That one resident

It took about a year to resolve all the outstanding bills from Paul’s birth.

I had foolishly hoped that, since this particular hospital stay was quasi-routine (I mean, so many people have babies, right?!) the billing/payment for it would be straightforward. It was anything but. It started out normally enough: we got a bill that seemed to be for the “room and board” portion of the stay, then a bill that seemed to cover the delivery, then a bill that seemed to be for Paul’s care.

Here’s a cute baby photo because it’s about to get real insurance-y and boring.

But then the bills kept coming. They were so random, too—just for totally nonsensical, unpredictable amounts. $483 to the hospital. $825 to the physician’s practice. $5,467 to the hospital, again, this time under Paul’s name (but didn’t we already pay that?). $17,699 to the hospital. Under my name.

At a certain point—I think between $825 and $5,467—I stopped blindly paying them. Instead, I tried to find time (between the not sleeping and the walking 15,000 steps a night and the howling baby and the desperately trying to pump and the looking on amazon at all hours for a way to buy myself out of the mess I was in) to check the paper bills we were receiving against the long, confusing list of EOBs on our insurance company’s portal. Hadn’t I already paid that $483 as part of the $978 I paid back in March? Why was my insurance denying over $16,000 in charges from my labor? Wasn’t there some kind of “out of pocket maximum”? Shouldn’t that kick in… at some point?

The truth is, I’ve spent an appalling amount of my life working with/researching/trying to understand insurance, and I still don’t. Which is of course, the point. If you told me my insurance company was running a long con where they just re-send the same bills to exhausted new parents every week for the first year the baby’s alive, I’d 100% believe you. But if that’s the con they tried to run on us, our insurance company got too reckless. Even at our current maximal level of exhaustion, a number like $17K was way too high to blindly pay.

I wasted a lot of time complaining at the outright injustice that there isn’t an assigned person who exists solely to handle insurance battles for new parents. That should be a job. Someone should do that job. Instead, it was me, holding off as long as I possibly could on paying anything—till we started to get letters from the hospital delivered certified, with proof of receipt sent back to them—about our outstanding debt.

If you’re interested (lol why would anyone be interested?) the main issue seemed to come down to the fact that we committed a major cardinal sin of insurance and pregnancy—changing providers during the pregnancy. Of course, that was not our choice; Stefan’s employer changed providers, but we, the subscribers, were punished. This seemed to create a massive battle between the two insurance companies over who would pay for what, especially because the hospital made the insane decision to bill EVERY. SINGLE. ULTRASOUND that I had while pregnant—from July 2019 through the day of delivery, February 27, 2021—in the same invoice.

At one point it literally devolved to me calling one of the insurance companies while a representative from the other insurance company silently waited on hold, like the way we used to prank call each other back in 8th grade. When the first insurance company told me on the phone that a certain charge was the second insurance company’s responsibility, the thus-silent representative from the second insurance company spoke up, scaring the shit out of the first representative and delivering a major “mike drop” NO IT IS NOT ON US speech. It was pretty exciting, if you find insurance battles exciting.

OK, believe it or not, the point of this post is not to complain about insurance. Lord knows I’ve done that enough. I actually started this post intending to discuss something slightly less tedious, hopefully? And that’s the resident. The one resident.

And to talk about the One Resident, I have to talk about the fingersticks. See, over the course of my year-long billing saga, I became very familiar with the various bills that the hospital seemed to be randomly sending me. Some of them even had an itemized breakdown explaining exactly how they reached their absurd totals. Which is how I learned that, while in the hospital for Paul’s delivery, every time a nurse came in and announced she “had to check my blood sugar,” the hospital added $45 to my bill.

Forty five dollars. For a single fingerstick.

So here’s the thing: when I was in active labor, I was on an insulin IV. It’s best practice and I was happy to do it. After I delivered him, though, maybe because I was at a more “progressive” hospital, the doctors conceded I would be the best person to manage my own blood sugar. I wore my insulin pump, dosed myself with insulin that I brought from home, and checked my own numbers.

Unfortunately, that didn’t stop nurses from randomly showing up at odd hours—maybe 3 or 4 times a day?—and announcing that they needed to get a fingerstick for “their” records. Which was stupid: since they weren’t giving me insulin, (in fact I never saw a single endocrinologist in my entire time in the hospital), why did they need to know what my blood sugar was? What would they do with that information? Nothing?

So they’d come in with these enormous, laptop-sized glucometers, bust out their one-size-fits-all finger prickers (I’d beg to be able to use my own, a request was occasionally granted), take my blood and wait for a number to come up. Then, based on what it was, they’d make a pronouncement about how good or bad I was at managing my diabetes and head off. Cha-ching. $45 added to the bill.

Seriously. Hospital glucometers are enormous.

For the most part, I was pronounced “good.” See, pregnancy wreaks absolute havoc on insulin needs— specifically, the placenta does. During pregnancy, the placenta secretes more and more hormones which can double, triple, or even quadruple your daily insulin requirements. But once’s it’s out, those higher needs almost immediately disappear. It was, frankly, thrilling to be able to quickly change my pump from the “preggo” setting I’d had to set up while pregnant back to “basal 1,” my “normal,” non-pregnant setting. In the hours after delivery, the nurses nodded proudly at my readings of 93 or 81.

The day after, however, was a different story. See, here’s the thing: for 9 months, my focus had been ON MY BLOOD SUGAR. Thanks to dire warnings from pretty much everyone in the medical world about the damage I could do to my baby if my blood sugars were out of range, controlling my blood sugar became my number one focus, all day, every day. I thought about it when I woke up, when I went to sleep. If I was afraid I was going to go out of range overnight and Mickey or my CGM wouldn’t let me know, I’d set random alarms for 1 AM, 3 AM, 5 AM just to check. Everything I put in my mouth was subject to intense scrutiny. By the end of pregnancy I was wound pretty fucking tight about it. (Too tight, as I’m sure my poor husband would agree.) Food was no longer joy, or even sustenance. It was a trial. The stakes were too high.

And then, suddenly, they weren’t. Suddenly every single benign or banal food, movement, medicine, or life choice I made no longer directly threatened my child. I could eat a peanut butter M&M without collapsing from guilt. If my blood sugar was out of range, that wasn’t ideal, but it also wasn’t life or death. It was fucking awesome. It was that first moment after taking off a very heavy backpack. It was the first sip of water after days of thirst. It was an exhale.

So yeah. The day after labor, my blood sugar sucked. And I wish I could say it was from eating a celebratory pizza for the first time in months—I did do that on that second day, but my blood sugar was fucked much earlier after the terrible, god-awful hospital breakfast they served me. I think I ate a piece of crappy white toast or something and I just spiiiiiked. And even though I felt that initial sense of fear and panic, I then realized with a beautiful exhale of relief that it was OK. The stakes were no longer quite so high.

The baby was out. I was holding him. He was no longer swimming in my crappy, glucose-ridden blood. I didn’t have to soak myself in an exorbitant amount of insulin to limit every second I spent high. I could afford to be a little more conservative. I corrected, but it wasn’t with the frantic urgency I would have felt the day before. I corrected, trusting that I’d get back to normal soon.

ah yes, the foundation of any good hospital breakfast.
(Sorry guys, I don’t really have any good photos from this period; I feel like I’m really padding this post with a lot of stock footage.)

Most unfortunately, that was the moment that a random nurse walked in and announced she needed to “check my sugar”—again…. why? To what end? Suddenly terrified to have her see a shitty number, I started to babble: “It’s gonna be bad! I just had a spike! I’ve already corrected. I know what I’m doing!” (I promise, I PROMISE I know what I’m doing!)

I think I was about 275. “Oh,” she said, looking down at the number, clearly un-used to seeing such a high number. To my great relief, she shuffled off without commentary.

My blood sugar was tested several more times throughout my stay, always randomly and following no logical pattern I could figure out. It was always “in range.”

Paul was born Thursday night. Friday morning was the Blood Sugar That Shall Not Be Named. Saturday, we were told we’d be cleared for discharge in the morning. The morning came and went, and we were not cleared for discharge. A passing nurse told us our exit had been pushed back to noon. At 1 PM, another nurse came by to apologize for the delay. There was apparently one resident who hadn’t “signed off” on our discharge. We figured it was a paperwork discrepancy and rolled our eyes at the tedium of bureaucracy.

Around 2:30, though, we learned that the issue was not as simple as a missing signature. Instead, it was about The Blood Sugar That Shall Not Be Named, all courtesy of those “pointless” forty five dollar fingersticks. See, apparently that single reading had reached That One Resident, and her refusal to sign off on our discharge was not an error. It was intentional.

She popped into the room in scrubs, looking healthy and eager and young, so fucking young. I mean, like, probably uses Tik Tok young. She sat down and pasted on a look that I think she wanted to read as Gently Concerned, and told me that she wanted to talk to me before letting us leave. She had seen my high blood sugar reading from the day before.

“I need to know that I can trust you to take care of yourself when you get out of here,” she said.

Um… WHAT. We were literally being kept from leaving because I had a single blood sugar reading in the 275s and a 24 year old who I would bet our entire hospital bill knew as much about type 1 diabetes as was written about it in one paragraph Elaine Marieb’s Human Anatomy & Physiology Textbook had decided I COULDN’T FUCKING TAKE CARE OF MYSELF?

That’s the one.

I KNOW MORE THAN YOU, I wanted to say. HOW ABOUT YOU TRY FIXATING ON SOMETHING WITH LIFE-OR-DEATH INTENSITY FOR NINE MONTHS AND THEN GETTING YOUR FIRST BREAK EVER? What attending doctor was this chick trying to suck up to at my expense? Did she have ANY idea how Type 1 diabetes worked? Like, any idea at all? Do all non-endocrinologist doctors actually think Type 1s manage to keep their blood sugar between 80 and 120 all the time? Are they actually that stupid? Also, what did this chick actually think she was going to do? Keep me in the hospital forever? Teach me to avoid all blood sugar spikes forever with a pamphlet written in 1985?

I felt such a preposterous, exorbitant wave of rage that I couldn’t even speak at first. My mouth just dropped open and I saw white. It was such a patronizing, out of touch response from someone who I was positive knew literally nothing about my disease but somehow had the power to keep me from being discharged from the hospital.

Months later, when I saw this gif, I felt *seen*.

Of course, because I’m ultimately terrified of confrontation and authority, I didn’t express any of said excessive rage. I launched into a long, maudlin, and I guess ultimately convincing speech about the emotional trauma of keeping everything under tight control, the lack of sleep from Paul’s first night earthside (cluster feeding, motherfucker!), and the natural adjustment period after the massive hormonal surge of childbirth. I basically begged this person who looked like she was born in the year 2000 to pwetty pwetty please let me leave.

In the first few months of Paul’s life, I thought back on this moment quite ruefully. What delicious irony that we were almost stopped from leaving the hospital because the staff didn’t trust I could take care of myself. Uh… what about the literal human baby we had just created? They just let you take those out, you know! Like, you just walk out with them and you have to somehow keep them alive and no one stops you and makes sure you know what you’re doing. For the first few months of his life, when I was pretty sure I was going to unintentionally kill him, I wondered why every single doctor at the hospital hadn’t refused to discharge us for being utterly freaking clueless about being parents. How strange that the stopping point was my disease. Not the baby.

We did not receive this pamphlet. I think I would have liked it.

In the last few months, though, I’ve thought back on this moment with a different attitude. I’m curious, mostly, about where all that catastrophic rage came from. Because ultimately, wasn’t the resident just being thorough? I mean, sure, I’ll maintain stubbornly that she had no idea what she was talking about, and her bedside manner was too patronizing to be effective, but theoretically her behavior was appropriate. I was just a patient who she wanted to see thrive. She was just showing that she cared, right?

No one said that to me the first time I was hospitalized. Isn’t that funny? The first time I was hospitalized, it was because I’d gotten diabetes. And people said a lot of things to me: they told me that I needed to lose weight, that it was probably Type 2, that it was probably my fault (you can read that whole saga here), that if I was really good I could reverse it. That it could be Type 1 but probably wasn’t. That I needed a visiting nurse and to talk to a social worker and to see a nutritionist. That I needed to memorize sliding scales and correction rates.

But no one actually sat down, looked me in the eye, and said “Listen. We know this overwhelming. There’s a lot of stuff coming at you. But it’s because we just want to be able to trust that you can take care of yourself after you leave here.”

I would have liked it if they had.

Was that the source of my rage with That One Resident? Not, fuck you I know more about this than you do! or How dare you presume to understand my disease! or Can you just give me a break?

But: Where were you six years ago?

Where were you those first few weeks after the hospital let me go?

Where were you for the worst lows?

Where were you when everyone else stopped keeping my care at Top of Mind, went back to their lives, but I still had to deal with this, all day, every day, every single second of every single day?

Where were you for the last 9 months?

See, I think I wasn’t angry that she was butting in. That she presumed expertise or patronized me. I was angry that she persisted in the fantasy. The fantasy that she understood what it was like to be me. That she could fix it. That she could ease the load.

Because I think, 7 years in, that the worst thing about type 1 diabetes is how incredibly lonely it is.

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