Sunday, December 18, 2011

Intensive Care

So I started turning over this new leaf during a month with a very easy schedule, allowing me to focus most of my energy on my little diabetic tasks. But this past week, I started working in the Pediatric Intensive Care Unit and am finding it increasingly difficult to maintain the hardcore regimen I started (granted, by "hardcore" I mean four on-time readings per day, as I had previously been doing none).
The reason for this isn't because I'm falling off the wagon. I am very aware that I need to stop and do a reading and go get food...whereas before, I would simply not think about it because I had ignored it for so long. But when my patients need an order for a medication, or a parent is calling me to the bedside, or I have to go down to MRI to oversee sedation...I put those tasks first. And when I'm finished them, I find myself in such a rush to make it to the mandatory noon conference that the glucose reading gets lost in the shuffle.
The irony of it all hits me sometimes...working so hard during the day to take care of my patients but putting my own health on the back-burner. Several of the people that have treated me over the years (Endocrinologists, diabetes educators, etc) have heard this and compared it to the old airplane safety warning that instructs parents to put on their oxygen masks first and, only after they have their mask on, aid small children. But this issue at work is a small part of my larger problem with diabetes, in that the danger doesn't feel imminent for me if I wait a few hours to do a reading or bolus my insulin. However, if I ignore the patient who needs his respirator settings changed or who is screaming in pain and needs morphine, the consequences are felt fast and strong.
So this week I pushed through it all as best I could. I carved out more time to take care of me, without sacrificing patient care. Hyperglycemia hasn't been the issue lately because I have been taking such good care of myself. But now, I have to worry about the lows. It happened just last night while on-call. We were doing "night rounds" in the unit, which entails going from bed to bed and reviewing the patient's chart and changes for the day. A group of the on-call residents, fellow, and several nurses work together throughout the night rounds. I was starting to feel hypoglycemic but we were half-way through so I started thinking that maybe I could stick it out instead of interrupting the rounds to go check my glucose and get some juice. Then I realized that if I didn't take care of it, I wouldn't be clear-minded enough to take the best care of my patients and keep track of the changes we were making. So I announced to the group that I had to go check my blood sugar, and then left. No one made it a big deal, everyone supported it, and they were shocked with how quickly I returned with my juice in hand. It really wasn't a big deal, but could have been had I handled it differently.
In conquering my old challenges (ignoring readings and being persistently hyperglycemic), I find myself coming across many new ones (many more episodes of hypoglycemia secondary to my better control, finding time to do it all). But I'll conquer those, too. One at a time.

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