A little glucola, a little Mabel

“Ugh I don’t want to taste that syrupy gross glucola again,” she said adamantly.  A long discussion ensued, where I reviewed her risk for diabetes- her size, her family history, and where I went over the risks of undiagnosed diabetes, including stillbirth.  I often have patients complain about the diabetes test.  It’s gross, but it’s necessary.  I offered her a jellybean test or referral to do finger sticks to assess blood sugar.  She didn’t seem interested.  I tried to instill how important the test is.

“I won’t sleep well at night until I know you don’t have diabetes.  I want to make sure your baby is okay,” I pleaded.  She reluctantly agreed to go before her next appointment, though I wasn’t convinced.  I knew this patient well- she’s generally jovial, educated and opinionated.  She had been my gyn patient before pregnancy and was seeing me exclusively for her prenatal visits.

“You better be there when I deliver!” she coaxed me.

“You know I’m not doing deliveries right now, right?”

“Well you’ll do them by January 1st, right? In the new year?”

“We’ll see. When I’m ready.  I’m taking it day by day right now.”

“Why aren’t you ready now?”

“My baby died.  It’s too sad for me right now.”

She stood up and gave me a big hug.

“So this is why you want me to do the glucose test, huh?”

“I know what it’s like to not take a baby home from the hospital.  I don’t want anyone else to have to do that.”

She did her glucose test right after the visit.  She passed. I’ll sleep better.

Mabel came up organically in this conversation, but I worry some people might view me a using her to guilt people.  I don’t usually bring her up under these circumstances, but it just came out naturally- and frankly, it felt right.  What do you think?  Am I using my experience in the wrong way?  Have you had a similar situation?

22 thoughts on “A little glucola, a little Mabel

  1. I think you used your experience in exactly the right way. I remember sitting in my dr’s office thinking that maybe I might put off getting my TDAP vaccine until the next visit. As I had done on the previous visit because I had to go back to work and I usually experience side effects (fever and flu-like symptoms) from vaccines. And then I saw a flyer on the wall about a family who lost their newborn son to whooping cough. I got my vaccine in honor of Dylan and his parents. I think sharing your experience really helped this woman to see the glucose test in a different way — to look beyond the annoyance of it and recognize it as something positive and necessary.

    • thank you! I have the tdap vaccine conversation with my patients every day. I simply say, “if you want to see some sad stories, google whooping cough newborns” and you’ll be forever changed. Poor Dylan, who had to suffer whooping cough and his family who I”m sure miss him dearly. I”m so impressed your office put that flyer up. puts a face on the disease and how to help prevent it. It’s a very good analogy to the glucola story for me- thank you for sharing from a patient perspective!

  2. Sounds like the patient made the connection herself, not you! Doesn’t seem like you guilted her at all. And I think your response was perfect. (Also: Glucola is not that gross, I really don’t understand why everyone hates it so much? I hate sweet drinks from pop to cocktails, I never even put sugar in my coffee, and I definitely wouldn’t choose Glucola at refreshment time but it wasn’t a big deal! Especially not compared to all the other aspects of pregnancy and childbirth…)

    • I was glad she did make the connection. It never feels right just to throw her name out there and say “you should do it because my baby died!” (though I confess, those are sometimes my thoughts). I was so frustrated because she seemed to just want to complain, despite me giving her alternatives. I certainly believe in patient autonomy, but I also believe I have to protect their babies too. it’s always a fine balance. and yeah- 10 minutes of gross syrupy is totally worth a pregnancy knowing whether you have GDM.

      also, on a side note, my care team and I were all terrified I was going to have GDM. I dont have too many risk factors (just, age and family hx) but if I did have GDM, I’d need monitoring and we had spent so much time trying to figure out what kind of monitoring was best for Mabel. GDM would add one more layer of ethical choices we had to make. thankfully, I passed. (it was the first test I passed all pregnancy!)

      • Ugh, I did not get to make a single ethical decision about anything and no one got any useful information to think about what was best for Sacha – or for me… Sorry, woe is me 😦

  3. Perfect timing. I don’t think you used Mabel purposefully to guilt trip her, but I’m glad that it pushed her in the right direction. (I was glad that they let me take the fruit punch stuff home and make it nice and cold. It was a little less icky that way.)

    • they used to let them take it home, but now the labs here want pts to drink it in the lab- mainly for logistics, so they dont show up 2 mins before they need it drawn and jump the line. plus it ensures they are actually waiting an hour for their blood draw. I think I wouldnt necessarily have shared had I not known the patient well. that helped bring her in.

  4. You were spot on!

    I remember my aunt sharing a story of her interaction with a 6th grade student one Thanksgiving. I thought she was harsh, but she shared more.

    My aunt was a nurse, a professor of nursing, and at that time working as a nurse in a major inner city school.

    The student was an organ transplant recipient and was making choices that were aginst his health.

    My aunt basically told him that his life was a gift, someone died so he could live, someone’s parents made a tough compassionate choice to donate their child’s organs, and there was no need for another child and family to repeat it so he could continue with poor choices.

    Was it harsh? Maybe. Was it reality? Yes.

    Some things just need to be said.

    You shared from your heart. Not all will be fluffy. Kudos to you for being professional and connecting to the patient while respectful of your reality.

    • what an amazing story- thank you for sharing. I have been thinking of it since I read your comment last night on my phone. bringing in the family losing another child perspective. plus it came from a professional, who had some knowledge, not just a stranger who is weary of everything. great story to share- thank you.

  5. Agree. Agree. Agree. Agree. Additionally, you are very brave for even bringing up your loss in this situation. You didn’t have to. You could have let your patient walk out without comprehending the importance of the test. It’s your life experiences, all of them, that make you such an effective and compassionate person and midwife.

    Sometimes I wonder if I would be so brave if ever in a similar situation at work. There are a lot of 30-somethings in my office having or trying to have babies. None of them know my story and I truly hope none of them have a similarly awful experience. But if they do, how will I react? Will I share Lily in an effort to connect and be compassionate? I really don’t know.

    • You never know how you’ll be in the situation! I have a feeling that hearing a story similar to yours will bring something out- if nothing else a compassion on a level far higher than those who had not lost like you did. Even if you never share her story, your experience with her will totally guide you in your reactions to others. I find myself so so much more compassionate to those who are miscarrying. I havent had that experience (yet?) but I understand that sadness of losing a wanted pregnancy. So i can be so much more gentle. and I”m not afraid to follow up more thoroughly.

  6. I think you did the right thing. As someone above pointed out, your patient made the connection herself. And sometimes a little wake-up call is needed, though it can probably be hard for providers to find the right words. I remember my MFM discussing induction because of my erratic blood pressure, saying how we had made it so far and that we really wanted to avoid the possibility of anything else going wrong. He didn’t quite put the possibilities into words, and he didn’t need to, I trust his judgement. But I imagine another patient with a different history might need a little more perspective, and I think there’s nothing wrong with sharing your experience.

    • yes, I totally think she needed a wake up call. I think SO many patients need a wake up call, but it’s not always right to share the “why.” I really wanted her to simply trust me, without knowing why its so important (testing for GDM has always been important to me. stillbirth has always scared the bejeezuz out of me even before my own loss) In other circumstances sharing could work against our relationship, but this time I think it furthered it.

      • I guess to me it’s a bit ironic that you feel so bad about this as Mabel’s death had nothing to do with GDM. You could first try to convince your patients with statistics (maybe you already do) – but many people have a “this won’t happen to me” mindset. And to me, that’s where Mabel comes in. How likely is DS, how likely is this particular kidney problem? It’s not my field but I’m guessing not very. But still, it does. To me it’s not about guilt. It’s about the fact that unlikely things do happen, and if it’s something that can be screened for and treated you may really want to do it.

      • Oh man, yes- I totally want to sometimes bring it up- i literally have patients decline genetic testing (which is fine) but say they are doing so because “I’m young and no family history.” well…. I’m a living example of that. I dont bring Mabel into that conversation because I dont want to influence peopls choices (just because I carried my baby with a chromosome problem doesnt mean everyone wants to) You are right. DS and the kidney problem are both very rare- anything can happen. I love your last line- yes and yes!

  7. I actually had someone say to me, “you’re so lucky you didn’t have to do the gestational diabetes test!” I was like – really? I’m LUCKY to have my baby born preterm and die? The nerve. I’ll take 100 of those tests to have my baby back.

  8. I think you did a great job! The conversation was perfect to bring Mabel in. I never understand how “selfish” some people can be…you don’t want to drink a sugary drink because it taste bad?? It’s not that bad and it’s to help have a safer pregnancy. I don’t understand. I work with other mom’s who don’t give their children the flu shot because they don’t want to see them in pain, the needle is scary etc…I tell them, do you realize if your child DOES get the flu they will have a lot more needles stuck into them??

    You are a wonderful mother!

    • thank you! and yes- my gosh, the flu shot! I could go on about that too! (I’m admittedly pro-vaccine or in my mind “rational.”) People can either be selfish or sometimes uninformed. But after I inform them, then they dont have an excuse 🙂

  9. My husband has actually encountered this one more than me. Most of my coworkers are grandparents, whereas he is actually the only person in his lab, male or female, who is not currently expecting a baby. He told me that one day he just wanted to scream at a couple of women who were complaining about the gestational diabetes test, “My wife would be thrilled to take a gestational diabetes tests. She would love to drink that shit, because it would mean she managed to carry a baby for that long.” It really got under his skin.

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