48 Hours, Orlando

9:42 a.m., Thursday, June 16

“Hey, just a heads up,” the text from Aaron forebode. “I may not make class today. I got food poisoning and idk if I can keep away from the toilet.”
Aaron lives in Orlando, 12 hours away from our home in Charleston, West Virginia, so all I could say was, “Do your best.”
Although my wife Tammy and I work together as law partners, I didn’t mention the text until we were at lunch.
“Have you talked to Aaron?” she asked.
“He sent a text saying he thinks he may have food poisoning,” I said nonchalantly. “Apparently he’s been throwing up.”
Tammy set down her fork and changed gears from corporate lawyer to Type 1 diabetes mom. “I hope he knows to keep drinking fluids,” she said, reaching for her phone. “Vomiting can cause DKA.”
“I’m sure he knows that,” I said reassuringly.
“Ok,” she said with a sigh as she put down the phone. “But let me know if you talk to him.”
Ironically, that morning I’d been talking with one of my running partners, a psychologist, about mothers of children with health issues. “They spend so much time caring for the child growing up that it’s hard for them to give up the ‘mother bear’ attitude,” he said.
“Trust me,” I said. “I know. I often remind Tammy that Aaron is 22 years old and he’s got to learn to manage his Type 1 diabetes on his own.”
“I’m sure it’s hard for her to let go,” Mark said.
“She’s not the only one who worries,” I said. “Several of our friends in the Type 1 community have kids going to college. The mothers are all in a panic.”
Tammy still winces when Aaron mentions a high reading. News of vomiting sets off a five-alarm alert. A few years ago at a Children With Diabetes conference I asked, “How do you deal with your wife’s mood rising and falling based on your son’s blood glucose reading?” Every T1D mom in the auditorium stared me down.

3:45 p.m.

Aaron calls Tammy to ask for money to stock up on G2. Fortunately he knows to buy G2 rather than Gatorade. At 12 carbs per 12 ounce bottle, as opposed to Gatorade’s 22 carbs, G2 provides the right balance of fluids and carbohydrates.
Tammy walked briskly into my office holding her phone. Before I could say, “What’s up?” she started talking. “Aaron just called. He’s still throwing up. I told him to keep drinking G2 and go to the emergency room because he probably has ketones.”
“He knows what to do,” I said. “He’ll be okay.” I kept my own concerns about Aaron needing to make a trip to Med Express to myself.

6:20 p.m.

Sitting at the kitchen table checking to see if Aaron had posted any Facebook updates, I receive an incoming call from a Maine area code. My apprehension was relieved when I remembered that Pedro, Aaron’s class partner, is from Maine.
“Have you heard from Aaron?” he asked. “He wasn’t in class today and he isn’t answering my calls.”
“He called this morning to tell me he had food poisoning and was vomiting,” I said, “I’ve tried to call him back, but he hasn’t answered.”
“Maybe I should go check on him.”
“Probably a good idea, if you can,” I said, breathing a sigh of relief. “We’d appreciate it. Stay in touch.” Pedro later reported that Aaron’s fridge was adequately stocked with fruit punch flavored G2.
When Tammy came home she immediately asked if I’d heard from Aaron. “No, but I talked to Pedro,” I said. Omitting any mention of the worrisome tone of his voice, I expressed bravado that Pedro would make sure Aaron was okay.

8:30 p.m.

I text Aaron for an update.  “At hospital now,” came the reply.
I immediately called Aaron’s phone. He answered on the third ring.
“Hey,” I said. “Just wanted to see how you’re doing.”
“I’m okay,” he said. His voice sounded strong.
“I’m glad you decided to go to take care of yourself,” I said. “I’ll let Tammy know.”
“Ha! I bet she’s ready to get on a plane and come down here,” he said with a chuckle.
“Not yet,” I said. “But I’m not making any guarantees.”
When Tammy walked in and saw me talking on the phone, she asked if I was talking to Aaron. I nodded and continued to probe, asking Aaron if he’d seen a doctor yet.
“I gotta go,” he replied. “They want to take some blood.”
As soon as Aaron hung up I reported to Tammy on what little information I had gathered. “He sounds good,” I assured her. “He even joked that you were thinking of getting on a plane.”
Tammy didn’t laugh.
For the next hour and a half Tammy washed dishes, ran laundry, and completed any other household task she could attack to take her mind off the thought of her son sitting in an emergency room over 800 miles away with her having no idea as to his current blood glucose level.

10:00 p.m.

When it came time to go to bed, I was more concerned with Tammy than Aaron. “He’s at the hospital, which is better than being in his apartment,” I said.
“I know,” she replied. “I hope he’s lined up somebody to take care of the dogs.”
Tammy called and texted Aaron, but by the time we turned the lights out she’d received no response.
My telling Tammy that her son was “probably just testing her” offered little solace, not knowing whether Aaron had thought to tell anyone at the hospital how to contact us in case of an emergency, much less whether the medical staff had our phone number.
We went to sleep worried, though blissfully unaware that at that moment Aaron was spewing a stream of red liquids in the ER waiting area.
“I’d been drinking G2 all day, and I couldn’t keep it down,” he later told us with a broad smile. “They took me straight back to a room.”

5:45 a.m., Friday

Before pulling out of the garage to leave for my morning run, I sent Aaron a text asking for any updates, and Tammy followed suit 20 minutes later. He didn’t respond to either of us. We went to the office and I spent the next five hours trying to keep Tammy at ease by focusing on client issues.
Shortly after ten-thirty Aaron sent a terse text: “Better but still in hospital.”
“If you can call before the next flight leaves I would appreciate it,” I replied.
“What u mean?”
Aaron’s concern as to whether I was being sarcastic took precedence over any update on the medical front. As a result, I was oblivious to the fact that his condition had required a transfer from the Orlando Health facility located near his apartment to another hospital.

5:30 p.m.

When Tammy and I got home from work, there were no conference calls or meetings to distract us from worrying about Aaron. I began to consider what to say when Tammy asked me to check out Saturday flight schedules. In the meantime, Tammy somehow managed to locate Aaron. He was at Dr. P. Phillips Hospital, Room 3019.
“I’m calling the nurses’ station,” Tammy said, tapping the iPhone screen as she talked. “I’m not sure they’ll tell me anything without his consent though.”
Tammy adopted a tone falling midway between concerned mother and corporate lawyer. “Yes, this is Tammy Owen,” I heard her say. “I was calling to check on my son, Aaron Owen. He’s in Room 3019.”  A couple of minutes later she said, “Thank you,” and ended the call.
“His nurse is in a meeting,” she said. “But she wouldn’t be able to tell me anything unless I have the four digit ‘code.’”
“Good luck with that,” I said.
“The nurse who answered went to check on him, and he told her he was ‘trying to sleep’ and would call later,” Tammy added. “I could choke him.”
“Look, he’s 22. He’s got to learn to manage this on his own.”
“I know, but that’s easier said than done, especially when he’s in ICU.”
“He’s in intensive care?” I asked, my tone turning more attentive.
“Yes,” she answered. “I only know that because they answered the phone ‘ICU.’”
Meanwhile, I sent texts to friends in the Type 1 community to fill them in what we did know, adding, “Hospital cannot tell us anything due to HIPPA.”
One Type 1 parent, who is a school nurse, told me Aaron could sign a “release of medical information and then they can talk to you. Ask him to get one from the nurse and sign it.”
“He’s 22 and stubborn,” I told her. “Itinerant texts are all we get.”
“Tammy’s going crazy.”
“I’m sure she is. You worry to death when you aren’t there and don’t know exactly what is going on,” she said. “Are you guys going to fly down?”
“No current plans,” I said. “But I may be overridden.”

6:45 p.m.

Aaron finally calls.
“Aaron reports he’s out of DKA and he is hoping they will take him off the insulin drip and hook up his pump later tonight,” Tammy told me.
Prior to 12/21/2004, the day of Aaron’s Type 1 diagnosis, I would have assumed “DKA” was a typo for DNA. Today I know it’s short for diabetic ketoacidosis. The Mayo Clinic webpage explains that this is a complication occurring when the body is lacking sufficient insulin and the body breaks down fat as fuel, which in turn leads to a buildup of acids in the bloodstream called ketones.
DKA is every Type 1 parent’s nightmare. Last year nearly 2,500 persons died from the condition. Medical experts advise managing DKA in the hospital unit during the first 24 to 48 hours. Hospitals treat DKA with an insulin drip to bring down the blood sugar level, coupled with fluids to flush the bloodstream. Protocol calls for admission to the intensive care unit so that vital signs and neurological status can be monitored frequently and glucose levels can be measured hourly. The process is exhausting for both patient and parents.
We can attest to the viability of the 48 hour rule. Two years earlier, shortly before eight o’clock one Monday evening, Aaron called for a trash can and G2 to accommodate vomiting and fluid replenishing before Tammy rushed him to the emergency room. He returned late Wednesday afternoon.
That time, however, Tammy was on site and was able to monitor Aaron’s condition and oversee the medical staff. This time, distance and HIPPA regulations left Tammy on hold.
Tammy was relieved to hear Aaron’s voice, but his terse report raised other concerns.
“He told me they let him eat and when he asked about covering for the meal, the nurse told him the insulin drip would cover it.” Rolling her eyes, she acknowledged, “Well, Aaron was right. He ran high again after he finished eating.”
She added that Aaron was suffering a headache, upset stomach, and exhaustion.
“Maybe that’s what he needs,” I responded.
“I know, but I hate it.”
She added that Aaron had promised to call back before 10 o’clock.
“Odds of Aaron calling are about the same as winning the lottery,” I said.

9:58 p.m.

My iPhone’s “By the Seaside” ringtone resonated through the house. I jumped to grab the phone to take Aaron’s call.
“I’m doing better,” he said. “My blood sugar’s down from over 300 after lunch to 200.”
Since “normal” blood sugar levels are between 80 and 120, hearing that he was “down to 200” did little to calm Tammy’s nerves. I picked up my iPad thinking Tammy might ask me to check the American Airlines app.
“I’ll call in the morning,” Aaron promised. “By 7 o’clock.”

7:30 a.m., Saturday, June 18

On Saturday morning the ringtone did not wake us up at 7 o’clock. “It’s so frustrating,” Tammy said. “You know they woke him up by now to check.”
I was just relieved that Tammy’s plans for the day did not involve the airlines.
Shortly before noon Aaron called to tell Tammy that he was being released from the hospital. He didn’t give any other details though and quickly ended the call. At 5 p.m. he called my phone. Hearing the ringtone, Tammy rushed to the phone ahead of me and took the call. They talked for a couple of minutes and then Tammy handed over the phone. Aaron was plainly relieved to be out of the hospital, though he sounded wiped out.
“I’m going to hop off here and get some food,” he said. “I’m friggin’ starved.”
“Just be sure to cover for the food,” I said.
“Yeah, I kinda got that.”

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