Travails of a Covid-Kidney-Sugar Patient in a Hospital

My temperature was high and I approached the hospital for early diagnosis and treatment of Covid. After an interview the doctor said unkindly, “Do not over react, wait for three more days. If fever persists come here.”

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My early detection - or at least suspicion - of the disease was called over reaction.

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After three days my fever was even higher and the CT scan of my lungs showed patches of ground glass appearance. Another doctor said by seeing the scan “You have been infected a week ago. You need to be admitted.” I detected enthusiasm in the doctor. A question hung in the air: Has the doctor nudged my case to hospitalization?

I was admitted at once and was assigned a bed.

The hospital worked like a well-oiled machine. The treatment began immediately. Scans and tests were conducted promptly without waiting. Drugs – Remdesivir, Antiviral Formulations, Antibacterial Combinations, Steroid and the rest of it - were given on IV. I was fed the best quality nutritious diet. The hospital seemed to be an embodiment of perfection till it came to insulin therapy to cope with elevation in sugar level caused by steroid.

Steroid intake can elevate sugar level beyond 500 mg/dL. Doctors usually monitor it at regular intervals and limit it to 300. This hospital seemed to follow a different strategy. They would measure sugar level only once, at noon, just before lunch, and give a single dose of insulin. Every day my pre-lunch reading was very high, above 600, well beyond the detection limit. The device would beep and show error, the nurse would give 40 units of insulin and again measure. This time she would smile for the device managed to read 570. In the evening it would be in the range 470 – 570. She would record the values in her register and go away without a word.

When the doctor came for evening round I mentioned this problem of uncontrolled hyperglycemia and asked him to change the insulin therapy. I suggested the slow acting Glargine, my on-going therapy, which has been experimentally found to suit my physiology by my regular diabetologist who is looking after my diabetes for more than ten years. My suggestion was lost on him. All he said was, “Yes. When the sugar level crosses 300 you get dry mouth,” and left the room.

I had long ago developed an intuitive way of predicting extreme sugar levels, like any chronic diabetic would do, without glucometers. I could judge hyperglycemia within 50 mg/dL and hypoglycemia within 10 mg/dL. I have even calibrated my inner radar. In the mid ranges I did not have luck. ?So in the evening when I told the nurse my sugar level could be high above 500 the nurse was surprised when the reading 575. I gave her my Glargine vial asked her to inform the doctors and use it to reduce my sugar level. She said she would communicate this to the doctor and get back. She returned with a negative reply. “You are advised to follow the prescriptions given by the hospital and not bring in your own medication.” I was stunned by the cognitive bias of doctors and insentience of the system.

On the third day the hospital turned its attention to my kidney. They noticed a gradual rise in Serum Creatinine and Blood Urea. The doctors were alarmed. They suggested I should meet their consultant nephrologist. I became restless. I seem to have a lifelong fear of specialists.

(My kidney ailment has a long history. It had been studied by a succession of nephrologists who took scans a horde of tests and finally said, "Take care of sugar. The rest will fall in line."

But a dietician put me on a low protein diet which brought down creatinine from a frightening 3.8 to an agreeable 1.7.

I approached a general physician known to me, and he saw my kidney reports and examined the scans and the cysts. He explained the anomalies in my kidney but assured me they were common and normal. "You have to do just one thing. Check creatinine frequently and keep it in control. Do not worry about the other details." Thank God. He reduced the dimensionality of my kidney problem and made it look simple. And above all he gave me confidence.)

Most certainly I did not want to take up kidney treatment sitting in a Covid ward. I already felt incongruous.

I was equally decided about not extending my stay on the hospital and add to the medical cost.

I took the line, “If I am free from Covid let me go. I will self-isolate and continue the follow up treatment from my home.”

Departure is always a harrowing experience in hospitals. Once the doctor approves discharge you are in a no man’s land till the discharge report comes to your hands. In my case the ward boy whispered to me in the morning while he wheeled me back from the CT Scan room, “All clear. You will be discharged today.” But the nurses were tight lipped. The doctor who came for morning rounds would not speak a word of it. Even today I wonder how the ward boy knew.

By noon the machine stopped. They cut off the calling bell attached to my bed and withdrew medical support. No one checked my blood sugar at noon and no one gave me insulin. I asked the nurse “If you can’t give me insulin, can I buy insulin at the pharmacy? I need insulin, for my sugar level is dangerously high, surely above 600”

She replied, “You can’t go down sir. It is not allowed. I will check with my seniors and get back to you.” It was the longest waiting in my life. I was waiting for insulin for three and half hours. I reminded the medical attendant every half an hour to get me my insulin. Every time she would say “I will check and let you know” and every time she failed to return. It was obvious, the hospital declined insulin treatment. To me it looked like a human rights problem. The hospital would neither give me insulin nor allow me to get my own insulin. That was not medical care. No one has the right to stop my ?insulin. I was physically exasperated and mentally suffocated. I felt unsafe in the hospital.

When I was ready to walk to the pharmacy a humanitarian nurse brought me insulin.

I wheeled down to the front office and settled my bill and received the discharge report in no time. The clerical side of the machine was very quick and efficient.

The traditional briefing by a doctor to a departing patient was conspicuously missing. The hospital has taken a dislike to me. ??

I had half a mind to complain. To whom? I saw the futility of it. The hospital was following a culture set by the leaders.

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