The Boss

Even before entering his room, I could hear my next patient yelling as I stood in the hallway. "No," he screamed. I heard a woman's voice murmur back. "I don't care. I won't eat it." The woman's voice, again, said something that I couldn't understand. "I hate it!" the patient screamed again. "You can't make me!"

Before taking that first big leap into the unknown, I knocked on the frame of the door. I entered. And there, sitting Indian-style on the cot, his arms crossed, with a big pout resting across his face, sat my next patient. A five y.o. little boy, chunky and sulky, in a huff, refusing to eat the spoon of vanilla pudding his mother was holding to his lips.

The nurse, apparently on her knees wiping up a glass of spilled orange juice, looked back at me. Her rolling eyes told me all I needed to know about this room.

The mother put down the spoon as I approached her with my hand extended. "Hello, maam," I said, "I'm Dr. Jim. I'll be working with Nurse Michelle to take care of your son today." She smiled as we shook hands. I then turned my attention to the patient. "Hello, Scottie," I greeted him, "how are you? It looks like you don't like vanilla pudding, huh? Me either." A blatant fib on my part, all for the sake of bonding.

Scottie stared me down, giving me his best angry look. I held my hand out to him to shake, but all he did was turn his attention from my face to my hand, probably willing it to explode. "No!" he exclaimed, either in answer to my question about vanilla pudding or in refusal to shake my hand. Either way, I hadn't made a friend.

I focused my attention back on Mom, who had since taken a corner seat to rest. "Maam," I said, "what happened that brought you here to our emergency department with Scottie?"

Mom explained that Scottie had been diagnosed with juvenile diabetes just a few short months ago. Since this diagnosis, they have been struggling to find the right balance between his medications and diet. Unfortunately, Scottie has also been acting out. He typically got three shots of insulin a day, prior to meal time. And on multiple occasions, after receiving his shot, he refused to eat the food placed in front of him, instead demanding a McDonald's Happy Meal. Of which the family, in exasperation, eventually allowed. "Thank goodness we live near a McDonalds," Mom said, as if this was the answer.

It seemed that Scottie was the boss. King of the house. Ruler of the roost.

Tonight, after receiving his dinner dose of insulin, Scottie again refused to eat supper. "I want a cheeseburger!" he had exclaimed, per Mom. And then, before they could run and get Scottie his demands, Scottie went unconscious. Paramedics were called and rushed to the house to find Scottie's blood sugar low--45. They squeezed oral glucose packets into his mouth while attempting to start an IV, and soon Scottie was back with a finger stick of 115. They transported him to our facility.

"Scottie," I asked him, "you don't want to get rushed here to the emergency room again, do you?" He nodded his head "no." "Then you need to eat what Mom gives you after your insulin shot. Do you understand?"

He stared me down. I stared him down. And he stared me down some more, before finally yelling, "I want a cheeseburger!" Supposedly, his aunt and cousin were heading on in with a Happy Meal soon.

Nurse Michelle, in her best attempts, had ordered Scottie a tray. When it arrived, I went back into his room to see how he was doing. No Auntie with the Happy Meal yet, but his tray was one of the best collections of hospital food I have ever seen. Chicken noodle soup, cake, apple juice, french fries, a peanut-butter and jelly sandwich, soda, peaches, potato chips, and chicken tenders. There were no dietary discretions as we struggled to keep his glucose level up.

Unfortunately, there was no cheeseburger. "The grill is down," Michelle explained, shrugging her shoulders.

Guess how much of this delicious tray Scottie ate? Not one bite. Not one drink. Out of defiance, I'm sure. Despite our coaxing attempts, this kid appeared to call the shots. And it was obvious we weren't going to change his behavior in this one ER visit. I eyed up those chicken tenders, though, sitting on a plate under a lid, and said a silent prayer that they would still be on the tray after Scottie was discharged. Michelle, it seemed by her intensely focused eyes, was claiming the fries.

We repeated Scottie's finger stick as he continued pouting, sitting on his bed Indian-style, and were surprised to find it only at 50. "Here," Michelle said, cutting open several packets of liquid glucose, "you need to take all of these, Scottie, or else I'll have to poke you for an IV." Miraculously, Scottie devoured all three packets. "Mmmm," he said, smacking his lips and wiping his face with his shirt-sleeve.

Great, now the kid was getting hooked on glucose packets instead of real sustenance.

As we repeated his finger stick (98), his aunt and cousin walked into the room with the McDonald's Happy Meal. With that familiar greasy smell trailing them. Scottie jumped from the cot, barely able to contain himself, stepping up to his aunt and snatching the meal from her hands. No "thank you." No smile. No gratitude. He just turned back to his cot and ripped open the box of food, unwrapping the burger and finishing it in just minutes. After that, the fries. And finally, he slurped his Coke until the glass was gone.

He was good to go.

Before discharge, I pulled Mom out into the hallway. "Mom," I said, "his disease is lifelong and serious. You need to take the control from Scottie and gain it back. It appears he is calling all the shots right now."

She nodded in agreement. "I know, I know," she said, "my friends and family say the exact same thing. It's just..." Here, she broke down a little before finally continuing. "It's just that it's not fair that he had to get this diabetes crap, you know?" Now I nodded my agreement, thinking back to having those familiar feelings when my son was diagnosed with his malignancy.

"I know," I said, "it seems so unfair when a child gets a serious illness like this. But you need to show him, by example, that this is conquerable if he follows the rules. Eating a McDonald's Happy Meal isn't following the rules. Letting him make demands and granting them isn't following the rules."

She agreed again, and assured me that she would try harder in her discipline. She also promised me that she would keep the morning appointment we made for Scottie with his endocrinologist.

I wished her luck. She was the mother of a child recently diagnosed with a long-term illness. She deserved a break and some time to figure things out on her own schedule. I hoped she could see, though, that her actions would significantly affect how well her son would respond to his situation.

I hoped, too, that someday again, she would be the boss.

As always, big thanks for reading. I hope you have a great weekend...