April 1st - Misadventures in Hypoglycemia aka Anson Pulls A Fast One

As some of you may already know, Anson has diabetes, the insulin dependent type. Beginning January 1^st we became enrolled in private healthcare coverage. I can’t say for sure about Anson, but for me this was the first time in my adult life that I had the ability to privately purchase coverage. It was due to this new coverage that we sought a new healthcare provider, who in turn placed Anson on a new delivery method for his insulin. Well, May 30^th we both worked too late, forgetting to take care of our basic needs. According to his mother, ever since he was born, Anson has been a night owl. But this particular evening the sun was beginning to show itself before Anson closed up his studio and came inside to ready himself for bed. Being the end of the first quarter, I had tax deadlines I was focused on and remained on my computer as he retired. Normally he takes his insulin upon waking but with his schedule a bit “off” he decided to take it before going to sleep to keep it closer to a 24 regime. I told him I would be coming to bed right behind him. He puts on a movie from Netflix and I hear him doze off.

I worked for another 15 minutes or so before I notice his snoring is crazy loud. Somewhat amused, I think, “Wow, he is really gonna have a sore throat when he wakes up!” And I continue to file the Sales & Use Tax report I had just prepared. Within the next few minutes I hear his breathing change from vigorous snoring to something strange, like shallow gasps. I stick my head around the corner into the bedroom and can tell from the doorway that he isn’t okay. Experience tells me to run to the kitchen to find easily consumable carbohydrates, which I urge him to swallow. No response. I quickly test his blood.  A normal reading is roughly 120. The human brain needs at least 70 to function normally and anything lower than 70 is critical. His glucose level was 35. As I am dialing 911, I run out to open the gate to our property so the medics can drive right up. I tell the woman on the phone our address and explain the emergency; he has low blood sugar and needs a shot of glucose, that he is unconscious. She gives me instructions on how to position him and says help is on the way.

I pace as what feels like the longest 8 minutes of my life stretched on.

Finally I hear the sirens approaching and head to the front door. Two young men spring from the ambulance and open up the back tugging at the gurney. I tell them not to bother with all that, “He just needs the glucose! Please hurry!” This wasn’t the first time I have had to call them. Sure, I was anxious but I knew from before that as soon as they gave him the injection he would be fine within seconds. But what they did once the medics were bedside caught me off guard. As they asked about allergies and other medications, they started an IV in his arm. And then out came this enormous plastic bulge of solution. It had to have been an entire liter! I queried them, “Where’s the shot?” He has gotten a shot before. It always worked. They explained it was a glucose solution and that one can’t push that much fluid into someone’s arm without giving their body the chance to absorb it. It was indeed taking quite a while...Like 15 or 20 minutes. There was no dramatic regaining of consciousness, where Anson asks why these strange guys are in his bedroom and we all have a good laugh in relief. No, nothing like that.

After a ridiculously protracted administering of the clear liquid came a rather flat, “Well, that didn’t work. We are gonna have to take him in.” Wait, what? I wasn't prepared for this. I wanted to stay with him “No, ma’am, due to CoVID protocols you can’t ride along. We'll meet you at the ER."

Stunned, I gathered together a set of clothes, and put them into a bag with some shoes. Before I left the bedroom, I noticed the pen of insulin on the Anson's nightstand. Instinctively I grabbed it and then flew out the door to the local ER.  My parents met me there. It took some time before I was allowed to see him but as I was being escorted to where he was being treated the staff person asked me if I knew he had been intubated? No, I didn’t. And was I told that he was being prepared for emergency transport to a facility in Las Vegas? No, I wasn’t. “We had to sedate him in order to intubate him and we just aren't equipped to deal with a patient on a ventilator.” Is he alright? We don’t know yet. I was permitted to stay by his side until the helicopter arrived, weaving my way through electrodes and tubes to grasp at his tape-covered hand. I managed to stifle any vocalization of my grief but there was no curbing the flow of tears.

I never stopped searching his face for a flicker of recognition; or waiting for a squeeze of the hand; any indication that he was aware I was there. I never found any. The medical technician who would be attending him during the 60 mile flight, kindly allowed me to walk out to the landing pad with them as they hoisted the stretcher into the chopper and clicked his safety straps in, pulling thick black nylon straps snugly against his body. I stepped onto the rails of the helicopter and leaned in to kiss his forehead once more before the door closed and they lifted up into the air. I stood there alone, in an expanse of grass and asphalt and watched the love of my life recede into the horizon, into a tiny black speck and finally disappear. The gravity of it all was oppressive and grew with each step I took back toward my car. When I finally was inside the vehicle, clutching at the steering wheel like it was the only hold I still had on reality, I screamed. Not with my voice, but with every fiber of my being. My fears finally came out in one great expulsion of energy. He was not leaving me this way. We had only been married a year. We were still newlyweds.

After I calmed down a bit, I pulled that insulin pen out from my pocket. It was only the second time he had ever used it. I didn't know how much was there when he started but it was half empty now.  It should've been a month's supply...That must have been what happened! He accidentally took too much insulin.

Let me just say that after several days in a Las Vegas medical center’s ICU, I found that rather than getting answers, we only had more questions. They had long since stabilized his blood sugar, but now there were concerns about his cognitive functions, his ability to breath on his own, and a low heart rate. But then, they said, most of those concerns could be the result of the sedation he was under. Not one to pass up the low hanging fruit, I suggest the obvious; that they stop sedating him so we can tell if he is alright or not. (I was still waiting for one of those signs from him that would indicate to me that he knew I was there.)  At that point they informed me he had developed some internal bleeding, the source of which they were unable to identify.  If they took him off of the sedation and ventilator, they said, his lungs could possibly fill up with blood. I called his parents to let them know the situation but as much as I was permitted, I simply stayed by his side; even sleeping in the car in the hospital parking lot the first night. 

That last night is when the superhero in Anson emerged to do the unimaginable. In the early morning hours, despite sedation and restraints, he managed to pull out the tubes which had been inserted down his throat himself. As it turned out, the injuries to the back of his throat were the source of the internal bleeding, sustained almost certainly when he was intubated. I couldn't have been happier when I walked toward his room and saw him through the window, alert, sitting up without any tubes. He smiled at me and motioned for me to come close to him. I was thrilled, and exclaimed, "You're all right!" He leaned forward and pulled me in closer, to whisper something to me. I didn't understand at all what he had said. So I asked him to repeat himself.  He spoke the exact same sounds, but they weren't English words. I felt my elation starting to slip away while I tried my hardest to keep a smile, praying that my face not betray me. He said those same things a third time, now with more emphasis.  My panic must have been evident at that point because with a quick dismissive gesture he flashed a devilish grin and said, "I'm just kidding!" and grabbed me, pulling me onto the hospital bed where we laughed and embraced, reveling in the moment I knew I no longer needed to worry!

I thought this is perfect, I get to take him home now. Instead, we waited. And waited. With lunchtime came an orderly who brought a single tray of typical hospital "food". An hour and half later they came back for the tray. Several hours passed with no medical staff ever once visiting his room, which I thought was odd for a patient in ICU. Eventually I sought out a nurse. She told us that the managing physician wanted a full cardiac workup on Anson and we were actually waiting on a cardiologist to become available. When pressed they admitted they had no idea when someone might be able to come by; it may not have even been that weekend! I recalled aloud, “The cardiologist that was here last night who said Anson’s heart was perfectly healthy and strong? The same one who said all of his EKG’s were normal?" Because you are diabetic, the doctor explained, I would like to exercise an abundance of caution.  Couldn’t this ‘abundance of caution’ be exercised on an outpatient basis? I asked. Apparently not, unless we left against medical advice. Seemed more like an invitation than a threat to me...and so we did!

We are still waiting to see a specialist about getting a subcutaneous glucometer implanted which sends high and low thresh hold alerts to our cell phones. We are still dealing with the billing and insurance of a balance which exceeded a quarter of a million dollars. How did a straightforward case of hypoglycemia spiral out of control like this? Charges like $1800 for “speech therapy” on the date the Las Vegas medical facility received him, unconscious and with a tube in his throat!  I am really curious what sort of speech therapy he could have possibly received. But hey, at least we had insurance. We haven’t yet started paying off the deductible but the good news is that we met our max out of pocket expenses. We won’t have to pay any more than that amount. By far the best news of all is the fact that we still have Anson Maddocks here with us! I for one, celebrate this fact in my own quiet (and sometimes not so quiet) ways each and every day!