A Day in the Life of an Physician

The Story of an Ivy League Doctor
AKA...
(academia disenchantment from the patient perspective)

When I was 18, I went to Yale

Praying the whole time that I wouldn’t fail

For my father is a surgeon, and my mother into psych

I’ve been programmed from the very start what I was gonna like.

Well, I worked very hard and I kept my nose clean

Kept busy in anatomy with hearts and eyes and spleens.

I knew that I could I do it- I knew most everything

And I graduated Mag.Cum Laude to get my classes’ ring.

On graduation day, my very first stop

Was a very exclusive clothing shop

They monogrammed my jackets, and pressed my silk screened tie

And off I promptly went to (3 letter medical school acronym) to apply.

My first official night on call, it truly was a blast

Wracked up twenty-two admissions and an old friend from my past

My resident smokes pot, and I really gotta go

There’s just too much to this doctoring I doubt I’ll ever know.

I kept my eyes open, and I kept my mouth shut

As I learn all the hospital scuttlebutt

I learned who has got the hots for whom

And the nurses hate the techies in the Operating Room.

Derm was pretty gross, saw a Basal Carcinoma

To me, it was anything BUT a Fascinoma

Is it Lyme, or Leprosy, its quite hard to tell

One thing is very certain, though- the patient is not well.

Now its off to Endocrine, the type 2's in denial

Are making it quite difficult to keep my pasted smile

The type 1's need new kidneys- theirs are fully shot

Cuz each was diagnosed with D, a diaper-wearing tot.

Let’s go to Ob-gyn, see some cute, small preemies

Is that a sudden gush of blood that’s making me feel squeemy?

Birth is very wonderful, but sick kids sure do holler

I think I’ll find some other way to make my daily dollar.

Cardio was fun, but as I walked through the door

Old ladies had M. I.’s- man, they all hit the floor

The CCU was full, the chiefs said go away

I lasted one full hour on that sunny day in May.

So where’s my special niche- maybe its in psyche

As I’ve been saying all long, as just a little tyke

My mother gave me therapy, I’ll feel your deepest pains

There isn’t anything, in front of me, for you to be ashamed.

But I think I’ll be a cancer doc- play hard life and death

As the patients look in fear to me, when they can’t catch their breath

I’ll supervise the interns, and attend the M and M’s,

All the time while acting that I CARE about them!

Now I have a fancy office on the very first floor

And the patients come from all around, because they need to hear more

The world, it does my bidding, not the other way around

Those nights spent sobbing in the bathroom seem such a distant sound.

( But there’s more to this sad tale

Then my pen can ever tell

Cuz when you’ve passed, and come up top

And really think that you’ve arrived- 360 to the stop

All of life comes down to this- we all must make the choices

But I am here to tell you, that bigger bucks, and razor red Rolls Royces

Will not stop the clock from slamming down your own blunt coffin nail.)

So be sensitive to your patient's needs.

All Work and No Play....

Gluco-Burst (Artic Cherry)gel is good stuff. Layed in a goodly supply(Krogers had a half off sale), along with various other D supplies. I also purchased 10 candy bars, which no doubt looked pretty weird to the cashier-but hey, its my money.

The blood sugars are doing much better (disaster averted). Still, I've had 4 numbers (this week) below 140, and one of them was a 36. Not a very number-friendly week.

And tomarrow? Tomarrow, I take my logbook to get my diabetes control anylized to the nth degree (by the CDE) Control is not remotely possible, neither is an a1c under 7. Not without a miracle (or continous glucose moniter). I have great hopes that they'll be available soon- one way or the other.(Either I convince the insurance company, or pay out of pocket for it myself) Its more of a war zone out there- and I'm glad some days just to have survived. Every day lived successfully with diabetes, no wonder WHAT actually transpired, is a cause for celebration. Kicked it in the rear once again. My SIL (as a cardiac nurse) sees many young PWD's up on her floor.(making the connection that they took rotten care of themselves) 30 years later, though, if you get cardiac complications who can really say its because of that? D-care has changed so much over the years, and I think I'd be very glad to see my 47th birthday,even if I had cardiac problems. Other things, (like genetics and smoking) count very strongly too. How many of those young PWD's also smoke? (quite a few, probably) Its not just diabetes thats a serious risk factor,but its always the biggie.(one that people look at)

Some bright individual hacked into my Ebay account+ listed a fraudulent item, putting their original email address in the auction listing so people would contact them directly. My regular email was immeadiently flooded with Me-Me-Me (Sell to me) offers for this high-priced Super Deal.
I promptly changed every concievable password, alerted Ebay, and closed down the listing, taking steps to secure my account. And then I emailed the would-be seller(in the hopes that I could get his reg.address + track him down). He didn't spring for the idea, informing me that he could only accept bank-to-bank transfers. I'm kind of dissapointed that he didn't take the bait, I'd like this guy to spend the next 15 years in jail. I'll think of something. I'm not stupid, and he obviously isn't either... I had the strong urge to tell him precisely what I thought of him, but that would be the last I'd see of him.

Thank goodness for a LONG weekend, I'm so glad this week is over. I intend to pamper myself to the gills, my initiary includes:
Friday- CDE appt, lunch at Golden Corral(buffet), shopping trip(Old Navy, Rite Aid, Bath and Body, wherever else), library, reg. doc appointment.
Sat.- Free meal at Chick-Fil-A,(breakfast) see Baltimore (Orioles'?) baseball game with b-friend...do some more clothes shopping on trip back. This weekend is 20% OFF weekend for all TJX employees, so I should be able to get some great clothing deals.
Sunday- Sleep.
Monday-Sleep.
Tuesday-Who knows, who cares-I'm lovin' it.
Wednesday-Back to work.

One Sunday Morning

Its 1:14 AM, my blood sugar is in the upper stratisphere(200-400) and it WON'T COME DOWN. I can't sleep (as the ketones bounce along with the bg, turning my stomach to mush + my throat into a second Sahara). I want to puke(but can't, it takes more then DKA to make me puke).
This has been going on approximently 13.5 hours. I've taken 4 extra shots of Novolog, to get the blood sugar +ketones down + I am now 205, small ketones.
The reason for this "bad D trip"? Extreme stupidity (on my part), I should have never gotten
a naval piercing. (May my mother NEVER read this blog) Funny how many sets I've gone through and never had one, now this. Suffice to say, it doesn't take a rocket scientist to connect the dots(infection=high blood sugars)
It might be true, D's are more prone to infections of this sort, but I didn't exactly take stellar care of the piercing. Regardless, I've changed my mind about having one- I want it out and healed up, navals can take up to a year to completely heal. The next time I decide to get a piercing, I'll just get a second set in the ears...(safer territory)
Next step=doubl(ing) of basal. I should probably call the intern on call, as thrilled as that will make him/her. I need an antibiotic + to clear up this situation but I'd rather wait till Monday to see the doc, if at all possible. Not possible, if the ketone situation doesn't get any better.
Stupid diabetes. (highs make me cranky as heck, in case its not immeadiently obvious)

Reflections upon Diabetes(andJulia's Meme)

Sometimes it all gets overwhelming (this generally isn't because of a bad D-day).
Coworker: "So, Heidi, what DO you spend your money on? You must be loaded-you don't have a family,mortage, OR other things of that nature..."
What do I spend my money on? Copayments for meds, copayments for dr. appointments, a sizeable weekly paycheck cut for that medical insurance, low blood sugar treatments, assorted herbal remedies to assist with managing the D- and all the other monetary struggles of the single working person. Diabetes dictates one's career path, its the primary reason I haven't finished my BD by now.
They say diabetes makes you a stronger, better person. I think, the only (positive) thing diabetes ever did for me was to make me more compassionate towards the health struggles of others. To see the person-not the failures that got them into that situation. Isn't that the heart of true medicine- helping the patient? not blaming them for their disease..
Quote for the Day:
From Disease, I have learned much that Life could not have taught me any other way.
- Goethe
I think I would be a much better person without the diabetes...
(any good effects that may have come from D I could still learn somewhere along life's path)
Thyroid results came back low.

Endo wants me to start taking Synthroid, once again. I was on it once, after the diabetes diagnosis (for about a year). Then (in my infinant teenage wisdom) I decided to stop, remarkably, my yearly tests have been normal. Except this last time. I had the thyroid antibodies at diagnosis, so I suppose it was only a matter of time before I needed it permanantly.
"You'll feel much less tired...and if you decide to get pregnant, its important to have normal levels.."
That's all fine with me- but I don't remember if it affects basal requirements?

Julia's Meme

1. Pretend you're stranded on a desert island. You already have shelter, water, batteries, an abundant food supply that doesn't revolve around coconuts and even a cabana boy/girl to minster to your, erm, needs. However, you need some intellectual entertainment. Give me your top five desert island:
Books
1. I want to go home! -Gordon Korman. (a kid book, but adults like 'em too. They're too funny)
2. Foxtrot(comics)
3. Zits! (comics)
4. Anne Rice books
5. My novel(when I get it published)

Movies
1.Flight of the Navigator
2. Complete dvd box set of ER(seasons 1-12)
3. Ladder 49
4. The Sound of Music
5. The Fugative


Albums (NOT compilations of your own making)
and tell me why these make the cut.
-Just give me a radio..


2. Now, pretend you won the lottery. It's a huge amount, although not sickeningly huge. After you've given away your chunk to charity, paid off all your bills, set up savings/trust funds for kids and self and given money to deserving family and friends, you're left with $5 million, which you must use to build a house. Where would it be? What would it look like? Tell me how you'd furnish it and then describe your first party there.

I'd build it in Switzerland, it'd be a chateau with all the basics of life(private movie theator, spa,pool, etc.) located close to a ski resort. Basically, big. I'd host a weekend diabetes conferance, but it'd all in be in English.(I don't speak French or German...) Everyone is invited, but you'd have to buy your own plane ticket (don't think I'd have much of the 5 million left over).


3. If you could have dinner with five people from history, living or dead, who would they be? What about five fictional characters? What would you serve at each dinner?
Abraham Lincoln
Neal Boortz
Nicole J. Baker
Ronald Reagon (pre Altzimers!)
Winston Churchill

Legolas-he's extroidinarily cute.(Went through a bleach-the-hair phase, when LOTR came out)
Garfield


I'm going to only serve ONE dinner, I hate cooking. Either that, or we'll just eat leftovers the other 4x!
Virginia Ham(Fried)
Corn on the Cob
Baked Potatoes
Chocolate Meringue Pie
Mint tea
4. Describe your least favourite and best characteristics. (are we talking about physical characteristics here?)
Least Favorite- I'm too short.REALLY too short. My 6'4 brother uses the top of my head as a elbow rest.
Best Characteristic- People automatically subtract 10-12 years off my actual age, so I get by with alot of stuff grown-up folks usually can't..lol.(And I'll be carded till I'm 50) I've been told its a wonderful thing to look young, maybe in 10 years I'll totally buy that.

5. And finally, answer James Lipton's Ten Questions:

What is your favorite word? Chocolate
What is your least favorite word? diabetes
What turns you on? Any guy in a silk,striped tie.
What turns you off? Old guys with goatees + ponytails.
What is your favorite curse word? don't curse.
What sound or noise do you love? the wind blowing over a body of water.
What sound or noise do you hate? belching/burping
What profession other than your own would you like to attempt? Journalism
What profession would you not like to do? undertaker!
If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates?
"Well done, good and faithful servant."
(I do believe in Heaven, obviously)

D-blurb(s) of the Week

We take a break from the normal, humdrum, painfully dull, diabetes self- recordings to bring you the latest and best D-Bits from 'round the world. (Yes Julia, I am working on those questions-but they require some major thinking, and it'll take me a few days...)

From the Czech Republic:
Got Islets? Get monitored!

Comments: Kind of interesting, but if the iron just decomposes anyway in the body...no way to moniter the existance of the islets. (Defeating the entire purpose)

The History of Diabetes Forecast:

From this: (November, 1948)















(In the early years, "Forecast" had a blue cover(this made everyone happy + cheery about reading it, as blue urine test=excellent control). Later, they switched to other colors as blue got pretty boring, and eventually, to pics on the front...)

To this: (December, 1998)
















Lastly this:! (June 2006)
















I wonder what it'll look like in 2048, if there still isn't a cure.

Need a Cat? Someone in the UK needs to adopt this sweetie.
I've considered getting a cat (it might turn out to be a great hypo-alert animal), but I don't have the time to properly care for it. (As selfish as that sounds-its true, and if you can't properly provide(food/shelter/medical care) for any animal, you have no business owning one)

CWD's Whats New lists are TRULY exciting reading. Especially the journal articles (exotic research studies), that generally have one of three effects:
A. Sigh, roll eyes, backclick. You knew all that stuff anyway. (it's nothing new)
B. Email a knowledgable friend for an interrpretation- you haven't managed to get past the first two words...
C. Gasp and stare in wide-eyed horror as you learn yet ANOTHER potential D-problem that nobody ever told you about.
I prefer the newspaper articles that tell of PWD's living happy, sucessful lives.

They've changed the rules on Lantus:
So now one could probably safely mix L+fast-acting. If I were on Lantus, I still wouldn't do it. It feels so WRONG, like one of those set-in-stone unbreakable diabetic laws (it has been around since 2001, so its practically that)

Surfin’ DCCT

(With apologies to the Beach Boys and Ray Stevens!)

We’ve a case of the ‘beates, it’s a ‘98
Its got a meter and a pump and its doing just great
We’re loyal to the party, and the party line
But us ‘betics (or PWD's) got to have a little fun sometimes.

We were having us a party, getting nice and drunk
When the leader of the type 1's (a green haired punk)
Keeled over like an anchor, he was trying to show
Half a keg of the best, would not get HIM low.

Now here we be
Surfin’ DCCT
(Surfin’, Surfin’, DCCT)
Hello CCU
As I’m turning blue
Yeah, we’re getting kinda drunk, getting totally layed
C’mon Honey Sugar, tonight we’ve got it made
We don’t wanna start no Endocrine Fight
We just want to smoke and drink and party tonight!

You thought the company exotic when you “did the Dew”
Till you met the charming nurses up in ICU
One prick of the finger, and we all flipped
There’s been a mutiny on board Denial’s Ship.

Let’s you and me
Keep the DCCT
(Keep it, Keeppp the DCCT)
My Hba1c
Is now 5 point three.
Yeah, now I’ll be real good, cuz I don’t plan to go
Up to my endo’s- to watch him blow.
It won’t be all bad, my friend, you just wait and see
A better lot you’ll have when you keep the DCCT.

Weekend Bargains

I'm a bargain hunter-I'll shop for anything. And in this rural community, some of the biggest events of the summer are the town yard sales. There are two of them that everyone (and their cousins) comes to, one was held last weekend, and the next will be held the 2nd weekend in June. I am fortuanate enough to live (now) right smack dab on what will be the busiest street in town, come June 9.
Bicycles, trucks, cars, vans, rollarblades, wagons, buggies, and go-carts will converge on this little piece of nowhere. Hispanics, Russians, Old Order Mennonites, West Va Hillbillies- the air will abuzz with a hundred clashing dialects not soon revisited on any other part of this country.(to my knowledge)
Borrowed a large slab of wood from my folks, that will be one of my main set-up tables. Still need to get some smaller card tables. My mom and I will take turns manning it( one shops for more junk, the other watches).
I got alot of deals on Saturday...
2 NIP zip disks
3 new Home Interior candles
decent pair of steel toed working boots
NIP shoelaces
dry erase (calander)
a Lego building table( which I'll either resell on Ebay, or give as a gift)
cute frog desk organizer
craft stuff
set of 4 quilted placemats
a Pegasus t-shirt
several cassettes
jar of homemade jelly
Part of the fun of extreme yard-sale-ing is figuring out what effect 6 hours of walking will have on your blood sugar. I decided I didn't want to deal with lows, I'd take my pump off and just shoot up for whatever I ate.
7 AM- 150. Ate breakfast, bolused, took pump off.
9 AM- My car being parked over a mile away, I knew I didn't have much choice about discreteness in diabetes care . I needed to test, I might need to shoot up, and I couldn't help it if half the world had to watch.
So, I found a corner, crouched down, and pulled out my little black kit.
A lady stared (trying to look like she WASN'T staring). From that look, I knew she knew I had diabetes + she was worried that I'd keel over at any second. Either that-or I am a drug addict, getting my fix!Her fears were confirmed by a syringe-in-the-abdomen 30 seconds later. Wide eyed horror flashed across her face.(Like "Why is she doing that HERE?!?")Finishing up my business, I quickly exited that yard sale before anyone else could observe this private ritual. (or call the cops) I don't like to make people uncomfortable, but I also don't like being made to feel like a drug addict or worse..
10 AM- I need a snack, so I buy a BBQ sandwich and Diet coke.
10:30 AM- Low.Drain juice, stagger along side of road, thinking about the cruel irony of getting low JUST when the food should be working! Daydream about CGMS's, and catching 99.9% of these things before they happen!
11:30 AM-226. Conservatively shoot 1U.
12:30 AM-156. Finish up yard sales, go home. Eat lunch, take nap. Wake up 210, feeling more like 500, drink 2 liter bottle of Diet Coke.(and half a gallon of water) Must have got slightly deydrated from the exercise.
It was fun though, I just need to better figure out my basal needs in these circumstances.

One Batch Novolog

Ingrediants: (x 10)
100 units Insulin Aspart
16 mg glycerin
1.50 mg phenol
1.72 mg metacresol
19.6 ug zinc
1.25 mg disodium hydrogen phosphate dihydrate
0.58 mg sodium chloride

Mix throughly, do whatever weird funky chemical reactions necessary. Bottle in 10 mL vials.
Sell to unsuspecting PWD's, $85+/vial.

Makes: 1 happy PWD, lasts 10 days-1 month.
Discard remainder.

I've gotta say, there's some pretty weird sounding stuff in there. No matter how safe it may be,its a little bit freaky to think its all being pumped into my blood stream. Especially the disodium hydrogen phosphate dihydrate!
I guess that's why it's so darn expensive...

Up and Down

This hasn't been a good week.
Yesterday, my check bounced the bank, I had to take out a cash advance(on my rent), and the endo's office called me to reschedule a much-needed appointment. My landlady informed me that I'm "breaking" the lease(by not mowing every week) and I'd better shore things up (or July will be Moving Month). I dropped my pump on the concrete floor(at work), its amazing it didn't crack/chip/blow up. And I had another exotic low at work, caught it though. I do not like these new low symptoms. (weakness in legs) I have a mountain of dirty laundry, but haven't had time to visit the laudrymat(along with everything else). And there is nothing to eat in the refridgerator, as I burned the pot of goulash(i.e., a little bit of everything) yesterday evening.
Butttt....
the blood glucoses are really, really stable. That's one good thing. Have only had 1-2 numbers over 200, and two lows since Sunday. Which, for me, is amazing. Usually, when I'm stressed to the skies, bgs follow suit.
More amazing numbers to follow, as I slave over my lawn tonight! My brother has loaned me his mower, but I don't have a weedeater(so I'll either have to pull them out, or use scissors).