!Prescribe money
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agk's phlog
31 August 2021 @ 0150
---
written on x61 in the garage while Evy sleeps
after a hard ride in the remnants of Hurricane Ida
---
> In case studies, I manufacture a composite patient
> and invent a name. They cannot be identified.
Administration shut down the med-surg floor and
cancelled surgeries. They moved us elsewhere because
of the shortage. So I've been on progressive tele-
metry. Progressive is a step down from intensive
care for people too sick for the floor. Telemetry
means they're on continuous heart monitoring.
Chase was admitted for diabetic ketoacidosis (DKA).
His blood sugar got very high (>800). He didn't take
rescue insulin in time to get the glucose safely in
cells where it could be metabolized. Instead his
cells starved. His glycogen and fat stores lysed into
more glucose---and ketones. His blood became acidic.
His brain couldn't handle it and checked out. He
peed and vomited a lot. His heart beat fast. His
blood pressure tanked.
His kidneys made it through and he was sent up to us.
We hung electrolytes (KCl, MgS), sugar water (D5W),
and an insulin drip. He got off clear liquids and
got a meal tray. He was hungry and protein/calorie
malnourished.
This could really be anybody post-DKA. Dig deeper
with hospital patients, though, and a critique of the
normal catastrophe in which we live emerges.
Chase's pharmacy is in the hospital, but he lives at
the edge of the city. It's a three hour walk each
way. The walk would be murder on his neuropathic
legs and make his heart beat too fast. It's
hard to keep his prescriptions filled. That affects
his decisions about when to use his rescue insulin.
He was diagnosed with diabetes and epilepsy as a
child in the foster system. Before the epilepsy was
diagnosed, it was treated as a psych issue. He was
loaded up inappropriately on neuroleptics by the old
child psychiatrist at the psych hospital where I
work---who has since rightly lost his license.
One foster mom broke his forearm, hand, ribs, and
lower leg, but he persisted and grew up through
other houses. He slowly weaned off the psych meds
through middle and high school. Medically complex
kids aren't something most foster parents want.
He was a boy of intense special interests. He chall-
enged himself with computer programming, energy-
transfer martial arts, and research on very specific
topics. He talked at length; well-organized lectures
about his interests. He had sensory issues, partic-
ularly light and temperature. He had flat affect.
You're reading this thinking, "Chase is autistic!"
Yeah, so, nobody cared to diagnose it. He had that
early psych stay and the epilepsy diagnosis. He
ended up with the shit end of the stick. What sounds
to me like sensory overload was recorded as grand
mal seizures. His behavior was diagnosed as ADHD and
schizotypal. Resources he might have had and the
possibility of a more positive identity never came
his way.
Some years he had dozens of DKA hospitalizations.
He got neuropathy in both lower limbs---"like
crushed glass under the skin" of his feet, "like
thousands of ticks biting" his legs. He graduated
high school. When he aged out of the foster system,
he recommitted, which got him rent and transport-
ation money. He got jobs, but they were hard to
keep due to sensory issues and diabetic neuropathy.
Living on his own, he knew how to cook to support
healthy blood sugar. That's how he wants to cook.
But like the pharmacy, Walmart is far and the bus
expensive, so he often ate from the convenience
store. He had asthma but started smoking to camo-
flage his hunger.
He took dozens of trips through the ED and ICU with
DKA in the last year, after losing his recomitting
income because he was arrested for stealing food
during a diabetic emergency. His tooth enamel
eroded from vomiting. Brushing or flossing chips it
more. Two DKAs last year damaged his kidneys.
I asked him to imagine himself in good health and
tell me what would be different. "I'd have $400/month
for food," he said. "And $40 for the bus. Maybe $60.
$60 would make it easier to get back home." I encour-
aged him to expose bigger dreams to me. "I want to go
to culinary school and be the first diabetic chef on
the food network," he said.
Medicaid pays thousands for each hospital stay;
probably well over $100.000 in the last year. I wish
the doc could prescribe money. He'd live in good
health for a year, on the cost of one hospital stay.
He could go to college on the cost of two per
semester. He could work without the risk that getting
fired could kill him.
I'm certain he'll use any opportunity he gets to do
something amazing. If he can afford health and
college, you'll see Chase on the food network before
his 25th birthday.
