I would look my parents straight in the eye and tell them I had been checking my sugars, that I was taking my injections, knowing good and well I was not telling the truth. A day or two before my appointments with Dr Ponder I would sit down with my One Touch meter and change the date and time to reflect the last two weeks of data. I would mix my own blood with the alcohol of a wipe, or with control solution, or even recruit my younger sister or friends to offer up a finger poke. When I was finished, I had a work of art: a completed digital log book that my endo's office could now download and review at my visit. The first time I brought in this BS record keeping I got a rush of adrenaline as I watched the nurse connect my meter to the computer, and my heart raced as I heard the results being printed on the printer. When Dr Ponder reviewed the results, he literally sat there scratching his head. Those 4-6 meter readings per day did NOT reflect the average glucose estimated by my HbA1c. He asked if I ever used control solution with my meter, had I allowed it to get too hot or too cold, how old was it and then asked my mother if there was a family history of any hemoglobin or other blood disorders (there wasn't). I left that appointment with instructions to increase my long acting (Humulin Ultralente) at bed time, and to set my alarm to intermittently check middle of the night blood sugars. SUCCESS! I had fooled the Dr and his staff. Or so I thought.....

At my next visit I strolled in there thinking I was hot stuff. No adrenaline rush, no heart racing, just the confidence that this visit would go as my last one had, and that I would sit there and say yes sir, no sir and I don't know sir, shrug my shoulders and leave. Dr Ponder had a different plan. Little known to me, I was not the first, nor was I the last, patient that had fudged their records. He walked in, sat down and this time looked at me over his glasses and asked how many times per day I was checking my blood sugar: I shrugged and said I'm not sure, maybe 4 times a day or more? He paused and gave me a "mmmmm hmmmmmmm". He then excused himself and said he would return momentarily. He walked back into the exam room with several resident pediatric physicians behind him. He introduced them to my Mother and I. Then he reached out and grabbed my hand, closely studying each finger and my forearms. He cleared his throat and said "Well, these fingers sure are smooth and non calloused for someone that's claiming to test as often as you do......", GULLLLP. "So how about you explain to these doctors and myself exactly how you managed to trick the meter". I looked at him, to the doctors and then darted my eyes to the floor. I said nothing at first while I processed being busted. I then carefully explained what I had done. Painstakingly taking the time and effort and several hours to put together this fairytale logbook within my meter.

I was ashamed and angry. Angry at the world, myself and Dr Ponder. How DARE he. What the hell did this guy know?? Before I left this visit he very carefully explained that I was to send in blood glucose logs, real ones, every two weeks until I saw him again. And should I miss a deadline for sending them, I was out. Finnito. Doneski. So being the difficult teenager I was, I took it as a challenge and said YESSIR!
But there was nothing challenging about NOT changing my destructive behavior. About 6 weeks later my parents received a certified letter in the mail. With a return address of Temple, TX. It was a letter dissolving the physician/patient relationship between Dr Ponder and myself for not sending in my glucose logs. My parents were crushed, I believe I muttered some curse words....and then went about my day.

With Dr Ponder far from my mind, I continued forward with my Sophmore year of highschool. Struggling because I was always sick. So sick, that one morning, close to my 16th birthday, I woke up to vomiting and nausea. An aching headache and weakness accompanied what my parents thought was a stomach bug or food poisoning. My parents quickly made an appointment to see our family physician. As my mid morning work-in appointment approached I began feeling worse and worse. Once the medical assistant called me back to the exam room I was even dizzier and felt like my thoughts were sluggish. It felt as though my feet weighed 500lbs each, as I struggled to follow her to the room on the left. As she showed me in and began to close the door I dropped to me knees and vomited into the trash can. I still remember seeing dots everywhere. I pulled myself up onto the exam table, and tried to call out for someone. My father was in the waiting room, and the nursing staff seemed a million miles away. I stumbled to the door and poked my head out and then the lights all went out. Blackness occurred. Dark, fluid dreams, spattered with bright lights and loud noises floated in and out of my brain. I would hear voices, muffled, as though they were in another room.
According to Dr Butts (yes, that was his name) and my dad, once I opened the door I said "excuse me...." and then collapsed onto the floor. The Dr and my father and a nurse attempted to wake me up. Dr Butts quickly smelled the acetone on my fruity breath and a nurse couldn't get my blood sugar to register on the office meter. Where we lived, 20 miles West of downtown Austin, had no hospitals at the time. Dr Butts had the nurse wheel me To my Dad's Ford Explorer, and I was laid in the back seat. They said my dad would have me to the nearest ER far quicker than an ambulance would. I remember none of this. Dr Butts called the emergency room physician on duty at St David's south and briefed him on my condition. Apparently a stretcher awaited my unconscious self as I was floppy and unable to follow instructions. Once wheeled into a room a brief history was taken and the Drs and nurses went to work. Putting me in a gown, drawing blood, initiating IV fluids and securing ECG leads to my chest and stomach. My heart rate was elevated, my blood pressure was extremely low, and my blood glucose was 680mg/dL. A respiratory therapist arrived with a male nurse to draw my arterial blood gases. And at this point, I awoke. I cursed the men for clutching my arm and wrist so hard. I called them names that would make a sailor blush. I bucked and cursed and I'm sure I was quite lovely in my disheveled state, hair half sticky with drying vomit and eyes ablaze.
The results soon confirmed what everyone suspected: I was in full blown Diabetic Ketoacidosis. I also had a UTI, presenting with a fever and bloody urine. I was admitted to the ICU and placed on an insulin drip, IV antibiotics and monitored with every 4-6 hour blood draws to monitor my glucose levels and anion gap status. The following day, the chief resident for whichever program service had the pleasure of seeing me, stood in the doorway of the small, private ICU room. It was a sunny day and the skies were blue. Austin, TX was a beautiful place to grow up, and exquisite that day. I watched the birds and the people, walking by, parking their cars in the hospital visitors lot. That's when I heard the number. "16...do you hear me? Your hemoglobin A1c came back at 16%...how did this happen? Don't you have an endocrinologist??"....and that's when I laughed and said he didn't care about me.

For many years I believed that. I blamed Dr Ponder for my behaviors. For my week long hospitalization and illness. He was my diabetes scapegoat until one day I decided I was sick of feeling sick. I was leaving for college soon and had to be well, both for myself and for my family. It was as soon as the excess glucose began to dissipate from my teenage brain that I fully began to see the MANY errors in my ways. Dr Ponder was never to blame. He was merely the only one to call me on my bull crap and challenge me. Which made me furious. I can't imagine the level of fun I must've been to treat with an average glucose of 500+ all of the time.

As I made my way through college and then nursing school, I began meeting persons affected by diabetes. Complications and illnesses, disabilities and handicaps. All from uncontrolled diabetes. And the doctors and nurses on the floor would pity these patients. Pity their situation and state of health. It was then I decided I would NEVER be that patient. I wouldn't be the girl in the ICU bed or Dr Ponder's office being pitied or thought less of. I would take ahold of my disease and own every inch. And that I did. At each Endo visit my A1c would register lower and lower. And this is when I decided I wanted to be a diabetes nurse educator.

Working in an endocrine clinic as a type 1 gave me a world of advantages. Patients saw
My experiences as the best "street cred" in the world. I applied one summer to be a nurse at Texas Lions Camp in Kerrvile for children with diabetes. It was the very place I had given my first insulin injection, the summer after my diagnosis. I met dozens of other girls that were also type 1. I was sent a "Welcome" packet and given a packing list. I diligently packed my SUV up, kissed my son, and headed West. The first day on campgrounds are for new Medical Staff to review policies and procedures. We were also welcomed by the camp's medical director, who introduced himself and gave us a background of the camp and the diabetes program. At the first break I walked up to the medical director, who was wearing a hat with a fake chicken on top, and I shook his hand. I said "Hello, my name is Kelley Champ Crumpler, and many years ago....."
He warmly smiled, his brown skin already golden from the summer sun, and said "I do remember you! There aren't many patients that get fired..so I remember you all!..."

And that, my friends, is how a grudge against a World famous pediatric endocrinologist can inspire you to lead a life of serving others with Type 1 diabetes. Diabetes is my ministry, and helping others is my blessing.

Thank you, Dr Ponder. Thank you.

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