Wednesday, January 30, 2008

250.03

WARNING:
The following post may be long and rambly!

I firmly believe the mind and body respond in ways that are completely entwined in our psyche. I think I now realize why fear grasps me, before I see this particular doctor.

Yesterday, I enter an extremely crowded waiting room, where the man at the front counter next to me makes a terrible joke. The receptionist tells him politely that Dr. A is very behind in his schedule. The man replies, "So does that make his Indian name, Running Late?" I think, he has to be nervous too!

I finally got back into a room, and the nurse takes my dreaded blood pressure. I hold my breath, and the automatic blood pressure machine breaks, while it is trying to inflate. I hear a retching sound next door, when someone grabbed my nurse and stole her away, while trying to get me out of the cuff. "He's throwing up, HELP ME!" another nurse yells and the commotion in the hall escalates.

I sat there, watching my arm turn blue, as I'm trying to restore circulation, and it hit me. The reason WHY I hate this office so much. I flashed back to sitting in the busy waiting room, engaged in my habit of people watching. Two amputees, one apparently fresh, with all of the billowy white wrapped around what's left of his leg. One blind woman was accompanied by her daughter, as well as many older couples with plastic bags filled up completely with medications. Then there's me. In heels, dressed for work, looking much younger than my age, and feeling quite well. I'm sick, but not. That could end up being me. I don't belong here. Suddenly, I wanted to tap my heels 3 times, and pray it will take me home, like Dorothy.

Then the nurse came back. This time, she manually took my blood pressure, and pricked my finger. 5.4.3.2.1..246. Crap! Not how I wanted to start this. She weighed me, made notes and rushed out of the room. Right behind her, a strange doctor entered, and he did not bother to introduce himself. He was curt, got the facts and exited. Then he quickly came back in with my doctor. Interns. Rotations must have just begun, because their was an intern at my last weeks DR.'s visit too.

I won't detail the entire visit, but I have to note that my doctor took way longer than 15 minutes with me, and even with his busy day was pretty jovial. I wonder if that was for the benefit of the intern. Call me a cynic. I did not ask about the pump and I totally chickened out. I was showing him my bruises on the back of my arm, and complaining about the shots, when I was quickly scolded about shot placement. "Why aren't you using you stomach or hips? You don't have enough F. A. T., and therefore don't get good absorption there." What? Totally caught off guard, and a little defensive, any good approach of a pump was forgotten.

Basically, he changed my insulin ratios, and I have to relive the torture in a month. Not what I was hoping for. His last words as I walked out the door were, "Don't forget. CALL ME if you have any problems, I'm here." I picked up my FMLA paperwork (3x I've forgotten about it), and I was somewhat distressed when I left for the lab downstairs. I looked at all the tests he was running, and noticed the code had changed. 250.03. Type 1 diabetic, presenting with no complications, UNCONTROLLED.

My head and heart just fell, for a moment I thought about ditching the lab and running to my car. In one hand I had the FMLA forms, to officially verify that I am chronically ill. In the other hand, a list of blood work to quantify how "sick" I really am. 250.03 and any one of those people with complications in the waiting room could be me. Sneaky and quietly, the diabetes could steal away all those things I take for granted and depend on. Reality sometimes seems surreal. How did I get here? When did this start? AND WHY, WITH ALL THE ATTENTION AND CARE I HAVE BEEN PLACING ON MY D, WAS I NOW DECLARED UNCONTROLLED?

I know my A1C will probably still be bad, since it hasn't been that long since the DKA. I now wonder, what other problems they will conjure up out of those little tubes of blood. I can't believe how hard I'm taking this. I cried last night, and was close to tears all day today, even though I KNOW nothing has really changed since Monday. Seeing the reality of how this disease can ravage a body is daunting, and visiting the endo is like admitting that one day, I could fall prey to those dreaded complications. I left feeling defeated and still unaccomplished since I didn't even ask about the pump.

Interestingly, I came home from work this afternoon, with pen needles and boxes of strips greeting me at the door. I had to laugh. It was odd, that laughter. I think in that moment it was like God was reminding me I had tools to take care. It gave me a small bit if solace and I recited the serenity prayer to myself. I am so lucky to have family, insurance, tools, and a team of health care professionals to aid me in keeping my health good, but I know I will never really be satisfied until THERE IS A CURE.

7 comments:

Amylia said...

250.03. Type 1 diabetic, presenting with no complications, UNCONTROLLED


What a label. I hate labels. I don't think diabetes is ever "controlled" really, just managed.

I'm so sorry to hear about your visit. I hope you advocate for yourself--I too need to bring up the pump on my next visit and I'm not going to let the Endo drop the topic with me!!!


Good luck!

Mandy said...

Thanks Amylia!
I hope your pump efforts go WAY better than mine! Maybe next time, you can accompany me to my next appointment. I need a little bit of your fire I think!

Araby62 said...

Sounds like the worst possible doctor's appointment experience ever. Sheesh! But at least the doc was good to you. The most important thing, though, is that you went, you got yourself checked out, and you're doing something about it. So many people don't even do that much.

I too think the universe was definitely trying to tell you something with the strips/pens. The best any of us can do is hang in there and take it day by day. Hope you have a better time over the weekend. Take care!

Jeff said...

Hi Mandy.

Gotta agree with Amylia on the "labels" thing, and I'm not so sure I understand the whole point of defining a patient as CONTROLLED, UNCONTROLLED, OUT OF CONTROL, CONTROLABLE, or IN CONTROL. What is that going to do for someone's health?

I want health professionals to simply evaluate me and suggest a workable game plan.

Have a great weekend.

Mandy said...

Hey Jeff!

I agree labels always get people into trouble, but at least this time it will feel good to prove him WRONG!

Bernard said...

I hate that code and it's description. FWIT, that's just the standard text for the code. Personally I think it should be changed to "Person with type 1 diabetes and no complications. Control is normal given the lousy tools they have to manage it"

I've had this box checked on my summary many times and I really like my endo. Allison told me about a new web site called Vitals.com that helps you find doctors. Maybe you can try that out and see if you can find a good endo.

Also, I just finished reading the book How Doctors Think. It's very instructive and an easy read. Maybe looking at it before your next visit would help you.

Don't forget this guy is working for you. You can fire him and move to another doctor. You can tell him to shut up and listen to you. Don't let the little idiot push you around. (I wanted to use a much nastier pejorative term!)

I hope your next visit goes much better.

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