Lessons Learned

So, along this diabetes journey I have learned so much about my daughter. Throughout her life we have tried to protect her, as most parents do their children. I remember right before she was diagnosed with Type 1 we had called every pharmacy within 2 hours looking for flumist (the nasal flu vaccine) so that she would not have to undergo the flu shot. You see, unlike her sister, she has always had such fear and panic over medical encounters, and especially shots. I remember feeling the irony when just a few weeks later she was diagnosed with a condition that would require four shots daily. Kids are programmed so differently, and I have been blessed enough to have one daughter who allowed her forehead to be stitched up without anesthesia and who laughs when she gets a flu shot, to her sister who reacts as I've already described. I say that I have been blessed because it has taught me so much empathy as a physician. I have often listened as staff have talked with disgust of the child that must be held down for shots, or who panics when he needs even a rapid strep. Oh, I think to myself...they don't have one of those children. I do, and since I also have her fraternal twin who has been raised exactly the same way and yet handles things so differently, I appreciate the genetic differences between children. And, perhaps just as importantly I also appreciate the stress and embarrassment their parents feel when they take them to the doctor. We have tried many different ways to handle her fears throughout her life, and thus have spent a great deal of time trying to protect her from those situations she fears so much.

What it took diabetes to teach me was that she is actually the bravest little girl I know. Behind that veil of terror and panic is a child made of steel. A child who is not afraid to be different, a child who has stood up to mean accusations as to why she has diabetes, a child who checks her blood sugar 10-14 times a day (which is more than any of my adult patients), a child who gave herself 4 shots a day, and a child who tonight inserted her own site and did every step of a site change at the young age of 8.

But, she doesn't always look brave, and it took diabetes to teach me how to help her realize how brave she is. I remember back to when she was first diagnosed. She would cry and beg us not to give her the shots. She then came up with this routine where she would count to 100, then tap her fingers all before we could give her the shot. All the while she would be shaking and sweating. A good friend reminded me at that time that I should be happy she had found a way to cope. This was good advice, but what I didn't realize until recently was that allowing her to do those things was actually the worst thing we could have done. What I have learned about Jessica is that for her the "before" is so much worse than the "after." She is a child who is consumed by fear so much so that she visibly shakes and sweats, but when the experience she is so afraid of is done she immediately is relieved and moves on without a look back.

We spent weeks trying to compassionately help Jessica give herself her first shot. She was so close so many times...her little hand shaking as she tried so hard to do it. Many times I reassured her that it was ok she wasn't ready, only to watch her try over and over night after night. How surprised I was when we went to a family support weekend and one of the counselors watched Jessica trying and then assertively, forcibly told her "Put it in!, just put it in!" I watched with shock as she did it. It was then that I realized for the first time that perhaps the kind, gentle approach I had always taken with Jessica was not actually helping her at all.

Tonight, for the first time she announced "I want to do a site change." I don't know what sparked this decision, and I have to admit I was definitely more than a little nervous as our pump trainer had told us the average age kids attempt this is around 12. But, I was not about to dissuade this interest. I led her through step by step all the preparatory steps and she did amazing. Then the time came to actually insert the set. We have the spring loaded sets, and I have to admit they even make me a little nervous with their quick and somewhat loud insertions. Jessica panicked and cried and begged me not to make her go through with it. But, I have learned. I saw through the tears and the pleas and realized that what she needed was not for me to tell her it was ok, and we could try again later. What she needed was for me to tell her that she is braver than she realizes, and that she can do it, and that she would do it. I did not back down, and even though it killed me to hear her cry and plead, I told her assertively that she would do it, and as I told her "push the button now!" she did it! I don't know if she was more surprised or I when we realized she had done it. She looked at her site with such pride and such relief. She proudly called her grandparents, and she instructed me to tell her diabetes care provider as she was just so proud of herself.

Thanks to diabetes and the lessons learned, we did not go through weeks of watching her suffer as she tried so hard to insert her own site. She did it the first night. I wouldn't know my daughter so well if not for diabetes. And, I don't think she would know herself so well either. I remember when I first met my husband I was so surprised when he told me that diabetes was his biggest strength. I didn't fully understand then, and maybe I still don't, but I think I am closer to understanding. I wish with all of my being that Jessica had not been given this burden of diabetes. Type 1 is a relentless, unforgiving disease. But, I can also see that it too might end up being her biggest strength.