!Prescribe money --- agk's phlog 31 August 2021 @ 0150 --- written on x61 in the garage while Evy sleeps after a hard ride in the remnants of Hurricane Ida --- > In case studies, I manufacture a composite patient > and invent a name. They cannot be identified. Administration shut down the med-surg floor and cancelled surgeries. They moved us elsewhere because of the shortage. So I've been on progressive tele- metry. Progressive is a step down from intensive care for people too sick for the floor. Telemetry means they're on continuous heart monitoring. Chase was admitted for diabetic ketoacidosis (DKA). His blood sugar got very high (>800). He didn't take rescue insulin in time to get the glucose safely in cells where it could be metabolized. Instead his cells starved. His glycogen and fat stores lysed into more glucose---and ketones. His blood became acidic. His brain couldn't handle it and checked out. He peed and vomited a lot. His heart beat fast. His blood pressure tanked. His kidneys made it through and he was sent up to us. We hung electrolytes (KCl, MgS), sugar water (D5W), and an insulin drip. He got off clear liquids and got a meal tray. He was hungry and protein/calorie malnourished. This could really be anybody post-DKA. Dig deeper with hospital patients, though, and a critique of the normal catastrophe in which we live emerges. Chase's pharmacy is in the hospital, but he lives at the edge of the city. It's a three hour walk each way. The walk would be murder on his neuropathic legs and make his heart beat too fast. It's hard to keep his prescriptions filled. That affects his decisions about when to use his rescue insulin. He was diagnosed with diabetes and epilepsy as a child in the foster system. Before the epilepsy was diagnosed, it was treated as a psych issue. He was loaded up inappropriately on neuroleptics by the old child psychiatrist at the psych hospital where I work---who has since rightly lost his license. One foster mom broke his forearm, hand, ribs, and lower leg, but he persisted and grew up through other houses. He slowly weaned off the psych meds through middle and high school. Medically complex kids aren't something most foster parents want. He was a boy of intense special interests. He chall- enged himself with computer programming, energy- transfer martial arts, and research on very specific topics. He talked at length; well-organized lectures about his interests. He had sensory issues, partic- ularly light and temperature. He had flat affect. You're reading this thinking, "Chase is autistic!" Yeah, so, nobody cared to diagnose it. He had that early psych stay and the epilepsy diagnosis. He ended up with the shit end of the stick. What sounds to me like sensory overload was recorded as grand mal seizures. His behavior was diagnosed as ADHD and schizotypal. Resources he might have had and the possibility of a more positive identity never came his way. Some years he had dozens of DKA hospitalizations. He got neuropathy in both lower limbs---"like crushed glass under the skin" of his feet, "like thousands of ticks biting" his legs. He graduated high school. When he aged out of the foster system, he recommitted, which got him rent and transport- ation money. He got jobs, but they were hard to keep due to sensory issues and diabetic neuropathy. Living on his own, he knew how to cook to support healthy blood sugar. That's how he wants to cook. But like the pharmacy, Walmart is far and the bus expensive, so he often ate from the convenience store. He had asthma but started smoking to camo- flage his hunger. He took dozens of trips through the ED and ICU with DKA in the last year, after losing his recomitting income because he was arrested for stealing food during a diabetic emergency. His tooth enamel eroded from vomiting. Brushing or flossing chips it more. Two DKAs last year damaged his kidneys. I asked him to imagine himself in good health and tell me what would be different. "I'd have $400/month for food," he said. "And $40 for the bus. Maybe $60. $60 would make it easier to get back home." I encour- aged him to expose bigger dreams to me. "I want to go to culinary school and be the first diabetic chef on the food network," he said. Medicaid pays thousands for each hospital stay; probably well over $100.000 in the last year. I wish the doc could prescribe money. He'd live in good health for a year, on the cost of one hospital stay. He could go to college on the cost of two per semester. He could work without the risk that getting fired could kill him. I'm certain he'll use any opportunity he gets to do something amazing. If he can afford health and college, you'll see Chase on the food network before his 25th birthday.