Tuesday, August 25, 2009

What NOT to Say About My Kid

Jenna routinely sees a physician about once every three months as part of her diabetes management. These are mainly just check-ups during which her log numbers are reviewed as well as her current pump settings. Diet issues, if any, are discussed and a HgA1c is done. The majority of these appointments have been with pediatricians. Twice a year we see her endocrinologist. This is likely the same routine most diabetics follow~ at least type 1, pediatric diabetics.

About six months ago a new diabetic clinic was set up at our local hospital with new funding obtained from the government. The clinic was staffed with a Diabetes Nurse Educator, a dietician and two pediatricians who, I was told, have considerable experience with type 1 diabetes. This meant that the original pediatrician, the one who saw us in the emergency department for Jenna's initial diagnosis, would no longer be Jenna's attending. A new pediatrician was to take over Jenna's care.

Our last appointment nearly two weeks ago was the second one we have had with this new doctor. Prior to actually seeing the doc, our nurse took us to perform the standard, preliminary height and weight check. It was noted that Jenna is tall for her age (something she gets exclusively from her 6'4" father), growing one inch since May and has gained 1 pound since her previous appointment; all good things. We then sat in a conference room with our nurse, the dietitian and an observing pharmacy student, having, in effect, a care conference on Jenna. Her log book was reviewed and the usual praise for how well we are doing was received from our nurse. The dietitian asked if we had any questions or concerns with regards to diet and carb counting. I explained, as I usually do, that I have a good handle on Jenna's diet and how to carb count and that the only thing I am working to perfect is how to handle fatty meals as they tend to creep up on Jenna long after the meal is consumed. I explained that as a result of this, I seldom provide meals containing excessive amounts of fat as it is a)healthier to eat a low fat diet and b)easier on Jenna and us to keep the fat down and not to have to check her multiple times in the night to battle a stubborn, delayed high.

During this portion of the appointment opportunities are presented to discuss concerns and praise is offered to reinforce our efforts and hard work for maintaining good control over Jenna's blood sugars. Compliments regarding how polite and lovely our girls are are expressed and graciously received. In summary, I am given the pat on the back I don't know I need until I get it. It's hard work trying to stay one step ahead of this disease 24/7, especially when virtually all of the leg work is up to myself and my husband to perform. Jenna, being only three, doesn't do much yet with regards to the daily tasks of managing her diabetes. Oh, she can get out a test strip (often popping the cap and flinging all the strips unceremoniously hither and yon for me to have to pick up) and insert the strip into the meter. She can even prepare the lancing device and press the OK button to administer a bolus. And occasionally she can recognize a low for what it is and sound the alarm. But that's about the extent of her involvement. So these "Sunshine-Up-The-Butt" appointments are a bit like gas in the tank for me.

Enter our new pediatrician; a woman probably no more than ten years older than I with a stressed expression on her face. She flips through Jenna's log book, making a comment about how all the numbers make her head swim. This doesn't exactly instill confidence in me regarding her abilities to interpret log data. She then leaves the room while our nurse takes us to an examination room where the good doctor, we are told, will join us again momentarily. Within a couple of minutes the doc arrives once again on the scene. By this time we have been in the clinic for over an hour and my girls are feeling a little restless. Jenna amuses herself by repeatedly sitting up and lying down on the examination table enjoying the crinkly noise of the white paper that covers it. This was an obvious source of annoyance to the doctor and she showed her impatience by asking Jenna to stop, making some mention of her coffee not having kicked in yet. Not necessarily the worst thing in the world, but it was a little odd. Not long after, she reprimanded my oldest daughter when she pushed herself up on the counter in the exam room to get a paper towel from the dispenser which was otherwise out of her reach so that she might wipe her hands. Again, this isn't necessarily jaw-dropping, but at this point I'm wondering why this doctor got into pediatrics if she doesn't have patience for children displaying normal, child-like behaviour.

She then conducted a brief physical examination of Jenna. Sensing her shortness, James suggested that he take our girls back out to the play area when it seemed she no longer required Jenna's presence, while I wrappped things up with the doctor. When it was just myself and the doctor present, she offered up some half-hearted praise while she looked at papers in Jenna's chart. Then, upon spotting Jenna's documented weight, punctuated her token approval with "...she's a little chunky..."

I stared at her unsure, at first, of how to respond and in disbelief that a professional would use such a term to describe anyone, let alone a three year old little girl that is tall for her age and to anyone with eyes, most definitely NOT chunky. She had just performed a physical exam! She palpated her little abdomen! She must have noticed the absence of "chunk"!

And I became angry.

"Are you implying that my child has a weight problem? Because I may have to get my back up!" was my initial response.

She must have sensed that she had awakened a ferocious beast because she began dishing out compliments in an effort to put out the fire she so recklessly started.

"She's doing fine. I'm just saying that we should be alerted to a possible weight problem. Don't worry." she replied as if that would make me feel less offended.

"I'm not the least bit worried. I can't believe that you would say such a thing about a toddler who is still in the process of shedding baby fat and who is already at greater risk of developing an unhealthy relationship with food and a distorted self image by virtue of the fact that she has diabetes; not to mention the fact that she is a female who will enter into a society that has cruel and unrealistic standards of what is considered beautiful. With such disorders as diabulimia and anorexia plaguing young women with diabetes, I'm disappointed that you would be so careless."

More compliments and praise were expelled like so much water on a blazing inferno. But it was too late. I had already made up my mind that this would be the last time we would see this physician. And when she asked me if I was attempting to offer Jenna a low fat diet, I was incredulous and explained that if she had been present for the meeting with the nurse and the dietitian she would realize how ridiculous that question was. She quickly withdrew it.

I spent the rest of the afternoon trying to quell repeated surges of anger each time I recalled what she said in my mind, telling myself to just let it go.

Diabetes is just as much a physical disease as it is a psychological one. This disorder can play havoc with one's head. I am making every attempt to raise healthy, happy, self-confident, well adjusted little girls. I want to surround Jenna with kind, sensitive health care professionals who aren't going to bring their shitty personal crap to work with them. I'll be damned if I am going to take the chance that some thoughtless, short-on-patience, fat-phobic doctor will make a stupid, careless remark with regards to my child's body that would sabotage my efforts to meet that end. Because the next time this doc decides to let her lack of sleep, patience or tact get the better of her, Jenna might still be in the room.

"Doctor... you're fired."


Crystal said...

Good for you!!! Way to take a stand. I applaud you for this.

Great blog. You are a great mom. Any parent of a T1 has their hands full. Again, you are a Great mom. Your girls are blessed to have you!

PancreasMom said...

I have goose bumps that run both arms and in fact up my back at this moment reading this. You are amazing and supportive, and correct! There is no reason to ever see that dr. again because she is wrong, about so much, and being tired is not an excuse!

Jenna is lucky to have a mom who holistically looks at her care and truly loves her and watches out for her... and you are her best resource! When you need support, find it elsewhere... the last thing you need to add to your trunk of 'pancreas parenting' is irrelevant worry about a non issue!

(Perhaps she had her eyes closed and her training in type 2 and forgot where she was!) I would let the clinic know why you won't be seeing her again... new clinics especially will want to know.

You are a great mom and I salute you!

Lee Ann Thill said...

Wow, that doctor needs to work on her bedside manner for sure! She doesn't sound like a pediatric specialist. She sounds like she was pulled from some other department because I agree that a pediatrician, caffeinated or not, should have far more patience for and understanding of children.

As for the "chunky" comment, I would try to put it out of your mind. None of the other health care providers with whom you've interacted regarding Jenna's care has said anything about it. Like you suggested, I think that doctor's issue with chunkiness has more to do with her than with Jenna.

Your concern that the doctor could say something to undermine your efforts to have your girls feel secure in their bodies would be my concern too. Children remember certain comments, interactions, events, and you never really know which ones are going to stick with them and which ones aren't. You wouldn't want a doctor's off-handed, thoughtless, uninformed comments to be what sticks with Jenna.

You've set a marvelous example for other diabetes moms by calling that doctor out, firing her, and like PancreasMom said, looking out for far more than just Jenna's BG's and carb counts. It's one thing to master those nuts and bolts (which *I know* is already enough work!), but really working on the mental side of this disease is something that gets undervalued far too often based on much of what I read and hear.