My wife Maxine is a type I diabetic and a brittle one at that.  That is, she has trouble regulating her blood glucose and has the consequences this brings about.  Her doctor list is extensive including an endocrinologist, a hematologist, 3 ophthalmologists, each with different specialties and a cardiologist.

More than a year ago she was diagnosed with spinal stenosis and was experiencing increasing pain and difficulty moving and walking.  A steroid injection provided no relief and  the implant required for extensive pain management was not what she wanted.  So she opted for surgery, a laminectomy which would reduce pain and allow her to continue her lifestyle.

The procedure was completed as an outpatient and appeared to be successful.   Both she and her surgeon were pleased at the results during at the 2-week post-operative appointment, but shortly thereafter she started experiencing fever and chills.  The steri-strips holding the incision together had allowed an infection to set-in.

Back she went to have the incision drained, cleaned out and a new bandage applied.  They inserted an iv (PICC line) by which she would receive antibiotics at home for the next 6 weeks. Eventually Maxine began experiencing severe back pain, but was told it was due to constipation.

So…, she required a trip to ER for an enema, but this provided no relief for her pain.  A few days later she fell and could no longer walk.

The doctor at her infectious disease practice ordered her back to the emergency room.  Constipation had never been the problem.  She was admitted to the hospital for about 10 days during which the surgeon again cleaned out the incision and sutured it up tight.

Maxine was released from the hospital, still unable to walk, to a facility known to Medicare as a “skilled nursing facility”.  We tried to get her into a highly rated facility but were never able to do so; these were “full up” or would not answer their phone.  A facility near our home, ranked “below average” for the state of Georgia was the bast available at the time.  It was not a good match.

After about 20 days at the facility Maxine was taken back to the surgeon’s office to have the sutures removed.  As the wound was now nearly healed I requested that Maxine be moved back to the hospital; this was refused because the skilled nursing facility provided “an island of protection against infection for Maxine” that a hospital could not.

Several days later Maxine began acting strangely, seeing objects that were not present and waving her arms strangely in space.  I suspected that her insulin pump had failed and told a nurse at the rehab facility that Maxine likely would need insulin to control her diabetes that her blood sugar was too high.  The nurse said she would do tests and remedy the situation.

The next morning  I received a phone call that Maxine had been transported to the emergency room at the local hospital and I could go see her there.

On admission to the hospital intensive care unit Maxine had a blood sugar of over 400 (about 100 in normal) resulting in diabetic coma, hallucinations plus a severe urinary tract infection, apparently from sitting around in bed in the rehab unit in a dirty diaper.  She also developed 2 blood clots, one (occluded) in a pulmonary artery and one in her left leg, for which she continues to receive medication.

She regained strength in the hospital but was still unable to walk when she was released around Halloween to go home.

On the 4th page of the “after visit summary” from the hospital was the subheading “Delirium Tremens”.  Someone thought Maxine was drunk and an alcohol abuser when she was admitted to the hospital. 

Diabetic coma results in the production of acetone bodies which to the uninitiated would smell like alcohol.

Back home, Maxine progressed from wheelchair to walker to walking stick with help from physical and occupational therapists.  A lady came in to help with a shampoo and with baths until Maxine was able to use our shower.

Maxine continues to make progress and her doctors, with the exception of her cardiologist, find her to be quite resilient and not much changed because of her ordeal.

As for me  I continue to be angry at the mistakes made in her treatment.  I did learn how to maintain a PICC line and remove a Foley catheter but at significant physical and emotional cost to our family.

A 1993 research paper (J. Michael Simpson, et al, The Results of Operations on the Lumbar Spine in Patients who have Diabetes Mellitus, J. Bone & Joint Surgery 75-A  December 1993) concludes:

In summary, it appears that diabetic patients who have lumbar disc disease or spinal stenosis cannot be expected to have the same clinical outcomes as non-diabetic patients who have these problems. Diabetic patients who have symptoms and findings of weakness or diabetic sensory neuropathy before decompression are likely to do poorly postoperatively. Furthermore, these patients are much more likely to have wound infections or delayed healing.