In the hospital ward Claudia and I were so grateful her mum was being cared for. Someone to come when she rang the bell, someone to help get her better. In a ward of three older women, Claudia’s mum was an experienced patient.
The charming lady in the next bed, small and cheerful with tousled white hair, had been newly diagnosed by the hospital with diabetes and was getting insulin injections five times a day. She was in her late eighties. In my mind I called her Flossie. Flossie had never been to hospital before, she told us. She looked pretty healthy.
Claudia’s Mama had diabetes for years, but she has aged now and has no diabetes anymore. That can happen when people lose a lot of weight and their kidneys don’t work as well as they used to. It’s a sign of her frailty, really, that nowadays she can eat all the pudding and ice-cream she likes. Despite Claudia’s best efforts, cooking all her favourite foods, that’s often been all she’ll eat.
Mama’s blood sugar remains low because she eats so little. A couple of spoons-full of food and she protests that we are stuffing her. It’s one of the ways we know that she’s very unwell, this formerly sturdy and strong woman, who always had a robust appetite.
So perhaps Mama still had apple juice on her fingertip when the blood sample was taken to check her blood sugar one afternoon when we visited. Claudia, the bush ambulance driver, watched as the worker, an awkward young woman in hijab, squeezed blood from her mother’s fingertip and fed it to an electronic reader.
Within a few minutes of taking the sample, the health assistant returned with a vial of 25 units of fast-acting insulin. ‘Stop! No. Don’t give her insulin,’ said Claudia. ‘But the doctor said I have to,’ the assistant replied, the syringe of clear fluid poised in her hand. ‘No. We refuse it. I’ll talk to the doctor,’ Claudia said. The insulin could be life-saving medication for someone else. But it would have made Claudia’s mum very sick and possibly even have killed her.
Claudia asked to talk to the doctor about the near-miss and the nurses were able to persuade her to come promptly. Claudia remained calm as she explained what had happened. She kept her voice low and firm as they spoke in the hallway, near the nurses glassed-in station.
‘Our mother is not diabetic any more. She hasn’t needed insulin for over a year and a half,’ Claudia explained. The young doctor, overtired, brittle, showed us the medication chart. ‘Well, that’s right,’ she said. ‘She’s not on any medicine for diabetes at all. We would be controlling it by her diet.’
‘She’s lost about 50 kg in the past year, mostly muscle. She’s starving. Her sugars are always very low,’ said Claudia, with steel in her eyes. ‘It would have been very dangerous for her to be given that insulin.’
‘But her blood sugar was high!’ the doctor exclaimed. ‘We are following correct procedure. When the reading is that high we have to give insulin.’
‘The sample was taken from her finger. She had been eating fruit and the nurse —‘
‘She’s not a nurse,’ the doctor interrupted.
‘When the blood sample was taken, she didn’t wipe Mum's finger,’ Claudia persisted.
‘We always take the sample from the ear,’ said the doctor. ‘It would have been taken from the ear.’
‘It was taken from her finger, which probably had fruit juice on it. I saw it —‘
‘It would have been taken from the ear,’ continued the doctor. ‘And the sugar was high so we would always give insulin.’
‘This is a very serious incident —' said Claudia.
‘There was no incident,’ interrupted the doctor.
Claudia sighed. The doctor was edging away. Claudia said, ’She is not to be given insulin. I’ll sign a bit of paper to say so if you need me to.’ The doctor was turned away. Her closed face seemed to say that she had no time for this kind of madness.
Claudia persisted. ‘She should not be on a diabetic diet. She needs calories.’
‘You see?’ said the doctor, turning back to us and pointing to a section of the printed sheet of paper she held in her hand, ‘It says here in her history — Diabetes. We have to keep her on her diet.’ She looked Claudia and I up and down contemptuously, judging us as plump, uneducated lesbians — the kind of people who eat full fat cheese and butter.
And so it was that each meal arrived in its grey plastic shell specially prepared for people like Claudia’s mum used to be — no sugar, artificial sweeteners, low fat. The soup of chopped zucchini and boiled potato in tasty stock was delicious, I admit. If I wanted a lunch of less than 200 calories it was perfect.
Each day we brought Mama treats, cajoled her into taking a bite or two. She was too weak and uncoordinated to feed herself, so we went to the hospital for at least for one meal time a day, sometimes two, to be sure she had something. Every day Claudia tried to explain to the nurses that her mum needed help to eat and that she needed calorie-rich food. Every day the food that came was scanty and calorie-poor. We were asked to leave the room when blood sugars were tested. Mama asked us to take away the halva we left in her drawer, even though she liked it, because ‘they’ said that we were making her sick with it.
Like Claudia’s mum, Flossie in the next bed needed help to eat her food. She needed someone to sit her up and direct her. But mostly she craved company. One lunchtime and then one dinner time a couple of nurses helped Flossie to eat. You could see Flossie enjoyed every bite.
There was an angry response to this. ’How dare you? This is not a nursing home! We do not do that here!’ yelled the senior nurse to her colleagues, in the midst of Flossie’s dinner. The outburst was a sign of a person under significant stress, I thought. The lack of compassion was stark.
Fortunately, Flossie’s family visited daily and she was delightful with them. But there was sadness in her family about the medical treatment and no one to talk to about it. ’She’s lived a long, good life,’ her daughter said to us one day. ‘She’s 87 years old. She wants me to bring her a packet of biscuits, but they tell me now she can’t have biscuits.' She closed up the open packet of biscuits she'd brought and put them in her bag. 'She has dementia. What’s the point of denying her things she likes? How do you ever get to see a doctor here? Nobody has talked to us about this.’
When her family weren’t there, Flossie got bored in her bed. One afternoon she found the plastic rubbish bag full of bits of paper and cotton wool and made confetti. Bits of paper and fluff were thrown in a extravagant snowstorm all over her bed, the floor and Flossie. Then she lay sprawled across the bed, legs dangling, waiting for something else to happen.
It gave the poor nurse something extra to do when she came to see her. ‘Oh, what have you done?’ she said, going to get the broom.
‘Did you see the long scars on her knees? She’s had knee replacements. Not the kind of thing you get at home,’ Claudia said one day as we were driving home. I guess it wasn’t really Flossie’s first time in hospital.
Claudia’s mum is in a different hospital now, where she is on a high-calorie diet. Yesterday she made Claudia read me the breakfast menu, which features strawberry jam, butter and full fat cheese. The tight-faced doctor did the work to get her transferred. I’m grateful for that.
We never saw that doctor again. We were told she’s gone on holidays. I trust she will remember the calm, persistent lesbians from Australia and their mum. Like all of us in my profession, she will learn from her mistakes. She'll come to understand that sometimes the rules can be bent — and it’s better that way.
Thumnail pic of patient with medical staff during a procedure by Taokinesis.