Tuesday 29 April 2014

Running out

I think of myself as a very secure person.  I endure a lot of stress at work, and despite sometimes overwhelming circumstances, I always manage to keep my cool.  I'm not trying to pat myself on the back by saying that, I assure you.  You don't want your trauma surgeon panicking.  Ever.  However, I keep my personal and professional lives separate, and I have no problem panicking outside work.  Here are a few things that can make me lose my shit:
  • snakes
  • swarms of bees
  • centipedes
  • sharks
  • running out of milk
Don't act so surprised to see that last entry.  When I see that the milk carton is almost empty and I realise that we don't have a backup carton in the refrigerator, I freely admit that I approach full-blown panic mode in exactly 4.1 seconds.

What will I give my children?  Water?  Juice?  Beer?  Ok fine, but when can I get to the store?  Should I just buy a cow?  Is unpasteurised milk safe?  What the hell is homogenisation anyway?  And what the hell will I put in my cereal?  AAAAH!!!

If that's my reaction when I run out of milk, imagine what my reaction would be if I were to run out something really important, like a medication.  I'm not talking about aspirin or ibuprofen here, I'm referring to medication that prevents you from really bad stuff like, you know, dying.  I like to think most reasonable people with an IQ higher than that of a cabbage would actually be worried about running out of medication, especially when it's something as necessary as insulin.

I guess Carla's IQ falls somewhere below "cabbage".

Carla (not her real name) came to the hospital when she was no longer able to stand.  She was pale, sweaty, and weak, and her blood sugar was off the chart.  No really - it was so high that the meter didn't go that high.  Her blood was dangerously acidic, and a test of her urine showed not only that her kidneys were spilling glucose into her urine, but ketones as well.  The emergency physician appropriately diagnosed diabetic ketoacidosis, a potentially fatal complication of diabetes which can happen when blood sugar gets and stays dangerously high..

"But wait, that's a medical condition, Doc.  Why the hell did they call you?"

Damn it, I was getting there.  In addition to being half-dead from diabetic ketoacidosis, she also had a tummy ache.  And as we all know, everyone who has abdominal pain needs immediate surgery . . . or so this particular emergency doc apparently thinks.  I suppose he missed Diabetes Day during his training or else he would have learned that abdominal pain is a frequent symptom of diabetic ketoacidosis.  Regardless, he ordered a full workup including an ultrasound and CT scan, both of which were shockingly normal.  And despite the normal results he called me.

"What exactly would you like me to remove?" I asked him.

He stared at me with empty eyes.  I've seen smarter eyes on a potato.  Needless to say I did not schedule her for surgery.

Two days later her blood sugar was under control, her abdominal pain had vanished (amazingly without any operation), and her medical team sent her home.  Before she left though, I asked her why she had stopped taking her insulin.

"I just ran out and didn't feel like getting more."

I tried to comprehend the words coming out of her mouth, but they made no damned sense in that order.  It probably didn't help that I knew I had to stop by the store on my way home and was reviewing my grocery list in my head.

Any guesses what was #1 on the list?


  1. Was Carla her real name??

  2. Replies
    1. Were you getting milk or insulin? Hehe.... running out of OJ is worse in America. WHAT WILL I DRINK IN THE MORNING????? There have been fights in my house over who gets the last glass.

  3. Carla's (NHRN) story reads almost like an attempted suicide by inertia. Interesting.

    Just a note to say how much I enjoy your posts. I found your blog recently and look forward to each new update.

  4. My primary care physician thinks I'm weird when I call for a renewal on my scripts two weeks out when I'm using the last refill. I've told him "Well, gee Doc, I'd hate to get busy in the next two weeks and forget to ask for the renewal and then have to wait for the whole process in the meantime I've now run out of meds and am starting to suffer the consequences of not taking the preventatives that keep my horrific migraines somewhat at bay..but I guess if it's such a hassle I can wait next time and I'll ask the ER staff to call you specifically when I show up there twice in a week because my brain has decided it hates me."

    He no longer questions me..and has started giving me more refills and larger supplies for each fill.

    1. The doc thinks you're weird for being careful to ensure you have your medicine?? I think the doc is weird!

  5. I always have two cartons of UHT milk at home in case I run out of fresh milk and for some reason can't go to the store the same day. It doesn't need to be refrigerated and keeps for about half a year prior to opening. It doesn't taste as well as regular fresh milk, but it's better than having no milk at all.

  6. Unfortunately I do run out of medications, in part due to the mail order service the insurance insists I use. Right now I'm fighting with them, they are holding my order hostage because I cannot/will not pay full price for brand-name Singulair, even after the doctor wrote "dispense as written" on the 'script.

    There is a miscommunication between the insurance adjuster, who approved the brand-name use, and the mail order pharmacy, who, for whatever reason, fail to get the message.

    1. But that's different than "I didn't feel like getting more." So, so different...

    2. My mail order service isn't much better. They sent one of my scripts to San Juan, Puerto Rico---it was supposed to come to Rhode Island. And they made me wait for it.

  7. I have a story for you, Doc, fresh from the ED at the hospital where I work.

    I was talking to a tech who works in the ED, and he said last night a woman came in with a blood sugar level of 1000. He said they kept noticing sugar, I'm not sure if he meant the little sugar packets or actual grains of sugar. Regardless, they discovered she had a stash of raw sugar in her bag and was consuming it every time that they left the room so her sugar would stay up and they would give her more Vicodin.

    Never a dull moment

  8. I don't… I just… I can't… WHEN YOU HAVE A LIFE THREATENING DISEASE YOU TAKE YOUR MEDS, GODDAMNIT! Even a vegetable knows how to keep itself alive when you let it stay in the ground. Merciful jehu. But then, I suppose we should count ourselves fortunate. Not everyone gets to see natural selection at work. Too bad the potato doctor intervened. She might have qualified for a Darwin Award.


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