Sunday, April 11, 2010

Sourcing Miracles & Keeping Dreams

Kaiser is seeking short stories for possible publication. Here is mine.

EIGHT!!! The subject line of my email streaked out across the Internet through Lotus Notes, screaming at my friends, Kaiser nurses and physicians all. My eighth patient was off insulin.

I recently queried those patients, many of whom lived with diabetes long before working with me. “Why did you do it?” I asked, “What made the difference?”

To which they replied, “No one ever said it was possible and no one ever gave me the steps to make it happen.”

The book Three Law of Performance would call that a change in their occurring world.

In 2008, I joined the Chronic Conditions Department in diabetes care management and invited patients to take-on their disease by learning to count and restrict carbohydrates and get off their insulin. Eight of them did.

“Number Eight (I’ll call her Annie) is an obese, 56 year-old female and a Kaiser Permanente employee,” my email read. “She has been in and out of my care management program twice. When I run at lunch, I pass her walking and we high-five as I yell words of encouragement.”

I encourage patients to get help and seek support.

"You are not reliable to eat for good glucose control and weight loss. If you were, you would have done it. There are many programs available in and out of Kaiser. Pick one and take your cook along. What appeals to you? Do something; do anything." 

Annie did, she attended the Kaiser's Diabetes and Nutrition Class, learning to count and restrict carbohydrates. The impact was startling, stunning, immediate and we regularly and rapidly decreased bedtime insulin in response to hypoglycemia and fasting blood sugars at the low end of the target zone.

Annie was happy with that result and it carried her through the holidays. In January of 2010 she joined Over Eater's Anonymous. Within days we decreased Glipizide due to recurrent hypoglycemia.

On day thirty-seven of her Over Eater’s Anonymous program, she reported a twenty-six pound weight loss and we stopped all glycemic agents but Metformin.

“I can see my toes!” she looked down and pointed. “The aching in my hands and feet is gone,” she stood in the doorway of my office flexing her hands. “I always felt like I had the flu, kind of achy all over; that’s gone. I had no idea how bad I felt.” She hugged me and said, “I love you.”


Annie’s new goal is to run a marathon in her 60th year. I will coach her through lunchtime runs and at least one section of that marathon.

Since then, Patient #9 is off all glycemic agents excepting Metformin and my meager pipeline is working, counting, keeping meticulous records and gunning for their insulin.

I have come to know that I provide an empowering context for these patients; that I am the keeper of this dream. Dreams and goals disappear, they fade in the frenetic pace of every day, they are beaten from us or we abandon them as unattainable. I meet my patients wherever they lie along the continuum of health, acknowledging what they have done. Together we explore small, attainable steps from which they choose.

“I want you to be successful so lets choose something that you know you can stick with. Can you do two five-minute walks every day?”

Most often I direct them into well-established Kaiser or community resources. I never recreate the wheel and it is always our first goal to achieve glycemic control with or without additional medications.

As healthcare providers, when we extend the invitation and provide a pathway toward health, some patients will play for and with their lives.

“In life there are many games we can play,” my email concluded. “We play health and wellness games at Kaiser Permanente. I love and play this game - it brings me to tears and fulfills me in every way. You are the first to know excepting my fabulous pod leader Dr. Huang - who provides a supportive, nurturing environment in which patients and employees can flourish and thrive, including moi’.

BE well and dare I say... THRIVE!”

Lorin Bacon is an Acute Care Nurse Practitioner with Kaiser Permanente in Sacramento, California.

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