Second Thoughts

She didn’t see him again until the following day, at the paediatric diabetic clinic.

As usual they were rushed off their feet, but at least the load was shared by the dietician.

They had a new patient, a little boy of five who had been admitted in a diabetic coma four weeks previously. He had presented with a history of increased thirst, weight loss and listlessness which his mother had put down to the heat and nerves about returning to school, until the morning she found she couldn’t rouse him. He had been stabilised and was now on insulin and coming back for his first check-up.

‘How are you getting on with Paul’s injections, Mrs Downing?’ Andrew asked his mother.

Oh, not so bad, I suppose. He doesn’t like it very much, but I think we’ve got round it now. If he’s a good boy, I give him a sweetie, don’t I, darling?’

Paul nodded.

‘Um — what sort of sweet, Mrs Downing?’ Andrew asked her.

‘Well, that depends what’s around,’ she said innocently. ‘This morning it was a few squares of chocolate.’

‘Ordinary chocolate?’

‘Yes — well, we tried the diabetic chocolate but it gave him terrible diarrhoea.’

Andrew sighed. ‘Mrs Downing, your son really mustn’t have sweets, they’re very bad for him. In order to keep him stable, he has to have sensible, high-fibre foods that will deliver the calories he needs gradually over a period of a few hours, not a sudden shock of sugar then nothing.’

‘Oh, but I still give him the other food as well,’ she assured him.

‘And how’s his blood-sugar level been?’

For the first time she looked vaguely uncomfortable. ‘Oh, well, I suppose it’s been all right.’

‘Do you test it before every injection?’

She shifted awkwardly. ‘No, not every injection. Well, he hates it so when I prick his little finger, but surely I can tell just by looking at him? I mean, he hasn’t gone funny or anything…’ She trailed off and flushed. ‘Well, you try doing it when he’s screaming blue murder and won’t co-operate!’

Jennifer could see Andrew’s frustration as he turned to her. ‘Sister, would you, please? We’ll need bloods anyway for HbA1.’

‘Of course. Paul, could you roll up your sleeve for me, darling, so I can put this strap on? That’s lovely. Right, you hold this little bottle for me and see if you can turn it round and round while I just have a look at your arm here. Oh, that’s lovely! You’ve got very clever veins, haven’t you? What a good boy. Just a little tickle and it’ll soon be over — well done. Keep the bottle turning — that’s lovely. Good lad. All right, now,’ she released the strap, laid a swab over the puncture and withdrew the needle. ‘Could you hold that on there for me, nice and tight? Well done. There’s a good boy.’ She gave him a bright smile, ruffled his hair and winked.

While she waited for the result from the blood analyser, she bottled and labelled the blood for the lab, and disposed of the used syringe in the sharps bin, then put a plaster on Paul’s arm.

‘Well?’

She turned to Andrew and shook her head. ‘Sky high. The urine was, too.’

She told him the result and he frowned. ‘Mrs Downing, if you can’t manage the finger prick each time, you must test his urine. It’s not as accurate, of course, but it’s better than nothing, and if you find it’s high, then you must test his blood as well. Do you understand? Especially in the early stages until he’s stable. If you can’t manage that, I’m afraid we’ll have to have him in and do it for you here, and we don’t want to do that, but you really must understand that high blood sugar can lead to all sorts of problems for Paul later in life, like heart disease, kidney problems, eye trouble — sometimes we just have to be cruel to be kind, and the last thing you must do is bribe him with sweets.’

‘Well, what would you suggest?’ she asked defensively.

‘You could perhaps offer him a treat — a day out at the weekend if he’s been good about his diet and treatment, taking him to the cinema or the zoo, buying him something he particularly wants, but don’t let him hold you to ransom. It’s a part of his life from now on, and if you’re firm he’ll very quickly grow used to it and accept it. If he feels he can wind you round his little finger, he’ll do it. They’re great psychologists.’

He jotted down something in the notes, and handed them to Jennifer. ‘Could you take Mrs Downing and Paul through to the dietician please, Sister? And I’ll see you again in two weeks, Mrs Downing, to see how you’re getting on.’

‘Thank you, Dr Barrett,’ she replied, somewhat stiffly. She was obviously chastened and didn’t like the feel of it.

Jennifer schooled her expression, and held out her hand to Paul. ‘Come on then, Paul,’ she said with a smile, and he put down the aeroplane he was playing with and slipped his hand into hers. ‘Let’s go and talk about what you can have to eat, shall we?’