My mom drove me to the hospital around 9:30 on Wednesday night. I’m quite sure neither of us had any idea what was going on. That was the thing about the whole Event – the severity sort of snuck up on me. I wasn’t unconscious, for gods’ sakes – and sure, there was the crippling exhaustion and the constant peeing, the dry mouth, the leg cramps, the vision problems, the blood sugar thingie I had just learned about, and that word “ketones”, that my doctor had ominously recited to me…but it wasn’t like I was having a heart attack. I could walk. Frankly, going to the ER seemed, (to my completely uneducated self), to be overkill.
But, when your doctor calls you at 9 pm on a Wednesday night and tells you to go to the emergency room, you listen. And so I walked my baffled self into the ER, mumbled something about “abnormal labs” to the admitting nurse, watched as an ID bracelet was attached to my wrist and I was led to a small bed in the very busy emergency hallway.
I had never been hospitalized before that night, and certainly never been in an emergency room. My previous trips to the hospital had been confined to visiting elderly relatives – a grim, challenging experience most can probably relate to, but not one that could have prepared me for being a patient myself. I kept waiting for a doctor or a nurse to come over, look me up and down, and wonder out loud why I was there before announcing that I was clearly fine and I could leave. Maybe someone would even run my blood and declare there had been a horrible mistake at the doctor’s office – someone had spilled a packet of sugar into my urine or confused my blood with some other poor sap’s – not only did I not have to be in the ER, I actually didn’t even have diabetes. I pictured myself generously forgiving the doctor’s office for their invasive and embarrassing mistake, but not before accepting compensation for my pains. I considered how much I would ask for in a settlement. $50,000? Maybe I could hold out for $100,000.
While I plotted how I would spend my malpractice earnings, some incredibly talented nurses inserted IVs into my right and left arm, and then, I suppose for good measure, inserted another into the back of my hand. I don’t even recall it hurting, which, considering how dehydrated I was, is a pretty impressive feat. It clearly takes a special kind of person to work an ER – what a complicated, insane, fascinating, terrible, wonderful place it is! I could write six or seven plays just about the things that go on in an ER. There always seem to be about a tenth of the doctors and nurses necessary to deal with all the patients, which results in a good deal of waiting time, which allows you to really do some great (grim/upsetting) people watching.
Rather than divulge the medical happenings that I overheard about a group of strangers who didn’t exactly ask to be written about on the internet, though, I will instead offer my top tips for a trip to the ER. For those of you who have been to the ER, none of these tips will be revelations – and for those of you who have avoided a trip so far, may you continue to do so! In case it comes up, though, a few things to consider:
- Bring your phone. However, it’s a 50/50 shot that you’ll have service. Which leads me to tip #2:
- Make sure you’ve downloaded at least 1 good App that doesn’t require wireless. My god, if I’d had Spider Solitaire on my phone that night… HOWEVER, since you’re likely to be waiting (and Spider Solitaring) for many hours, that leads me to tip #3:
- Bring your phone charger. Dear god, bring it. Nothing is worse than watching the percentage drop lower and lower, and wondering when a visitor/savior will arrive with a charger. (Unless your phone dies before you can text your request to someone who can bring you a charger. THE HORROR). Should you play another game of spider solitaire or should you try to preserve the last drop of juice so you can make a call tomorrow? Unless you’ll be out by tomorrow? When are you getting out? The charger makes all of this phone strategizing and worrying unnecessary… HOWEVER, the likelihood that your stretch of ER hallway will have access to a PLUG is also unknown. Maybe you’ll luck out and be right by one. BUT MAYBE YOU WON’T. Which leads me to tip #4:
- Bring a book. Or a magazine. And no, not your kindle or iPad. Given the scarcity of plugs, as well as the likelihood that you forgot your chargers to begin with (I mean, you’re going to the ER, you’re not exactly in ultimate “packing mode”), it’s nice to have at least ONE thing that you can do that’s not dependent on a battery. Unfortunately, in the confusion of the moment, I’d brought nothing to the hospital. In retrospect, if I’d had even a takeout menu in my purse it would have made for decent ER reading.
- No segue into my fifth tip, but probably the most important (and least necessary, considering I can’t imagine anyone but myself would make such a critical error): DON’T TAKE OFF YOUR SHOES AND SOCKS. My god. In my confused haze, I remember taking off my shoes and socks as I lay on the bed (to “be more comfortable”, natch), which worked just fine until I got up to use the ER BATHROOM and had to pad down the ER HALLWAY in my bare feet. IN MY BARE FEET. I arrived at a bathroom, pushed open the (unlocked) door, only to reveal a woman without pants making a poop on the ER toilet. How do I know it was a poop, you ask? Don’t ask. You asked. Her body was contorted weirdly and obviously it wasn’t going especially well and basically I COULD SEE IT. I COULD SEE IT. DEAR GOD WHY. In shock, I opened a second bathroom door, which was mercifully empty, and proceeded to wander in IN MY BARE FEET, traipsing across all the mystery fluid the floor contained. WHAT WAS I THINKING.
Despite my paltry lack of reading material, my rapidly dying cell phone, and my severely contaminated feet, my time in the ER passed in a blur of confusion. Stand out moments (besides, obviously, watching a very sick woman defecate in a super contorted way because she’d forgotten to lock the bathroom door) included anytime a doctor, nurse, or resident came to check in with me, take more blood, or begin drips. How nice they all were! Literally everyone I interacted with in the ER had both the looks and personality to anchor an NBC drama about ER workers. Seriously, these people made Clooney look like an ugly poser.
At 3 AM, another handsome doctor arrived by my bedside to explain – finally explain – what was going on with me. And to my great shock, he did NOT start by apologizing on behalf of the hospital for the confusion and send me on my way with the promise that a lawyer would contact me tomorrow for my malpractice settlement. The blood was mine, and it was diabetic. And, just as my doctor had fortold, it had something swimming around it a lot worse than glucose – ketones.
“You’re in something called diabetic ketoacidosis,” he said, and I nodded sagely like I had ANY idea what he was talking about. Sure, whatever, just give me the pill I need to take and get me out of here so I can figure out what is even happening. Too many new words today. I’m lucky that I got that pricky finger thing figured out.
Somewhere around “your system is malfunctioning,” I began to pay attention. Oh, maybe this was a bit more serious than I had contemplated. I must have asked him to repeat himself, because he started again. I was very sick, it had gone on way too long without treatment, I was lucky that it hadn’t progressed far enough that I’d fallen into a coma, and I needed to be admitted to the hospital right away. I was headed straight to the ICU and hopefully “within a few days” I’d be out.
And now, for another educational gamebreak:
DIABETES 102: DIABETIC KETOACIDOSIS
OK, so the basic mechanism of insulin and blood sugar: you eat carbohydrates, they turn into glucose in your bloodstream, and then your pancreas makes a nifty little hormone called insulin which gets that glucose into your cells so it can use it for energy that you need to, well, live – move, talk, jump, dance, play spider solitaire, whatever.
“Blood sugar” means the amount of glucose circulating around your bloodstream at any given moment. If you’re not a diabetic, your blood sugar, if you haven’t just eaten, will be anywhere between 70 and 100. If you’ve had a meal (and eaten carbohydrates, thus adding to the glucose in your bloodstream), it can go up to maybe 140. But eventually your pancreas will make enough insulin to sweep this new glucose off to your cells for energy, and get the number back down to that sweet 70-100 range.
What was happening to me? Well, for some reason, the cycle wasn’t working. The food that I was eating wasn’t heading to my cells. Instead, it was building up and up and up in my bloodstream as glucose – hence the blood sugar reading of 500 that was measured in my doctor’s office. This, in turn, sent my kidneys into overdrive – in trying to filter out all the excess sugar in my blood, they reacted by flushing it into my urine. And that, my friends, explains the constant peeing, and the resulting dehydration (which caused the dry mouth and the charley horses).
However, the most obvious problem that was being caused by this interrupted cycle wasn’t the peeing or even the dehydration. It was energy. If I wasn’t getting any energy from glucose, where was I getting my energy from at all? Essentially, how was I even still alive?
Well, the truth was, I wasn’t getting much energy – hence the constant exhaustion. However, our bodies are insane machines with a lot of tricks up their sleeves. Unable to access energy from food, my body turned to the next best source – itself. It began breaking down my own fat, muscle, and liver cells and using those for energy, instead. Between this self-destruction and the constant filtering of almost every calorie I ingested into my urine, it was no surprise I was losing weight so quickly. The problem, unfortunately, with the whole “eat yourself since the food’s not working” system is that it produces a toxic byproduct – called ketones – which leeches into the blood. Ketones are chemicals which, when released by the body in its effort to eat itself for energy, slowly poison the blood. You know acetone, that stuff in nail polish remover? Also found in ketones.
Ketones = bad.
Untreated, diabetic ketoacidosis can lead to extreme dehydration (check), extreme weight loss (check), that whole poisoned blood thing (check), metabolic/electrolyte “derangement” (check), coma (gulp) and death (double gulp).
(Note: if you’re wondering about my craving for fruit juice, that’s an interesting one, too. It’s certainly not a symptom in everyone with DKA, but it actually makes a ton of logical sense. Sugar – especially easily accessible sugars found in juices – are some of the most instantaneous sources of energy that there are. Meaning, they convert into glucose in your blood faster than almost anything. My body, starved for glucose (it was in my blood in spades, but sure wasn’t getting to my cells), was desperate for it. The idea that it would send me cravings for the most immediate and extreme source of glucose there is is actually pretty brilliant on its part. Nice try, body. Nice try.)
So. All this is what I know now. Fortunately, it was not what I knew then. Then, all I knew was that all three of my IVs were soon activated with different drips (at the time, they all looked like “clear” – I now know that they were insulin, saline, and glucose…. Wait, uhm…maybe? I think? It blurs), and then I was being whisked away on my little ER bed to my own private Intensive Care Unit room where what seemed like four nurses were suddenly upon me, covering my body in EKG stickers and hooking me up to far, far too many machines.
People kept hinting how bad it was – and I know now how bad it was, but honestly at the time my main concern was how I was going to pee when I was literally tethered to half a dozen life-monitoring machines. Remember, I was still in my constant peeing phase. And, of course, there was that voice inside my head that was suggesting that this could still possibly be some kind of huge mistake, and the hospital lawyer was going to come in in the morning, apologize for the hospital’s misdiagnosis, and present me with a clean bill of health and a check for… oh, $200,000 for my pains (hey, I’d been admitted, my price was going up).
I can’t remember if the ICU nurse that first night was actually named Athena, or if I just named her that in my head because she appeared, as a goddess, at all hours, seemingly out of thin air, all compassion and gentleness (and with the magical ability to detach me enough from my machines to make it to the creepy half-toilet that came out of a closet in the side of the room.)
Oh yeah, and then there was the potassium. Somewhere between the ER and the ICU, someone jimmied one of my IVs to a small clear bag filled with potassium. “This one can burn a bit,” I remember they said before they put it in.
I almost laughed when I heard it. “Warning, this might hurt”? As though I had to be introduced to the concept of pain? I thought of the dozens of wasted glucose test strips as I prick prick pricked my clotting fingers, hearing “It’s diabetes”, the looks on my parents’ faces, the text I’d sent to my boyfriend that morning (“It’s the thing I was afraid it was and I don’t want to talk about it”) and “this might burn a bit” somehow seemed like the least of my worries. Please. I can take it.
SPOILER ALERT: I COULD NOT TAKE IT. If you have never been on a potassium drip before, THANK WHATEVER GODS YOU PRAY TO. The potassium drip is a special kind of evil. It feels like liquid fire pushing straight into your veins. I remember the ride from the ER to the ICU was a vile plagueground of burning burning BURNING and by the time I made it to the ICU I was begging Athena – the nurse, the Greek Goddess, really whichever one would listen – to make the pain go away. Which she (Nurse Athena, perhaps encouraged, in a spiritual sense, by her namesake Goddess) – actually kinda did, by turning the rate of the drip all the way down, to almost infinitesimal slowness. Wouldn’t that just prolong the pain, you ask? I will respond to your question with a question: Would you rather hold a lit match to your tongue for 4 hours, or stick your head in a campfire for 2? [The correct answer, of course, is “neither”. You would rather NEITHER.]
And oh yes, one more memory from that first night in the hospital – one of the ER residents, right before I was whisked away to the ICU, visiting my bedside and smiling apologetically in a way that people had taken to smiling at me the past day.
“We ran some tests,” she said, “and it’s looking like it might be Type 1.”
Type what now?