She races in the back door at 11:00 p.m., heads straight for the bathroom five feet away and shoves her head in the toilet just in time. He came in a few moments behind her, an unopened bag of Zofran in his right hand, receipt attached. As I hurried to help her, I hear him say, “She’s been puking like that the last two hours.” I could tell.
The three of us stand in the back hallway as if to catch-up like normal, and I notice he’s struggling. His face steeped in a quiet anger that didn’t have anything to do with diabetes, and everything to do with her response to the first time she’s been punched in the gut since her diabetes diagnosis, and one other thing I’ve forgotten already, but at the time it was something I was proud of and he wasn’t. How he was feeling wasn’t right or wrong, but it was a big enough distraction that made him take his eyes off our most important task; help her manage diabetes and always remember the black-and-white basic rules of care. It could happen to any one of us.
As soon as he left, I sprang into sleuth/superhero mode and started ticking off the boxes, going back to basics, trying hard to push away how I felt about why I had to do it in the first place (sloughing off the baggage).
“Have you checked ketones?” No. (Ugh, Don’t react.)
“Did Dad give you Zofran?” No. (Uggghhhhh! Don’t react)
“Can you pee for me?” I think so.
“You need to check immediately.”
She did. They were Large. I quickly went for the puke bucket (yes, we really do) and tissues while she headed to the couch to inject the amount of insulin needed to battle Large Marge ketones. I got back just in time with the bucket for her to double over it. She looked at me with dread as I handed her a dissolvable Zofran and Gatorade. I opened my Dexcom Follow app to check her BG trend from the last 12 hours. She was now somewhere in the high 200s, and I couldn’t make sense of it, thinking she must have had ketones a long time because her trending didn’t at all reflect her activity, which was atypical.
“When’s the last time you ate and what was it?” Grilled sausage. An hour maybe.
“That must have been gross.” Nod.
“Was it some super spicey thing, or?” No.
“Did you eat at band rehearsal?” No. Couldn’t.
She doubles over again, retching. We’re in trouble.
“Did you eat at camp neuro today?” A little, but I don’t know.
This is when she started doing this jerking, rocking motion.
Raising voice: “Hey, talk to me! ARE YOU HAVING A SEIZURE?” No.
I asked this because if she could answer me I’d know she wasn’t.
“Why are you jerking like that?” Because. My. Stomach. Hurts. So. Bad.
“Like how bad?” Never felt before.
Alarm bells. She’s a puking professional, but this was new territory.
“Do you need to go to the hospital?” Silence.
I called her dad who was now at his house, put him on speaker so my husband could participate, and started laying out the situation, the three of us, right in front of her. There was no judgement, just a play-by-play factual account of the last 24 hours, which is hard to do when you have a child that’s practicing leaving the nest, driving herself to events, work, and doing the two-house bounce. We have less and less control every day, and have to work extra hard to make her stop for just one damn minute, to stand in one place and give us details of her hours, of her days.
Calmer now: “Pip, do you need to go to the hospital?” I don’t know, I don’t know.
More herkie jerkie. I say to the guys, “Let’s talk this through.” We go round and round about which one of us would go to the hospital, the impact of stress on ketones, better details from the time she was at the other house, and if she had any ill symptoms.
“Hey, Pip, do you have any symptoms?” No.
“What do you want? Do you want to go to the hospital?” Indecipherable mumble.
(We are practicing her making these decisions – for when it’s really all in her court.) She didn’t say yes, and I am almost convinced a trip is not warranted. It’s now 12:30 a.m. To the guys: “Okay, let’s do this. Let’s call in.” We agreed and hung up, with a plan to talk again. I reach the doctor on call and quickly paint a picture of the situation, telling her when she did this and that and how she does the two-house bounce. I also let her know that we are puke professionals. Surprisingly, this took some convincing! At 16 years in! (with dedicated bucket, no less.) Ketone strips are used so frequently they live on the bathroom sink.We know our kid, we’re over five years in, and are smart enough to check in when we’re on the fence, or if we have differing opinions. She likes hearing this, which makes me believe she hears her fair share of ex-bashing.
Tip: Stop ex-bashing. It doesn’t get you anywhere!
Running a situation by a Endo doc takes the decision away from one of us spending the other’s money!
If the Endo says, “You better come in.” money becomes no object and it wasn’t any one persons’ decision so there is no possibility of blame (speaker phone saves the day). That person would nearly always be me, but in another person’s house, it could be the one who feels less confident in handling a scary situation on their own.
An ambulance is called if an ambulance is needed, or when you just KNOW. Ya know? Knock wood, we haven’t had that experience. The doctor says,”Let’s go over the food. An empty stomach for too long causes ketones.” Light bulb glares brightly overhead, illuminates smacking of said head.
“Oh, duh. We’ve never encountered the not-eating-for-days thing! Okay then. We’re good!”
I tell her we’ll come for a drip if we can’t get anything in her. More speaker phone convo. Nibbles and sips turn into big bites and gulps. Bullet dodged. In a family that deals with managing diabetes (and teenage angst) in a two-home family, all it takes is one person to grab hold of a situation and run with it. In a family that deals with managing diabetes (and teenage angst) in a one-home family, all it takes is one person to grab hold of a situation and run with it. We’re not so different after all. On most things.
Distraction causes you to lose your head, and the basics you know. I can still say STFU to the devil on my shoulder who insists on me being mad at her dad. Brushing off that devil (more like a shove) feels freeing. If her response to a shocking experience is to not eat, she’s likely to do it again. Not everyone is like Lorelai and Rory Gilmore who reach for pints and spoons when life gets painful. Control over what/when/how our kid eats is truly no longer ours to have. A teenager who eats ALL THE CARBS, ALL THE TIME can immediately stop. I was shocked by this! 24 hrs of little-to-no eating causes vomiting and grows ketones. Or it grows ketones and causes vomiting. Since I’m not a doctor, I put that one into the chicken or egg category. You know, she really may have wanted to land in the hospital. I’ll probably only know the truth when she’s in her mid-thirties, reminiscing about the heck she put us through! This is why I believe maintaining the patient/therapist relationship is important. Maintaining relationships between houses matters most in these moments, too. All parents around a speaker phone makes all parents involved. It still works for us.
“All it takes is one parent to make a difference.” Our pediatric psych told me a long few diabetes years ago, if one parent is in the kid’s corner, that is enough. One parent is enough. It may sometimes feel like UTTER GARBAGE to her, and to you, but its enough. Set down your baggage, or shove the devil off your shoulder, or whatever.
Be the one.