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P-O-P-T-A female, thirty-three, weak and thready.” Sara glanced at the charts, then her watch. A thirty-three-year-old woman who had passed out prior to admission was a puzzle that would take time to solve.
“He ordered a CMP, then went to get coffee
“How long did she lose consciousness?” “She says about a minute.”
“She doesn’t look right.” That last part was what got Sara out of her chair. Grady was the only Level One trauma center in the region,
The nurses at Grady saw car wrecks, shootings, stabbings, overdoses, and any number of crimes against humanity on an almost daily basis. They had a practiced eye for spotting serious problems. And, of course, cops usually didn’t admit themselves to the hospital unless they were at death’s door.
Faith Mitchell was an otherwise healthy thirty-three-year-old woman with no previous conditions and no recent trauma.
A petite blonde woman was sitting on the edge of the bed, fully dressed and clearly irritated. Mary was good at her job, but a blind person could see that Faith Mitchell was unwell. She was as pale as the sheet on the bed; even from a distance, her skin looked clammy.
“She passed out,”
“She’s never passed out before.” Faith Mitchell seemed aggravated by his concern. “I’m fine,” she insisted, then told Sara, “It’s the same thing I said to the other doctor. I feel like I’ve been coming down with a cold. That’s all.”
Sara smiled, shining her penlight into Faith’s eyes, checking her throat, running through the usual physical exam and finding nothing alarming. She agreed with Krakauer’s initial evaluation: Faith was probably a little dehydrated. Her heart sounded good, though, and it didn’t seem like she’d suffered from a seizure. “Did you hit your head when you fell?” She started to answer, but the man interjected, “It was in the parking lot. Her head hit the pavement.”
“Any other problems?” Faith answered, “Just a few headaches.” She seemed to be holding something back, even as she revealed, “I haven’t really eaten today. I was feeling a little sick to my stomach this morning. And yesterday morning.”
“Have you had any recent weight loss or gain?” Faith said “No” just as her husband said “Yes.” The man looked contrite, but tried, “I think it looks good on you.”
“Faith, I think the extra weight looks great on you. You could stand to gain—”
“We’ll need to do an X-ray of your skull and I’d like to do a few more tests. Don’t worry, we can use the blood samples from earlier, so there won’t be any more needles for now.”
Faith wrote something on the bottom of the page and gave it back. Sara read the words I’m pregnant
“How far along are you?” “About nine weeks.” Sara put this in her notes as she asked, “Is that a guess or have you seen a doctor?” “I took an over-the-counter test.” She changed that. “Actually, I took three over-the-counter tests. I’m never late.” Sara added a pregnancy test to the orders. “What about this weight gain?” “Ten pounds,” Faith admitted. “I’ve kind of gone a little crazy with the eating since I found out.”
“I was walking to the car, I felt a little dizzy, and the next thing I know, Will’s driving me here.” “Dizzy like the room spinning or dizzy as in light-headed?” She thought about the question before replying. “Light-headed.” “Any flashes of light or unusual tastes in your mouth?” “No.”
Sara supposed that there wasn’t much that could embarrass you after having a child at fifteen.
She stopped mid-sentence. She closed her eyes, pressed her lips together. A sheen of sweat had broken out on her forehead. Sara pressed her fingers to Faith’s wrist again. “What’s happening here?” Faith clenched her jaw, not answering.
“Have you been irritable lately?” Despite her condition, Faith tried for levity. “More than usual?” She put her hand to her stomach, suddenly serious. “Yes. Nervous. Annoyed.” She swallowed. “I get a buzzing in my head, like there are bees in my brain.” Sara pressed the cold paper towel to the woman’s forehead. “Any nausea?”
“In the mornings,” Faith managed. “I thought it was morning sickness, but …” “What about the headaches?” “They’re pretty bad, mostly in the afternoon.” “Have you been unusually thirsty? Urinating a lot?” “Yes. No. I don’t know.” She managed to open her eyes, asking, “So, what is it—the flu or brain cancer or what?”
She handed Sara a piece of paper. “CMP’s back.” Sara frowned as she read the numbers on the metabolic profile. “Do you have your monitor?” Mary reached into her pocket and handed over her blood glucose monitor. Sara swabbed some alcohol on the tip of Faith’s finger. The CMP was incredibly accurate, but Grady was a large hospital and it wasn’t unheard-of for the lab to get samples mixed up. “When was the last time you had a meal?” she asked Faith. “We were in court all day.” Faith hissed “Shit” as the lancet pierced her finger, then continued, “Around noon, I ate part of a sticky bun Will got
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“I thought the test came later,” Faith said, sounding unsure of herself. “When they make you drink the sugary stuff.” “Have you ever had any problems with your blood sugar? Is there a history in your family?” “No. None.” The monitor beeped and the number 152 flashed on the screen.
Sara told Faith, “You have diabetes.” Faith’s mouth worked before she managed a faint, “What?” “My guess is that you’ve been pre-diabetic for a while. Your cholesterol and triglycerides are extremely elevated. Your blood pressure is a little high. The pregnancy and the rapid weight gain—ten pounds is a lot for nine weeks—plus your bad eating habits, pushed you over the edge.”
“I want you to follow up with your regular doctor first thing in the morning. We need to make sure there’s not something else going on here. Meanwhile, you have to keep your blood sugar under control. If you don’t, passing out in the parking lot will be the least of your worries.” “Maybe it’s just—I haven’t been eating right, and—” Sara cut her off mid-denial. “Anything over one-forty is a positive diagnosis for diabetes. Your number has actually inched up since the first blood test was taken.” Faith took her time absorbing this. “Will it last?” The question was one for an endocrinologist to
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“You have to promise me that you’ll call your doctor first thing—and I mean that, first thing. We’ll get a nurse educator in here to teach you how to test your blood and how and when to inject yourself, but you’ve got to follow up with him immediately.” “I have to give myself shots?” Faith’s voice went up in alarm. “Oral meds aren’t approved for use in pregnant women. This is why you need to talk to your doctor. There’s a lot of trial and error here. Your weight and hormone levels will change as the pregnancy progresses. Your doctor’s going to be your best friend for the next eight months, at
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“Faith, this isn’t the end of the world. You’re in good shape. You’ve got great insurance. You can manage this.” “What if I …” She blanched, breaking eye contact with Sara. “What if I wasn’t pregnant?” “We’re not talking about gestational diabetes here. This is full-blown, type two. A termination won’t suddenly make the problem go away,” Sara answered. “Look, this is probably something you’ve been building up to for a while. Being pregnant brought it on faster. It will make things more complicated in the beginning, but not impossible.”
“Mary will give you an injection. You’ll be feeling better in no time.” She started to leave. “I mean it about calling Dr. Wallace,” she added firmly. “I want you on the phone with her office first thing in the morning, and you need to be eating more than sticky buns. Low-carb, low-fat, regular healthy meals and snacks, okay?”
massive amount of morphine they had given her in the ambulance.
She hadn’t realized it was coming up on one in the morning, probably because the insulin shot had given her a strange sort of second wind.
Faith leaned down and picked up the chair, feeling a bit woozy as she straightened. The nurse educator had been more of the former than the latter, and Faith was still unsure about what to do with all the diabetic instruments and supplies she had been given. She had notes, forms, a journal and all sorts of test results and papers to give to her doctor tomorrow. None of it made sense. Or maybe she was too shocked to process it all. She had always been very good at math, but the thought of measuring her food and calculating insulin made her brain go all fuzzy. The final blow had been the result
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Maybe it was for the best that she had some time before she talked to Will. She had no idea how she was going to explain why she had passed out in the parking deck at the courthouse without actually having to tell him the truth. She rifled through the plastic bag filled with diabetic supplies and pulled out the pamphlet the nurse had given her, hoping that this time she would be able to concentrate on it. Faith didn’t get much further than “So, you have diabetes” before she was telling herself once again that there had been some kind of mistake. The insulin shot had made her feel better, but
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And it wasn’t just that she was pregnant anymore. She had a disease. She had something that could be carried in families. Jeremy could be susceptible. He had a serious girlfriend now. Faith knew that they were having sex. Jeremy’s children could become diabetic because of Faith.
Sara asked, “Have you had anything to eat since we talked?” Faith shook her head, looking down at the doctor’s food selection: a scrawny piece of baked chicken on a leaf of wilted lettuce and something that may or may not have been a vegetable. Sara used her plastic fork and knife to cut into the piece of chicken. At least she tried to cut into it. In the end, it was more like a tearing. She moved the roll off her bread plate and passed Faith the chicken.
“I heard she passed out.” He feigned surprise. “Did you?” Amanda raised her eyebrows at him. “She hasn’t been looking good lately.” Will assumed she meant the weight gain, which was a little much for Faith’s small frame, but he had figured out today that you did not discuss a woman’s weight, especially with another woman. “She seems fine to me.” “She seems irritable and distracted.”
The truth was that Faith had been irritable and distracted lately. He had worked with her long enough to know her moods. For the most part, she was pretty even-keeled. Once every month, always around the same time, she carried her purse with her for a few days. Her tone would get snippy and she’d tend to favor radio stations that played women singing along to acoustic guitars. Will knew to just apologize a lot for everything he said until she stopped carrying her bag. Not that he would share this with Amanda, but he had to admit that lately, every day with Faith seemed like a purse day.
She was just sane enough to realize that her level of fury might be out of proportion. It wasn’t until she sat down at the kitchen table and measured her blood sugar that she realized why. She was hovering around one-fifty again, which, according to Your Life with Diabetes, could make a person nervous and irritable. It didn’t help her nervousness and irritability one whit when she tried to inject herself with the insulin pen. Her hands were steady as she turned the dial for what she hoped were the correct units, but her leg started shaking as she tried to stick herself with the needle, so
jamming the pen down, pressing the button. The needle burned like hellfire, even though the literature on the device claimed it was virtually pain-free. Maybe after sticking yourself six zillion times a week, a needle jamming into your leg or your abdomen felt relatively painless, but Faith wasn’t to that point yet and she couldn’t imagine herself ever being there. She was sweating so badly by the time she pulled out the needle that her underarms were sticky.
“Will,” she interrupted. “I’ve been on a diet for the last eighteen years of my life. If I want to let myself go, I’m going to let myself go.” “I didn’t say—” “Besides, I’ve only gained five pounds,” she lied. “It’s not like I need a Goodyear sign strapped to my ass.”
As penance for her sins, Faith took out her monitoring device. Her blood sugar was on the high side, and she had to think for a second about what she needed to do. Another needle, another shot. She checked her bag. There were only three insulin pens left and she had not made an appointment with Delia Wallace as she had promised. Faith pulled up her skirt, exposing her bare thigh. She could still see the needle mark where she had jabbed herself in the bathroom around lunchtime. A small bruise ringed the injection site, and Faith guessed she should try her luck on the other leg this time. Her
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She was hungry but didn’t know what to eat. She was running out of insulin and she still wasn’t sure she was calculating the dosages correctly. She hadn’t made an appointment with the doctor Sara had recommended. Her feet were swollen and her back was killing her and she wanted to beat her head against the wall because she could not stop thinking about Sam Lawson no matter how hard she tried.
Faith squinted at the list, blurring her eyes, trying to see it the way Will would. He was so damn good at fooling people into thinking he could read that sometimes Faith forgot he even had a problem.
“A-T-L thin.” She realized spelling wouldn’t help him. “It’s shorthand for ‘Atlanta thin.’
It wasn’t the numbers Will couldn’t manage. It was the left and right.
Faith Mitchell didn’t strike her as particularly sentimental. Nor was she very smart—at least not about her health. Sara had called Delia Wallace’s office that morning. Faith had yet to make an appointment. She would be running out of insulin soon. She’d either have to risk another fainting spell or come back to Sara.
There was a low hum of activity in the ICU, but nothing like downstairs in the emergency room. The cops were back at their station in front of Anna’s door, and their eyes followed Faith as she passed. One of the nurses told her, “They’re in exam three.” Faith didn’t know why she was being given this information, but she went to exam three anyway. She found Sara Linton inside. The doctor was standing by a plastic bassinet. She was holding the baby in her arms—Anna’s baby.
She went through the desk drawers and found a glucose monitor. “Let’s test your blood sugar.” This time, Faith was too contrite to protest. She held out her hand, waited for the lancet to pierce her skin. Sara talked as she went through the procedure.
Why is there an “exam room” in the ICU? And why are there just naturally blood sugar supplies in the “desk drawer”?
She read the machine, then showed it to Faith. “What do you think? Juice or insulin?” “Insulin.” She confessed, “I ran out at lunch.” “I gathered.” Sara picked up the phone and called one of the nurses. “You need to get this under control.”
“It doesn’t help when your blood sugar is out of whack.” There was a rap on the door, and Sara walked over, taking a handful of insulin pens from the nurse. She shut the door and told Faith, “You have to take this seriously.” “I know I do.” “Postponing dealing with it isn’t going to work. Take two hours out of your day to see Delia so that you can get yourself right and focus on your work.” “I will.” “Mood swings, sudden tempers—these are all symptoms of your disease.” Faith felt like her mother had just scolded her, but maybe that’s exactly what she needed right now.
“Anna couldn’t have had a baby if she was starving herself. Not without serious complications.” “Maybe she got it under control long enough to have him,” Faith guessed. “I’m never quite sure which is which—is anorexia where they throw up?” “That’s bulimia. Anorexia denotes starvation. Sometimes anorexics use laxatives, but they don’t purge. There’s growing evidence about genetic determinism—chromosomal blips that predispose them to the disorder. Usually, there’s some kind of environmental trigger that sets it off.”
