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Published On Jan 18, 2017

Clinical Care

The Patient Between

A women with diabetes struggles to be heard in the emergency room.

Just in front of registration for the emergency department, I lost the power to stand. “My blood sugar is really low,” I said, crouched like a gargoyle clinging to some edge. “I need glucose. Please.”

A well-controlled type 1 diabetic for 12 years, I had always been able to correct my low blood sugars with a few glucose tabs. The pancreas normally calibrates the hormones needed to lower and raise the blood sugar down to the molecule. But people with my form of diabetes must test our blood sugar and make adjustments many times a day. I’d been both lucky and diligent. But eventually, something fails.

Today brought that moment. Waiting in that Chicago hospital, my hands shook and my mouth went dry. During the past hour, I had scarfed 20 tabs, down to the bottom of the bottle, and then two granola bars. My blood sugar still would not stay level. This was what people meant when they say that type 1 diabetes is manageable until, suddenly, it’s deadly.

A nurse guided me to a bed and tested my sugar. “Seventy,” she said. “Not bad.” I told her that it would drop again quickly, though. Unconsciousness or a seizure could come. “Do you usually get insulin through pills or injections?” she asked. I told her I used an insulin pump. “No pills?” she said. These were vital lost minutes.

“Sorry,” I offered, body shaking, as she inserted an IV, a doctor arriving behind her to ask about my history again. “I think I’m a little panicked,” I said. I meant: Of course I’m panicked, given the monstrous gravity. I regretted saying it right away.

“Yes, a little adrenaline,” said the doctor, glancing sideways to the nurse as they swept out the door. “We’ll get the saline going soon.”

Saline? I must have heard wrong. Surely, they knew I needed glucose.

Through the glass, I watched her retreat. A doctor wearing a scarf over his scrubs brushed past, waving off well-wishes from the nurses for a good weekend.  Muted by the glass divide between us, they joked and smiled.

“Here’s your saline,” said the nurse at last.

“What about the glucose?” I said weakly, still hoping through my haze that the sugar was on its way.

Suddenly my husband was over my bed. As a doctor, he knew the right words to get the nurse bustling down the hall. “Quickly,” I finally pleaded.  

The doctor materialized at the door, brows furrowed. “You want glucose? You know you might go high, right?”

“Yes, please,” I said, holding down a bestial scream. “Now.”

I got the glucose, and overnight I slowly recovered. Later my endocrinologist would tell me that the stomach virus I’d just recovered from had probably thrown my system for a loop, limiting my body’s ability to absorb the carbohydrates I consumed. I learned to watch for this post-viral effect—another lesson in this disease’s brambly path.

But I wonder where else we went wrong. I understood vicariously how hard it is for doctors to zigzag among bleeding wounds and broken limbs. It’s too easy, perhaps especially for female patients with less obvious symptoms, to be discounted as overwrought. It didn’t help that I apologized for my body’s desperate adrenaline rush as I lay there on the brink. But I had articulated the danger; I assumed I would be heard. I assumed my clinicians understood the urgency of hypoglycemia. I assumed I would be saved. But the reality is that as a woman, as a patient, as a diabetic, sometimes that kind of trust is a luxury we can’t afford. Sometimes, even half-gone, we have no choice but to rescue ourselves.

Before I left the next morning, I wiped away my smudged mascara, combed through my matted hair with my fingers, tried to look presentable. As I walked toward the exit, the doctor called out that my blood sugar had dropped to a dangerous 33 towards the end. “I’m surprised,” she said.

“Thanks,” I said—standing again, for now.

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