This day a meeting was scheduled to take place at noon — an IEP meeting to assess how the school is doing at addressing Jenna’s needs in school. Both my husband and I were present along with Jenna’s teacher and the student support teacher. The meeting went well. I was able to voice my concerns about the fact that no one in the school has been trained to give life saving glucagon to Jenna in the event of a severe hypoglycemic episode. We were informed by the public health nurse before the start of the school year that the school is not permitted to give insulin or glucagon. For reasons that are all too obvious, I have grave concerns about this policy.
The support worker understood my point – that it is imperative that someone at the school is trained to administer glucagon. He too questioned why this is the policy. In an effort to demonstrate the steps involved in giving glucagon I reached into my backpack that contains, at any given moment, my laptop, a few books and a large makeup bag with an extensive array of back up diabetes supplies inside (no makeup, whatsoever). This includes, but by no means is limited to, a glucagon kit. I always have it with me. I keep it in an old rigid eye glasses case that used to house my glasses, before my laser eye surgery. I haven’t opened the case to gaze upon the prefilled syringe and accompanying ampule of glucagon powder in months. But today I did.
This day was all about the worst-case scenario. I went into detail about what can happen during a low and when it is the appropriate time to give glucagon. I noted out loud that our glucagon was expiring soon and J and I both agreed we would have to pick another one up at the pharmacy. I then carefully placed the glass syringe and ampule back into the case, closed it and returned it to the makeup bag, grateful for another year that we didn’t have to use it.
Fast forward to this evening:
It was around 7:00pm. The girls had just had baths and were enjoying a hot chocolate before bedtime. I was working at the computer desk and J was snuggled up with the girls in the living room. We live in a new, rural townhouse development with quiet roads that are only used by locals.
It was Jenna who first noticed the black SUV sitting right in front of our town home unit.
“Why are there cars sitting outside?” We all turned to look out the living room window at the black SUV sitting, engine running and brake lights on. Another car was trying to maneuver around the SUV in an attempt to get by. It was a little strange to see a car running yet stationary in the middle of the road with the driver at the wheel, making no attempt to park or continue driving. Just sitting.
We kept our eye on the vehicle for another four or five minutes.
“What the hell is this guy doing?!” J finally said.
“Go out and ask him if he’s okay” I replied. I wasn’t thinking this guy was in any need of medical help. In all honesty, I thought maybe he just needed some directions. But then J said he could see his hand on the steering wheel was moving up and down repeatedly.
“Okay. That’s a little strange” I said. Now it starts to cross my mind that this person may need medical assistance of some kind.
J got up from the couch, headed out the door and walked around to the driver’s side of the vehicle. Another woman, a neighbour, was also there. She had been out for a walk and was compelled to check on this individual who was stopped in the middle of the road, conscious but not responding to questions.
J knocked on the driver door and started talking to the guy.
“Hey, man. You okay?”
The man startled when J knocked on the door and made a feeble attempt at eye contact.
“You okay, bud?” J repeats the question.
I opened the deck door and J looked up at me.
“911” was all he said.
I headed right back inside and grabbed J’s cell phone from the coffee table and made the call. J came and took the phone from me to talk to the 911 attendant while I tried to help the man and keep my girls on lock down at the same time. The neighbour woman who was there told us she was going to get her husband to help and she would be back. I was attempting to get the girls to stay inside the house while neighbour woman’s husband (who we later found out is a medical doctor) arrived, turned off the engine to the vehicle and did a quick assessment.
“Maybe he is diabetic” I said. “I’ll get my daughter’s meter.” I ran inside and grabbed Jenna’s OneTouch. Back out I went and performed the check.
Three….two….one….BEEP. 1.4 mmol/l.
“SHIT!” My suspicions confirmed, my heart suddenly broke into a gallop and my legs quickly followed suit as I ran inside to grab sugar. I raced around the house trying to find glucose tabs.
“JUICE!” J shouted from outside.
Juice! Of course! The poor guy can’t hold his head up, let alone chew, for shit sake!
I ran to the fridge but J beat me there. There were three boxes of grape juice sealed together in plastic. He grabbed them and started fiddling with the plastic. I had a feeling we would need more than one box since this was a grown person we were dealing with — not a five year old little girl.
“Just take all of them.”
Back out the door to the black SUV where a man was experiencing the very thing I have been terrified of happening to my daughter for the last three and a half years — the very thing I have been losing countless hours of sleep in an effort to prevent — the very thing that haunts me and compels me to advocate for her with a passion.
And all the while my little girl with type 1 diabetes is looking on — taking in the urgency and seriousness of the situation.
We started feeding the man juice box after juice box. He was able to suck the juice up through the straw. Seven minutes later, he was still very diaphoretic and still unresponsive, his head hanging down with his chin touching his chest. Neighbour-Doctor-Man (Doc, from here on) was attempting to palpate a pulse while holding his head up so he could continue taking in juice.
“Time for another check?” I asked with a voice I didn’t recognize. My words tumbled out of my mouth all at once. The adrenaline was flowing full chisel.
“Good call” said Doc.
Doc readied a finger for me and I cued up the strip and fresh lancet.
“He needs glucagon” I said.
“You’re right. I will take responsibility for that” Doc states, reading my mind about the legal ramifications of this intervention.
I ran back inside and got the very kit I had pulled out just hours before to demonstrate to school staff the steps involved in reconstituting and administering glucagon. I then went back out to our deck, sat down on the cold concrete and proceeded to do just that — nursing skills kicking like an old friend, there for me when I need it.
I brought Doc the syringe loaded with a full dose of reconstituted glucagon, still inserted in the vial to avoid anyone getting an accidental stick and to show Doc what he was about to administer. He revealed the man’s forearm, unable to roll his shirtsleeve up past his elbow, and gave the injection.
At one point I looked up toward my deck to see Jazmine standing with Jenna, holding her in a full embrace while Jenna cried. My heart broke knowing my smart girl was getting a harsh lesson in what could happen to her. But I was also somewhat grateful for this. Jenna has never had a bad low. Not like this. And as I mentioned recently in another post, Jenna is stoic and prefers not to invite attention on herself, especially where her diabetes is concerned. She has insisted many times in the past that she is fine when a check reveals a blood sugar between 2 and 3. I worry that Jenna could opt not to speak up when she feels symptoms and therefore risk having a bad low.
Five more minutes passed and Fire and Rescue showed up followed by the paramedics. Finally. From the time we called 911 to the time the help actually arrived was a good 20 minutes, at least. By this time the man had received the proper help from his neighbours — who just happened to be a former nurse with a type 1 diabetic child and a medical doctor — and was now conscious and responding, insisting that he was fine. His girlfriend arrived on the scene at some point and asked him why he had driven so far down the road, passing his parking spot entirely. I quietly wondered if she was ’new’. He told her, in a manner laced with slight annoyance that she would even ask that question, that he had driven too far and missed his parking spot. Clearly, he had been confused and plummeting before he finally, somehow, fortunately made the decision to put on the brakes right in front of our house. We told him he couldn’t have picked a better place to have a bad low.
I apologized for the crazy high he would no doubt suffer after all the sugar we poured into his system.
“It’s cool” he replied through chattering teeth as he shivered in his sweat drenched shirt in the cool night air.
A few more words of relief and gratitude were exchanged and we decided to give the guy some privacy and retreat back into our home to deal with the emotional fallout our girls were, no doubt, experiencing. It was a little past their bedtime but I knew we had to let them express their feelings about what they had just witnessed, especially Jenna. I was interested to know what was going on inside her head.
Once we were back inside and closed the door, Jenna wrapped herself around me and we sat together for a while. She cried some more. I asked her if that was scary for her to see what could happen if a low was really bad. She nodded. She sobbed. I assured her that we do everything possible to make sure she is safe and that we would never stop doing that. I also told her how important it is for her to tell us or her support worker at school if she is feeling low so that she never has to go through that. She hugged me tighter.
This day has been a strange culmination of a series of events that I am going to be pondering for some time to come. I do believe, now more than ever, that there are no coincidences; things don’t just happen. I have seen too many “coincidences” that are just too uncanny to be such. This day was a gift on many levels. This day has strengthened my resolve to advocate for better care in schools for our children with diabetes. This day has left me dumb-founded.
This day has also left me without glucagon and with the sobering realization that we live in an area where timely emergency medical assistance can’t always be counted on. I’ll be making a trip to the pharmacy tomorrow and picking up a real-estate magazine while I’m there.