Sunday, August 15, 2010

When even "normal" gets overwhelmed...

I had a really great day today. Really great. A good day with the family. We attended worship services at the Abilene Mission church, which was a interesting experience for us. Afterwards, we fellowshipped with two great families all afternoon. Great worship, good food, friendship, swimming and even a nap. Not bad for a Sunday!

So why did I get overwhelmed this evening? Because sometimes it all just catches up with you. Let's rewind....
On Friday, we had our quarterly A1C checkup at OU Children's Hosptial. This checkup allows us to get a glimpse of how Mary Hannah's and Ethan's bodies are handling their blood sugars, and consequentially, allows us to know if we need to make adjustments in our Diabetes Management strategy. In general, we feel like we have a handle on how our family copes with this chronic illness that has afflicted my older two children. When people ask us how we deal with Type 1 Diabetes, my response is usually that it has become our 'normal'. Yes, it was traumatic when we got the diagnosis for Ethan. Yes, it was a kick in the pants when we got Mary Hannah's diagnosis. Yes, if I stop and think about it, we are affected everyday in a million small ways by how Diabetes gets to dictate how we go about living our 'normal' everyday lives. But the truth is that most of the time, we don't stop and think about it, we just do it. I asked Amelia recently what she told people when they asked her about our coping strategy. She said something like, "I tell them that we just do it. People usually are pretty sympathetic and say stuff like, 'I don't know how you do it...' and I always just think, 'The options are: you do it, or :your child dies, so you just do it."

Well, I don't know what combination of factors fed into how I was handling things tonight, but I got a little overwhelmed this evening. After a great time today, we got home and I started making some dinner for Ethan and Eleanor (Mary Hannah was spending the night with a friend). Ethan's blood glucose has been high most of the day, and so I opted for a meal with few carbohydrates. See, this is one of the things that I usually don't think about. As a family, we can't just decide what we want to eat based on what we're hungry for, or what we have on hand to cook. We always, always, have to be aware of how what we eat will affect blood sugars. Because Ethan had been running with high BG all day, it indicated to me that for some reason, he was not getting the insulin he needed to process the sugar in his blood. It could have been an occlusion in his pump. It could be that he is getting sick and despite having insulin to cover his BG, his liver could be dumping extra sugar into his blood to help his immune system. It could be that Ethan was sneaking food and not telling us (doubtful). It could be a ton of different things. Anyhow, I figured that a low carb meal would be best, so we had what we call 'homemade lunchables'. Basically: lunch meat (effectively zero carbs), cheese (again, very low carbs), crackers (just a few carbs each), sugar free pudding (just a few carbs) and flavored water drinks (zero carbs). I told Ethan to go ahead and check his BG again before dinner. Turns out, he left his insulin kit at our friend's house. Now, in our case, leaving the insulin kit isn't a big deal if we are at home. We have extra syringes, extra insulin, extra glucometers, extra everything here at the house. But in principle, we're trying to help Ethan grow in his responsibility for managing his diabetes on his own. Part of that is remembering to take his kit with him wherever he goes. I gave him the ol' pep talk about being responsible and we sat down to eat.

After dinner, it was time to change Ethan's pump site. For clarification, Ethan has an Omnipod insulin pump. It is a nifty little pump that has all of the component parts contained in a 'pod' that is about the size of a small pager. We fill the 'pod' with insulin and affix it to the site and a spring loaded needle inserts a short 1/4" plastic cannula into the subcutaneous fat tissue and the pump begins delivering insulin to the body. The pump's computer is programmed with all the information about Ethan's insulin needs and does for him what your pancreas and endocrine system do for your body. Back to the story... there are basically only a few sites on the body with enough body fat to serve as sites for the pump: the abdomen, thighs, upper arms and buttocks. Over time, if the same site is used over and over, it builds up a resistance to the insulin absorption and becomes less effective. Thus, it is considered to be 'best practice' to rotate the sites you use. The site is usually changed every three days or so, so if you use all the available sites, each site will only have to bear the burden for three days every couple of weeks. On a little boy who is experiencing growth spurts and losing his baby fat, this process can be challenging. Ethan does not like to use his legs, as he says it is uncomfortable for sitting and when he is lying down. However, after our visit to the Endocrinologist, we were reminded of the necessity of rotating sites. So, I told Ethan that we needed to use his legs, too. He whined and fussed at me because he really didn't want to place the pump on his legs. Incidentally, MH doesn't like to use her abdomen and prefers her legs and arms. Ethan continued fussing at me. I reasoned with him:
Me: Hey buddy, look at your fingers. (he holds up his fingers) How many do you have?
Ethan: Twenty.
Me: Count again, just fingers.
Ethan: Oh, ten.
Me: How many have callouses because of how often you have to prick them to check your sugars?
Ethan: (counting his callouses) Four.
Me: Okay, so those fingers are getting worn out, right? It makes it harder to check your sugar when you overuse those fingers. The same thing happens to your pump sites. We really need to be using your legs, too, buddy.
Ethan: But I don't like it with my 'pod' on my legs!
Me: I know, brother. But, listen, I can't take the Diabetes away from you. All I can do is help you do the best job taking care of it, and I'm telling you that even if you don't like it, this is the best thing to do.
Ethan: (crying now) I hate it. Why did God even have to invent... (he catches himself here...) Why does God allow Diabetes to happen?
Me: ...
Ethan: I hate it. It... (looks at me right in the eyes) it SUCKS!
Me: Yes. Yes it does. But until someone figures out a cure, we just have to do the best we can, alright?

We go on to get the 'pod' affixed to his thigh and the spring loaded needle inserts the cannula with a *pop* and Ethan just explodes with crying and fussing. I know that it hurts to some extent, but we've been doing this for a while now and I know that his crying is out of proportion with the actual pain and has more to do with the mileage he's getting in attention from Daddy, but I'm feeling pretty sympathetic to him right now and so I just let him fuss. I drew him into an embrace and just let him cry. After a few minutes, I sent him back to his room to get ready for bed and promised to come read a story in a few minutes. Ethan left the room and it was as if his emotionality had been transferred to me. All the unfairness of Diabetes, all the sh.. stuff we have to deal with on a day in-day out basis, all of the expense, all of the vigilance, all of the equipment, all of the .... you get the idea... The frustration of having to hold my son and not have an answer for him about why *he* has to suffer from this condition, it all just hit me and I cried. Not for long, and not very loudly, but I cried. Amelia had been watching me and asked if I was okay. I told her that I know we usually just consider all this to be our 'normal', but that the experience of having to reason with my son, to just accept the suck-iness of this disease... it is an experience that I shouldn't have to have. I don't cry about it often, but tonight it just really got to me.

So, Amelia held me for a few minutes while I cried and then I sucked up my fussiness and read my babies a nighttime story and tucked them in to bed. I told them that I love them and that God loves them and that everything is okay. Then I went back into the living room and Amelia and I sat, reading books in companionable silence till the phone rang. It was from Mary Hannah's friend's mom letting us know that MH didn't have extra insulin so that she could change her 'pod'.
Amelia: Do you want me to go?
Me: *sigh* Nah, I'll do it.
Amelia: (lightheartedly) Well, I managed to pack extra test strips for her glucometer and an extra 'pod' for her because I knew she'd need to change sites tonight... I just forgot the insulin.
Me: (kissing Amelia) 'sokay, baby. This is our life. Be back in a bit. You want anything while I'm out?
Amelia: I don't *need* anything, but if you manage to bring home a sweet tea, I wouldn't mind.
Me: Back in a bit...

And I'm back to 'normal'

*I am not looking for sympathy here. My purpose in blogging about this is to heighten awareness about the social/emotional toll of chronic illness. For people who don't deal with it, I hope it will raise your awareness about some of the challenges that families face on an emotional level. For people who read this and identify with the emotions and struggle, I hope that this narrative will reassure you that your feelings are normal and acceptable. Often, caregivers get stuck feeling like they can't express their feelings because they'll be seen as whine-y, or misunderstood, or pitied, etc. I appreciate what you are going through and I hope that you have a way to cope with and find strength in doing what you do best: caring for and loving your families despite the way that the illness tries to tear down and control your daily life. May God richly bless you. - jeff

Wednesday, August 4, 2010


I sometimes find it quite interesting how stuff happens. Sometimes there are topics, circumstances or what appear to be coincidences that happen that just make me wonder about the cosmic design.

First, I frequently share with couples who are seeking my help in counseling that I prefer to have us all start on the same page by using the following definition of 'love' : Love is ... valuing the other person AND refusing to devalue the other person. (as espoused by Everett Worthington in his book, "Hope-focused Marriage Counseling") I have found that due to varied family of origin issues, past relationships, trauma, and assorted reasons, people come to my office with widely differing ideas about what love is. I, too, have my own issues, past relationships and traumas that inform my definition of what love is, so this helps everyone be able to have a common reference point for whether certain behaviors, attitudes and values are 'loving'.

I had just such an occasion recently to help a husband evaluate his own behaviors and attitudes toward his wife by sharing this definition for his consideration. So, here we are, using words like evaluate and value and it makes me curious about how value is created. Value is a quality that is assigned to a person or a thing or a concept based on a personal or societal standard, or more often, by personal reasons. In my experience working with couples and families, there seems to be a trend to give lip service to how much we value the other person, but to behave in such a way that we communicate to the other that they are not valued. So, I find this definition of 'love' to be useful in helping couples evaluate (determine the worth) of their attitudes and behaviors.

Okay, so, let's transition to the next thing that happened to catch my attention: I received my annual performance evaluation at work today. That is right, a time honored tradition from corporate America designed to measure productivity and determine all sorts of Human Resource data. However, I have found that it is often difficult to separate the person from the performance and to actually walk away from a 'performance' evaluation without feeling like it was a 'person' evaluation. This time, for me, it was actually pretty decent. Here are some good excerpts:
*satisfactory job knowledge, understands and performs most phases of job well, occasionally requires assistance or instruction.
Okay, so far so good...
*Room for improvement, frequent errors, work requires checking & re-doing.
Wait, what? It just said that I only *occasionally* required assistance or instruction...
*Usually gets the job done on time, works well under pressure, follows up in a timely manner.
That's a little better, but c'mon... *usually* ? Who wrote this evaluation form anyhow?
*Proceeds on own with little or no direction, progressive, makes some suggestions for improvement. (in relation to Initiative and Creativity)
That sounded more promising, but this is beginning to feel like a validation roller coaster...
*Inconsistently accomplishes normal requirements of job.
Now I'm totally bumfuzzled! Is this good or bad? It seems to indicate that someone thinks that I'm doing a normal job of things, albeit inconsistently.

Actually, taken out of context, the above statements could be applied in any way I chose (as I illustrated with my comments after each). The gist of the performance review indicated that overall, I get the job done and do it well. The only real issues were some prodding to improve my paperwork and organizing my schedule more efficiently, both of which are valid points.

The one part of the evaluation that really got to me was: *Generally does not communicate well with clients, staff, and others. Paperwork is unclear and untimely. (Written and Oral Communication category)
Okay, okay, I get the paperwork thing already. I admit I need to tighten up in that area. But seriously, I'm not an effective communicator? This really attacked my sense of self. If anything, I consider myself to be an above average communicator. I'm not just referring to my speaking ability, but I also consider myself to be a great listener. In fact, those are two really important factors in my profession.

So, although I thought that the performance evaluation went well overall, part of me walked away with a sense of self-doubt about my value to my workplace and to my clients. I had to ask myself if the quality of my work and efforts were of value. (don't read too much into this, my self-doubt didn't last long. I'm still the same slightly arrogant, confident person I was before my evaluation.)

Okay, so... again... one more thing about the how we value each other, a friend brought the following article to my attention: (CAUTION: By clicking on the following, you are leaving this blog and will be presented an article about marriage, libido and sex drive. It may not be appropriate for all readers) A Letter from a Sex-Starved Husband. I found it to be an interesting read and it brought to my mind the comparison of a 'performance evaluation' and how men in general, determine whether they feel 'loved' (or 'valued', remember the definition from earlier?)

I was curious whether this man felt frustrated that his 'job' in his relationship was being valued by being compensated in a way that made him feel loved. It seemed to me, that in many categories in his relationship, he seems to meet the standard of being a good husband, a loving, caring compassionate husband. But there is this one area that bothers him. It doesn't change how he values his wife (does it?). He claims to love her enough to be able to fill volumes about how wonderful she is... but the long term effect of feeling devalued in this one area has created self-doubt in whether he is truly valued in the relationship. His closing paragraphs sound eerily similar to disgruntled employees who are looking for another job.

It makes me wonder how similar things would be if someone were to compare job turnover to divorce rates.