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?

Do you have kids

“Do you have kids?”

I’ve been ready for this question. As a midwife, who chitchats a lot during exams, I’ve been on the receiving end of the questions many times. I remembered being pregnant and thinking how excited I was to finally be able to say yes! Obviously there were many things I was excited about, but having the experience of pregnancy, of birth and of raising kids gave me yet another thing I could relate to my patients about.

When we learned Mabel’s kidneys weren’t working, making her fluid low and affecting her lung development, we were told she might die. I remember asking my midwife, “What do I say if she dies and someone asks me if I have kids???” I couldn’t imagine a more distressing question, but here I am living it. I had one hairdresser and one patient ask me so far. I’ve actually been surprised I don’t get asked more, but I attribute that to the sign I put up about Mabel for patients to read. My responses so far have been “None living,”  which didn’t feel good, nor did it get a good response and “I had a daughter,” which felt okay and got a much better response.

So when I was asked this hallmark question again, I was ready to try a different answer, one inspired by what another bereaved mom uses in these kind of situations.

“I had a daughter but she died shortly after birth.”

“Oh.”

The tone in the room changed. The patient was pregnant and not dealing well with the physical discomforts of the third trimester. When I met her the last visit, I suggested she reframe her thoughts on pregnancy because she had three more months to go and, no, I would not induce her 27 weeks because she was tired. I also had to let her know that by not doing her diabetes screening, she was risking the life of her child. “If you have gestational diabetes and we don’t know it and your sugars are uncontrolled, you could have a stillbirth.” I was exasperated already with what I perceived as her lack of gratitude.

And when we broached the topic of the diabetes test again, which she still hadn’t done, she changed the subject and asked me about kids.

In my head when talking about the diabetes test, I wanted to scream “you don’t know how lucky you are! You don’t understand how precious that life inside of you is! Why would you risk it just because you heard the glucola tastes gross??” But I didn’t. I calmly explained to her the repercussions of refusing the test. And when she asked about my kids, she got more than she was intending. It took all my effort to not say “Listen, my baby died and I would have done anything to keep her safe. Can’t you please just do the test so I can just know that your baby won’t die because you had undiagnosed gestational diabetes?” But I didn’t

I simply said, “I did my diabetes test.” I looked at her with raised eyebrows, my facing telling her that I would only ask her to do what I have done myself.

I’m hoping she does her glucose test. If Mabel can help her see the light, then I’m glad she was brought into conversation. I know this woman has her own struggles, I just wish the glucose test wasn’t one of them.

What’s your response to this question?  What kind of reactions have you gotten?