#1197 Cold Wind: Pediatric E.R. Nurse
Scott Benner
"Dani" is a Pediatric E.R. Nurse and the mother of a child with type 1 diabetes.
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Scott Benner 0:00
Hello friends and welcome to episode 1197 of the Juicebox Podcast.
Today we'll be calling my anonymous guests Danny, this is a cold wind episode of course. Danny is an army forces reservist, a pediatric ER nurse, the mother of two children, and one of them has type one diabetes. Today we're going to hear about what she sees at her job. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout. That's juice box at checkout to save 40% at cozy earth.com. Do you have type one diabetes? Or are you the caregiver of someone with type one? Are you also a US resident? If you are? I need your help. And so does everyone else. Go to T one d exchange.org/juicebox and complete the survey. That's all I need you to do. Your answers to simple questions that you will know the answer to are going to help to push type one diabetes research forward it takes about 10 minutes T one D exchange.org/juicebox. Support yourself. Support the podcast support other people with type one. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juice box. This episode of The Juicebox Podcast is sponsored by the ever sent CGM and implantable six month sensor is what you get with ever since. But you get so much more exceptional and consistent accuracy over six months, and distinct on body vibe alerts when you're higher low on body vibe alerts. You don't even know what that means. Do you ever since cgm.com/juicebox Go find out this show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. All right, Danny, let's get some background from you. Let's start personal first, What's your connection to diabetes?
"Dani" 2:33
My daughter who is four is a type one. Okay has two children, but
Scott Benner 2:38
she's the type one and how old was she? When she was diagnosed? She was to two and a half year and a half ago ish.
"Dani" 2:45
Yeah, a little over a year and a half ago. So
Scott Benner 2:48
it's your oldest, youngest.
"Dani" 2:50
She's my oldest. I was pregnant with my other child when she was diagnosed perfect.
Scott Benner 2:57
I mean, honestly, right. You're trying to make a baby.
"Dani" 3:01
I had definitely some moments where I was like, I definitely asked my OB, I was like, what kind of testing can we do on this fetus? Because like, I'm really stressed out, it was, you know, you just go in that spiral mode at the very beginning when you're like, just overwhelmed with all of the information. So it feels
Scott Benner 3:17
like it's a joke a little bit to you're like, I'm, I have this little baby, and I'm making another baby. And this is what's gonna happen right now. Yeah, anyway. Yeah. How about professionally? What do you do professionally?
"Dani" 3:28
I'm a pediatric emergency room nurse.
Scott Benner 3:31
How long have you been doing that for
"Dani" 3:32
this role? In particular, I've been doing for five years, I've been a nurse for about 12 years.
Scott Benner 3:38
Okay. That's a long time.
"Dani" 3:40
It's a minute, it's
Scott Benner 3:43
how do you get that education like the undergrad? I hear people talking about it all the time that some nurses go to like private schools and cost a lot of money. And they feel like the education is not much different than if they had gone to community college. Is that about? Yeah,
"Dani" 3:57
I think that it, like, there's definitely different ways that you can do it. Like there's a lot of different routes and a lot of different ways to skin a cat. And you know, at the end of the day, an RN degree is an RN degree. It does affect like your ability to sometimes get hired at like magnet facilities, if you don't have a bachelor's degree. I graduated during the recession. So it was really hard to get a job at a baseline. So it was like a bachelor's degree was a must have. Yeah, you can get an associate's degree and still take the NCLEX, which is the same test that you're going to take if you have a bachelor's degree, okay, and take doing a bridge program to get your associates to your bachelor's. It's really not that complicated. I have my master's degree as well. But
Scott Benner 4:35
okay, let me take you back for a second to you finished your NCLEX. Right. You took them they went well, you passed. What was your feeling about your readiness at that point? Like if I could go back and talk to that naive person? Was she like, I am Danny with an eye and I can probably do anything, or where were you then?
"Dani" 4:57
I think that's an excellent question. I was thinking about this yesterday. Today, when I was walking into work just like Who was I, as a nurse, when I was a new grad and walking into work, so naive to just like people and how human beings are and like how that has changed, like my perspective, so much like, you know, over time as I've become a parent, as I've had a child with a chronic illness, how that perspective has changed. But I think like when I was a new grad nurse, I went to a really great school I had, I mean, nurses listening to this will think this is strange. I took seven semesters of clinical normally, it's only four semesters of clinical. So I was adequately prepared for my, like college that I attended. But I think you're naive, you don't know what you don't know. And it is on the job training. And there is so much that you learn like when you are taking care of real human beings. And you're not just like having these hypothetical situations where you're like, This is what's going to happen when you have this patient scenario present. So yeah, I think just like the night naivety, I was 22 years old. Also, I was mature. So like, let's be honest, about how much that changes things, too. So
Scott Benner 6:10
what do you think you learned about people? Like, what were your first, like, oh, my gosh, I didn't realize this about the world stuff.
"Dani" 6:17
Yeah, I actually live with my best friend, the first year. And I remember we had our hallway full of sticky notes of like, one positive of the day, because I honestly wanted to quit nursing after the first year, I worked on a cardiac step down floor. So as taking care of adults, you know, I think you come out of our I came out of nursing school with the perspective of like, I'm going to make people better and I'm going to help people in be a really great person to people. And like, people don't care about themselves sometimes, like, I'm taking care of these adults that like, don't take their medications. They're there for a congestive heart failure, like episode where they're swollen all over because they haven't taken their medicine or, you know, they didn't go to dialysis. And so now they're in an arrhythmia that we need to resolve or, you know, they like you'll get a patient that just had open heart surgery and then their families bring them Burger King and you're like, Well, you didn't get this way from
Scott Benner 7:13
in the hospital. Yes, have it your way. Absolutely.
"Dani" 7:17
You know, so you're just like, I think that the humaneness part of it is like something that I just was unaware of and it would just be really frustrating like I'm trying to help you and you don't care like the patient doesn't care.
Scott Benner 7:29
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"Dani" 9:01
I think it's probably all of the above, I worked in a very urban area when I was a new grad like I worked in the same city that I mean, I can like say like a general area of that, but I don't work in that area and more a very, very large city in the United States. And like you have a conglomerate of people. So there is going to be an educational discrepancy between different people have like what they know, resources available to them. Like level of care, sure, but like definitely level of understanding of the impact of what they're doing, how that's gonna affect their health in long term. Like do
Scott Benner 9:34
you think taking the Burger King example? Do you think they don't know that's not good for them? Do you think they don't know? That's what got them into that position? Or do you think they know and they just, they don't care? It's all they can afford? Like,
"Dani" 9:48
I mean, like if you look at it from like a general demographic standpoint, like I think that there's absolutely all of those variables in play like some people do, like want to do better for themselves, but they can't afford it like fast food is cheap. And so like, you're still gonna get really good, like, not overly cautious about you know, like of value
Scott Benner 10:05
for your dollar as far as like quantity and not buying
"Dani" 10:09
organic lettuce is more expensive like buying a salad is more expensive than buying a Burger King hamburger. Yeah,
Scott Benner 10:16
I gotcha. Okay, so like but to you the person who's got to get up drag their ass there do this thing. Poop pee pee pee, a lot of unpleasant things happen in their death, people are generally at their worst, you know, for not their even their fault. Like when you get thrown into that over and over again. You said you felt like you wanted to quit early on? Do you think that it's easy to blame them? When it's the situation? Where do you think it's them?
"Dani" 10:44
I think that there's definitely both but like having worked with adults and children. I think that in large part, like, I think that at some point in your life, you have a choice to make, and you're an adult, and you can make your own adult choices. I think my perspective changed a lot when I worked with children, you know, like, parents want the best for their children. And so they want them to be well, and they will do without at whatever cost in general. Not always. But in general, they will do it at whatever cost and I think adults like sometimes they know and they're just like, this makes me feel good right now. And so I'm going to do that because that's what's best for me right now. Like whether that's like, a financial issue, an emotional issue, a literacy level, like problem, like a resource level problem. It's hard to say exactly what the specific issue is. But I think like it is variable depending on the patient, but I think people in general, like have a choice to make. And at some point, you're an adult, and you get to make choices. And there are consequences to your choices.
Scott Benner 11:43
Yeah, no, I want to tell you, I agree with you. Like Like, and I've also, I've also been in the middle of a situation where I'm watching myself make the wrong choice. Right. And while I'm doing it, I think this is not the right thing to do. Right, and you just don't stop that part is difficult to understand, I guess, for me personally, but you said parents want the best for their kids. What about parents who clearly don't want the best for themselves? Do they still want the best for their kids? I
"Dani" 12:14
would say on a whole Yes. Even the really, really, really terrible things that I see. There is some level, you know, like, unfortunately, I see really sad things like I see people abusing their children. And there is some level of remorse even if they're the abuser like you can see it like,
Scott Benner 12:32
are you there? Yeah, I'm here. I'm sorry. You paused, it was such a pause. And I thought, Oh, my God, so quiet. I think she's gone. I actually I was in the middle of a thought and you pause which screwed us up. I was in a I was in a home store recently. And this guy was being really pity to his, like, 11 year old daughter. And I was in an aisle looking at something and I was trying to concentrate on something. I didn't know exactly what I was doing. So I was learning while I was standing there. They were 40 feet away. And just over and over again. He was just like, reductive to her and kind of treated her like she was stupid. Like you don't I mean, like the end. And then it stopped and you thought okay, maybe there's a bad moment. And then they open their mouth again. And it's happening again. And there's this feeling inside of you like I can't do anything about this, right? Like what am I good to good? Like,
"Dani" 13:27
there are definitely parents that come in and I see the way that they interact with their children. And it's unfortunate that they are inadequately prepared to be a parent Parenting is hard. Don't get me wrong, I yell at my children sometimes. I don't want to do that either. But like
Scott Benner 13:41
you have to their little mother.
"Dani" 13:46
Just sometimes last night, get in bed. It's time now. I've been awake all day.
Scott Benner 13:51
But so I had that moment where I thought like, is this like, is this a great guy? These two have a fantastic relationship. And there's just something happening right now. And I thought in the end, I thought maybe, you know, but there are also people who that's their. That's how they are to each other constantly.
"Dani" 14:07
Totally. I don't. I don't think it sets kids up for success in some ways. But like, I hear what you're saying like Absolutely. But at the end of the day, you brought your child to get care in some capacity. Whether you are present in this care, because I've had a kid dropped off literally yesterday, a young teenager like early teenager dropped off by her parent and her mom said, let me know when you're done. I'll see if I can leave work to pick her up. type of a problem.
Scott Benner 14:33
Can you tell me vaguely what was wrong with the kid?
"Dani" 14:36
I don't remember what she came in for. I feel like it was like abdominal pain or something. But like, that's really sad. Like we did lab work and you're just gonna let her do this by herself.
Scott Benner 14:47
Yeah. Interesting. Like a taint like 13 like that kind of a Yeah,
"Dani" 14:52
I think she was like 1314 Yeah, just sit in the ER
Scott Benner 14:55
and give me a call when you're done. And if I can get out of work, I'll come get you.
"Dani" 14:59
I'll see I'll see if I can get out. Interesting, isn't it? Yeah.
Scott Benner 15:03
I don't know how to ask this question. Oh, boy, I don't know how to ask this question. Was the mom a big mess? Like, what was the problem?
"Dani" 15:11
No, I think like, you know, from a resource standpoint, and I don't understand everything, I got social work involved. And it's probably like, I need to work because I need to make sure that I can pay for my child right on, I'm trying to, like, look at it like, from a different perspective to like, yeah, yeah, I think it's really crummy. I would never do that to my child. However, I don't know what your financial work situation is. Maybe you just started a new job, and you're on your like, 90 day trial, and you need to show up, because you need to make money to pay your mortgage. Maybe you're a single mom, like, I don't know, all these other variables that are going into it. So I try to be like gracious in that piece. But I'm also like, though, I wouldn't do that to my kids. But this is what we're dealing with. So Right. Well, yeah, I
Scott Benner 15:53
mean, I guess that's really the issue is that you're, you know, first of all, you're experiencing it over and over again. I'll talk to that piece. first talk about what happens when you're surrounded by repetition all the time. Do you start believing the worlds that way? Or do you just believe that works that way? This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since cgm.com/juicebox. The ever since CGM is the only long term CGM with six months of real time glucose readings giving you more convenience, confidence and flexibility. And you didn't hear me wrong. I didn't say 14 days. I said six months. So if you're tired of changing your CGM sensor every week, you're tired of it falling off or the adhesive not lasting as long as it showed or the sensor failing before the time is up. If you're tired of all that, you really owe it to yourself to try the ever sent CGM. Ever since cgm.com/juicebox, I'm here to tell you that if the hassle of changing your sensors multiple times a month is just more than you want to deal with. If you're tired of things falling off and not sticking or sticking too much, or having to carry around a whole bunch of extra supplies in case something does fall off, then taking a few minutes to check out ever since cgm.com/juice box might be the right thing for you. When you use my link, you're supporting the production of the podcast and helping to keep it free and plentiful. Ever since cgm.com/juice. Box contour next one.com/juice box that's the link you'll use. To find out more about the contour next gen blood glucose meter, when you get there, there's a little bit at the top, you can click right on blood glucose monitoring, I'll do it with you go to meters, click on any of the meters, I'll click on the Next Gen and you're gonna get more information. It's easy to use and highly accurate. smartlight provides a simple understanding of your blood glucose levels. And of course, was second chance sampling technology, you can save money with fewer wasted test strips. As if all that wasn't enough, the contour next gen also has a compatible app for an easy way to share and see your blood glucose results. Contour next one.com/juicebox. And if you scroll down at that link, you're gonna see things like a Buy Now button, you could register your meter after you purchase it or what is this download a coupon? Oh, receive a free Contour. Next One blood glucose meter, do tell contour next one.com/juicebox head over there now get the same accurate and reliable meter that we use. I
"Dani" 18:39
actually think like the last year has really changed and shifted my perspective, like from people. I don't know the whole story. I don't know the full picture. I try to see like the other side and like, view it from a different lens, like take a step back. What are the resources available to this person or this nurse or this family that maybe are lacking or are abundant and maybe affect the way that they perceive this situation? So
Scott Benner 19:07
this last year has changed your perspective a little bit are you talking about since your daughter has type one?
"Dani" 19:14
Absolutely like so I just had a really crummy year right around the same time that my daughter got diagnosed like my dad was in ICU for two weeks with a subdural bleed and had brain surgery. This was like two weeks after my daughter was diagnosed and I had my child that my my younger child that was not a planned pregnancy. Like I just thought I had gotten back from a deployment. That's the short version of the story. I just got back from a deployment. And so it was just an unplanned pregnancy and not not not unwanted. But it sounds really terrible. If you got the whole story, it would be even better. Then you can really go with the stripper name. You can
Scott Benner 19:52
just roll in the door. You're like me so yeah, yeah. Okay. All right. All right. Well,
"Dani" 19:57
it's even better than that. So yeah, my I'll just tell you, the whole bit. I went on a deployment, my father in law ended up getting really very ill. So I went on emergency leave for my deployment came home, because my husband was trying to take care of his father, and of life choices, things like that. Yeah. And just was overwhelmed with taking care of our child. She was not diagnosed at this point in time. This is like right before she got diagnosed, but, you know, it's overwhelming. Like, he doesn't have the extra resources and help. So came home. I was home for literally a week because
Scott Benner 20:29
his cover like citement sex, what were you doing? Were you trying to make him feel better? Yeah, it's
"Dani" 20:33
great. It's grief. You know, it's a real thing. Yeah, I think we all understand. Yeah. To my deployed location. In the Middle East, buying a pregnancy test is really fun and pleasant. So it was a really great lifetime.
Scott Benner 20:48
Oh, my God, I want to remind you to stay close to that microphone. I like you so much better when you're close to it like that. Okay. Wow, I didn't realize you were in the military. Are you in the reserves? Yes. I'm
"Dani" 20:57
a reservist. Okay.
Scott Benner 20:58
So you got back and you say to somebody, Hey, I can't stay long.
"Dani" 21:03
Yeah, it was definitely one of those moments. I mean, I like was knew that there was going to be consequences to my choices. I had sex with my husband, which is not allowed. But those are things that, that there is consequences to my actions. So I dealt with those. And it was just like, you know, hard on that piece of my career time for the military. You know, this is not, it's not unwanted. But it was unplanned pregnancy. So I'm, like, overwhelmed, like with hormones. And then my child has this chronic illness diagnosed, my dad's in the ICU, like, it was just overwhelming.
Scott Benner 21:33
His father's passing. Yeah. Are you? Is it a great, I don't know what the word is, I'm looking for like, are you not allowed to get pregnant? Like cuz you're in the reserves? Like, what? What is that?
"Dani" 21:46
You are allowed to do those things, you would think based on some of the ways that people respond to those things that you are not allowed to do those things.
Scott Benner 21:53
And that you maybe did it on purpose to get out of your deployment?
"Dani" 21:56
Right. And I definitely did not. Like he was crying. What
Scott Benner 22:00
did you want me to do? Yeah,
"Dani" 22:03
I hear you. Yeah. Yeah, the way that that is handled in the military is just really sad. And I get it. Like, I'm not saying that people don't do that on purpose. But I didn't. And like, you know, I was disappointed in myself, like, from a career perspective. And it was frustrating. And it was embarrassing in a certain way. And did it hurt you?
Scott Benner 22:21
Like, career wise? Did it hurt you? Oh, absolutely. Absolutely. Just get put, like on a mental like, Oh, she's one of them lists? Yes,
"Dani" 22:30
some of the things that were said, like, behind my back that came to me at some point were entirely inappropriate. And there is, you know, I was eligible for upgraded my role responsibilities, and someone was giving me feedback. And basically, I repeated to them, and I'm like, so basically, what I'm hearing you say is that I'm being punished once again, for having children. This was pretty recently interesting. In the last six months. Yeah. So I was like, okay, like, that's fine. I will pick my children every time now. So yeah, interesting. It was experiences definitely just, you know, made me feel like, you don't always know the whole picture of what's going on with someone. So
Scott Benner 23:07
right. So that's the idea is that now people come into that er, and it's easy just to think like, Oh, you shouldn't just drop your kid here. So I do this thing, Danny. It's this idea that I took out a commencement speech. So this is convoluted. But this, this writer gave a commencement speech, it's gotta be 20 years old. At this point, it's called This is water, you can actually buy it as, like a little book now. Or you could you could listen to it on YouTube or whatever. One of the things I took from the man's speech was that I don't know why people are doing what they're doing. And there are reasonably speaking, speaking, people doing those things for poor reasons that they could have avoided. And there are people doing those things for reasons that were unavoidable. And so the example I normally use is if somebody's driving horribly and cuts you off in traffic, and it's all very dangerous. I can choose to believe that that person's an asshole. Or I can choose to believe they're about themselves. They're trying to get to a bathroom. Right? Yeah, absolutely. And I don't know, which is which. But it only hurts me to choose that they're an asshole. Like that. Absolutely. That's what it taught me is that that if I if I decide everybody's a dick, then that's an anger that lives in me. They don't know. I feel that way. And, and it's of no value for me to walk through the world believing that everybody's terrible. Because the truth is, is that some people are terrible, and some people aren't. And some people just need to get to the bathroom. And so like when I don't know the truth, why would I choose to believe everybody's terrible?
"Dani" 24:52
Anyway, I agree. You said it's called This is water. Yes. I'm gonna have to check that out. You can listen
Scott Benner 24:59
to it on So I mean, somehow back then there was a video camera there, you can actually listen to him give the speech, the little book when people graduate, I give them a copy of the book. It's not really a book, it's the, you know, it's the speech press down. Just because it's just such a clarifying thought for me that I don't know, your situation. And you might be an asshole like, I might be 1,000,000%. Right, right. You might just be driving badly. But
"Dani" 25:28
you might have Crohn's disease and be needing to go to the bathroom.
Scott Benner 25:32
All I'm getting that like somebody's just trying to get to the Starbucks and get through the lobby without looking too conspicuous. You don't I mean? Yeah. And what is it helped me? It only helps me to believe that they're just the person in a bad situation.
"Dani" 25:47
Absolutely. I think that like, that peace of clarity and like level of compassion, and empathy is something that takes time to learn. And I don't think that when you're, you know, a new grad nurse when you're 22, that you have the life experiences to like back that. Yeah, no, some people do, but I didn't.
Scott Benner 26:04
So let me say this, this all makes me sound very, ultra liberal and soft. I want to be completely clear, I do think some people are just getting horrible.
"Dani" 26:13
Oh, I don't disagree with that. There are some people that I'm like, Yeah, okay, well, you're kind of a piece of, again,
Scott Benner 26:20
it's, how is it for me to decide who's who. So instead, I just keep a balance in my head that I know that, you know, there's a spectrum of the way people act. And there are a spectrum of different implications that are happening in their lives that are changing their, you know, their behavior. I know, I'm a decent person. And I also know that you could easily find me and isolate two minutes of me and think back is terrible. And as a matter of fact, it happens to me sometimes. So like, because of what I do, if somebody is just to pick up the wrong episode of this podcast as the first one, I'll might come off very poorly to them. Well, I
"Dani" 27:02
mean, like, I still have this, you know, deep feeling of deep seated empathy and like wanting to grow and be a better human being at this point, but like, there are days that I have no real bitch. No, I'm not always the kindest human being in the world, either. Like as an I realized, like that I have flaws. And I'm not perfect either. So yeah, like,
Scott Benner 27:20
let me give you a great example from from right kind of around. Now. It's been a few weeks, but someone tried the podcast, and started off on an after dark episode about sex workers. And that episode, it's called after dark sex worker, and it's called sex worker, because that's what the person called themselves. Colloquially, she's a stripper. And if I was going to name the episode, I actually would have called it after dark, like stripper, but she called herself a sex worker. So I did her the respect of being in that in the title right. Now, I had this long conversation with her. I mean, I don't I can't remember if I'm being 100% honest with you. I couldn't like if you took me to court right now, what I could remember about it was she was a newer diagnosed type one. She was stripping her she said that her diet consisted of Jack Daniels and cocaine. Like when I tried to ask her about her like, she was talking about our blood sugar. At one point, I tried to ask her about her diet. And she's like, it's mostly Jack and Coke. And I realized what she was saying she told me a story in there about her father dying of an opioid overdose,
"Dani" 28:29
like recently, and
Scott Benner 28:33
I remember her making a joke about how great are puppets were? These are the things that stuck out in my head. I asked her Do you feel bad? Do you feel bad getting those guys in the back room, getting them worked up and taking their money off of them? And she said, No, because I've got great tits. And I was like, Oh, fair enough. And like, so good. We moved on. This is literally my remembrance of this conversation. And it went on for an hour. And I don't remember the rest of it. Yeah. A week or so ago, someone left a review to let everybody know how icky I am and how terribly I treated her and all that other stuff. Now, you know what that person doesn't know. That six months ago, that girl sent me an email, said she's clean now. And is giving me the credit for it. Bravo to her write fantastic for her. And she listened back to that episode and hurt herself for the first time and made some changes to her life. Now, the person who heard the review, read the review. What does she really know? I assume it was a woman. And so, I mean, I don't know. All right, that was sexist, but I assume there's the reviews from a woman. Now, here's the funny thing. Danny, someone's going to hear me say that and leave a review six months from now that says I'm a misogynist. That's what I mean about not being done. Not possibly, Danny, I've been doing this for a long time. I know exactly how this is gonna go. Yeah. But like that's what I mean about not knowing other people because do you know me as a misogynist? No, I
"Dani" 30:00
don't see you as that. But I yeah, I don't know you on a day to day basis ether. So
Scott Benner 30:05
Well, all I do is I kick dogs and punch women. What does that make? Yeah,
"Dani" 30:09
100% I definitely wouldn't have imagined that. But you know, if that's what you do in your spare time, that's your choice if you do differently, but see, obviously,
Scott Benner 30:19
you can you can tell a joke and be funny and sarcastic, and someone will come along and miss that they won't know that you were being sarcastic, the review will say he said he kicks women and dogs. And that woman laughed, right? Like my point is, is that we can't know each other, right? Like, like really know each other and what's in our hearts and what's happening. Now having said all that, let's talk about what it's like to work in an ER, and especially a pediatric er. And I want to know, all the things that have struck you that you've reevaluated since your daughters had type one diabetes.
"Dani" 30:56
That's a that's a lot of things to think about and say, but I think, you know, there are times in your life like becoming a parent, I started there. Right around the same time I got pregnant with her, I had worked at the same facility in like, several years prior for like, nine months or so. So I'd worked for that company before. But being a parent changes the way that you treat other children, because you have a level of empathy and compassion that you didn't have when you weren't a parent. And not to say that I wasn't a good nurse and wasn't compassionate and empathetic before that. But I think it gives you a perspective that you truly can't understand until you become a parent. And then more. So like, when you become a parent with a child with a chronic illness, you become empathetic in a way that only people with a child with a chronic illness can understand. I mean,
Scott Benner 31:53
you have something that you look back on and think, oh, I shouldn't have done that that way. Or we shouldn't be doing this like this. Because nursing is a younger person's game,
"Dani" 32:03
right? I mean, bedside nursing tends to be a younger person's game. Absolutely. Okay.
Scott Benner 32:07
So go ahead, please. Yeah,
"Dani" 32:10
there's absolutely been moments, I'm trying to think of something more specific. But there have been moments where I'm like, Man, I didn't say that the right way. Or I could have handled that situation differently. Or I should have said something else to the patient, because maybe they perceived what I said wrong. And I am the first to go in and say, Hey, I'm really sorry. I think maybe we misunderstood each other. It is hard. Like I don't I don't do it right every day either. Yeah.
Scott Benner 32:34
And that's not for lack of trying or concern or desire. Right? Right.
"Dani" 32:40
But there are people that I work with that maybe don't have the same tact or compassion or empathy, to be, like, just aware of those little isms that people are giving off and vibes that people are giving off. So,
Scott Benner 32:55
yeah. So you see it now, like another nurse will do something, and you'll think, Oh, I would have done that five years ago. And Oh, absolutely. Right. Now, do you say something like, is there a mentoring situation? Or is that not the vibe? Oh,
"Dani" 33:11
100%. I am like real big. Like, that is one of my great passions. And like feedback, it's hard to give feedback, it's hard to receive. But like, that's the only way that anyone is going to be better like, and there's a time and a place to do it. So I'm not going to do it in front of a family member, if you're making unless it's a glaring safety mistake, I'm not going to like, correct it in front of a family member, because I don't want them to lose trust in the person that's taking care of them, if I'm just in there helping you hold for a procedure or whatever. But I will pull you aside afterwards and say, hey, my feedback for you next time. Like would be to do it this way. Yesterday, I had a new grad, I was in charge yesterday. She had, she kept sending me messages. And there was one message that she sent me that was kind of urgent. And so I didn't see it right away because I was doing something else. And I was like, if you ever have something urgent, just give me a call next time. Like, I want to help you and I want to help you do it. Right. Just give me a call like, because I don't always see the messages in the chat
Scott Benner 34:13
that helped is that received? Well, normally, the
"Dani" 34:17
constructive criticism I have learned but it's it's not always it's not always received well, but I think that it's the presentation and like, you know, feedback is hard. Again, it's hard to receive at any point in time, but like recognizing like, Oh, you're really busy right now. This is definitely not the time to give it to you or hey, I have something that I want to talk to you about. Let me know good time for you. So that they're in the right headspace so that they receive it better.
Scott Benner 34:40
Have you seen nurses in a position of power? give good feedback the wrong way? Oh, absolutely. And then is that just a stone wall then like it's not received? Well at all. It's just for nothing. Absolutely, yeah. And why do you think that happens? Why do you think that people are like pity in that situation?
"Dani" 34:58
Some people have an ego that is larger than it should be an inflated ego like, we have, you know, like, there are some people that are really great nurses, or they're really, really intelligent and maybe they're not as socially aware, is that the right way to say that, like, you know, they can be incredibly book smart, but maybe they're not as good at communicating things with like family members. And then there's some people that are vice versa, that they're really, really good at having rapport with the families and communicating with patients. But maybe you're like, wow, like, you got to think through this, like prioritization right now, like socializing with the family and developing a rapport is not as important as getting this antibiotic to accept a kid right, Bob. So that
Scott Benner 35:38
seemed like a very specific example. But okay, just sitting around chatting while the kids just drifted off into hell. And they were like, holding the hold Mr. Engineer hand, like that kind of thing. Yeah, yeah.
"Dani" 35:48
There are definitely some times where I'm like, I love that you are so good at communicating with people in developing a report. Right now. That's not the time.
Scott Benner 35:58
It's not the thing. Yeah. How well, I mean, it's a pediatric, er, how prepared is that er, or others that you've worked in? For a DKA? A child in the UK, for example.
"Dani" 36:14
I think it depends on the nurse that you're going to get for the day, which is really sad. I think that there are people that are more well equipped to handle that type of patient. And there are people that are not as equipped to handle that type of patient, I think on a whole, my colleagues are going to provide care that is reasonable, but like, the detail oriented and like attention to detail, and the things that are required in the why they're required, is lacking in some of them. I definitely think that there are many people like I think on a whole, my colleagues aren't adequately equipped to do it. But maybe the details are a little muddy.
Scott Benner 36:54
I'd have to be honest with you, the use of the word adequately is not is not filling me with hope. Okay, great, as long as everyone's adequately prepared.
"Dani" 37:06
Yeah, I think I think people forget to look at the resources and like, they realize there are some people that I have seen, like, rely on their memory of what the, you know, policy or says, and it's like, I look it up every time. I'm like, I feel like I'm pretty good at this, like now, but like, I'm going to look it up every time because number one, it changes. Number two, I don't know everything. Like I don't want to miss something. Because this can be a really critical patient. Tell us why
Scott Benner 37:34
the why is important. Like how come not just following the rules is important. Or it's step by step, like, why is the why am I doing this? Why is that so important? I
"Dani" 37:46
think the why in what you are doing helps you understand the details. So you know, the way that our policy is written, like you're supposed to do a full neuro exam every hour on a patient, that is in DKA. And I think that I just know, like that. Some people don't do that every hour. And I think if you don't understand why you need to do that, like that this patient is at high risk for cerebral edema, then maybe, if you knew why, then you would do it. Because you're like, Oh, that makes sense as to why I'm need to do and
Scott Benner 38:18
we're looking at brain swelling, because if it tips the wrong way, it could go quickly. Right?
"Dani" 38:23
If you are dropping their blood sugar way too fast, or they're so acidotic, like they have a high risk for those changes, like osmotic pressure changes to occur. That would be bad for your patient and could potentially be fatal. I mean, feels strong, but like, you know, can cause them brain damage. So how
Scott Benner 38:45
many kids that go into DKA
"Dani" 38:49
end up with brain damage? I feel like I looked this up very recently. I don't think it's a really very high number. Like it's probably less than 5%. But there are certain, like populations that are at a higher risk for cerebral edema, you know, like if they're under a certain age if their blood gas so something that you check to see if they're in DKA if their blood gases more severe than that can really increase their risk for cerebral edema. Yeah, okay. But
Scott Benner 39:21
if it's 5% Then you're saying five out of every 100 kids could end up with like irreversible damage.
"Dani" 39:29
brain cells don't go back. So the degree to which your brain cells like also you're going to have you know, potential damage if you're like, hypoxic or something. But yeah, brain cells don't go back but like irreversible damage. Like To what degree like I don't think I think 5% is like probably generous, but don't quote me on that. Because I don't know. Yeah, I don't know off the top of my head. I
Scott Benner 39:53
think that's what I read. Have you seen it happen in your 12 years? Oh, yeah.
"Dani" 39:58
I had a kid probably like Six months ago that I was taking care of who was definitely altered and needed mannitol. So, and 3% because they were having cerebral edema, so Wow. Because they were so I mean, they already came to us in a really bad place. Sure. So it wasn't us. Like it was the situation. And we just, yeah,
Scott Benner 40:19
gotcha. No, I understand. I just Yeah, trying to give some context for people. So
"Dani" 40:24
Right. I don't I would say the majority like that. I think that that is the only one like, there's another one that I think I took care of a long time ago that needed that in the PICU. But I would say the majority are well, and I would, I don't have the statistics or data to support that. But like, we send a lot of patients home from the ER, that are new onset, and we don't even admit them to the floor. They go and they follow up outpatient, that are new, that new diagnosis, why
Scott Benner 40:50
would they not be admitted? Depending
"Dani" 40:52
on your level of like, if you're not truly in DKA, like if you come in, my child was not admitted, we went home and we followed up with our patient the next day, even though she was two years old, which that was more because I asked them to do that. And I was
Scott Benner 41:05
looking back, should you have done that? No, I
"Dani" 41:09
actually think it was fine. It really early. And so she wasn't truly a DKA. I mean, her blood sugar was 701. Like the blood sugar is going to you can be a DKA as you know, like and your blood sugar can be 120. Yeah. So yeah, I think we do send people home that are new diagnosis. I would say the large majority don't even go to pick up on a lot of kids just to med surg. So
Scott Benner 41:31
is there any other autoimmune in your family or any other type one?
"Dani" 41:34
There's no type one that we know of autoimmune. I think that that is like, I've never been formed. Personally, I've never been formally diagnosed celiac that I've been gluten free for like 15 years, my dad has been told that he's probably shouldn't have it. Like more formally, he does take like a liver enzyme called Kreon. It's like a pancreatic enzyme that helps him digest food a lot better. Now, she's, she just drew the short straw. Gotcha. Okay,
Scott Benner 42:04
what made you want to come on the podcast? Like, what what did you hear that you thought, like I can add to this?
"Dani" 42:10
I think like, the big thing that I'm like super passionate about is like, we can do better. Like there's always room for medical professionals to do better and be better. And, like, it is the small things that matter. And it's also the big things that matter. Like there are small ways that you can interact with people. And there are big ways that have bigger impact, just knowing that, like if you're a healthcare provider listening, like you can do something small, like for example, my facility, or whatever reason, I don't know why they have this. But before my child was diagnosed, like we were using adult lancets to do fingerprints, and like those turret like. And so like, and they don't use those in outpatient facility, like, literally, not very far from the building. And so like we advocated to get those parts numbers and stuff close in our floor. And so that's what we use now. Because you can get an adequate sample of blood test glucose with a smaller Lancet. So why would we not do that? And like cause less harm to the patient? It's a small thing.
Scott Benner 43:09
But it's easily I
"Dani" 43:11
think it has a big impact. Yeah,
Scott Benner 43:13
let's easily adjusted and it does have a big impact. Because if, I mean, if you're being tested that first time, you know, and it hurts that badly, it will flavor what your expectations are moving forward, probably your anxiety level and a number of other things. Yeah. Have you made other adjustments at work based on your new knowledge?
"Dani" 43:33
Oh, absolutely. And I will be the first person to say, before I had a child that was diagnosed with type one, I was scared to take a patient with DKA, I was probably adequately prepared to do a standard, I could follow what the policy said in black and white, but I didn't really understand the why behind everything in the level of capacity that I should, because like, you need to know enough about a lot of things. You can't know everything about everything. Like you can't, you just can't you don't have the bandwidth for that. And so it's not something that I was like, deeply passionate about. But I think that's because like I remember in nursing school, that diabetes was something that I had a hard time understanding. And I just did it, like, totally grasp it. And so it was something I avoided because it wasn't easy for me.
Scott Benner 44:15
Do you recall how so? Like, why? What about it was difficult to understand.
"Dani" 44:20
You know, when I was in nursing school, like you'd have to like know, the peaks and the troughs of like all of the different kinds of insulins. And like, I think it was just overwhelming to me. And I don't know why but for whatever reason, it was just not a type of pathophysiology that clicked well for me and my brain. And I tend to be a learner that if I don't get something right away, like I am a relatively intelligent human being, but if I don't get something right away, I get frustrated. And so I avoid it, which is not the best way to handle things. But like, I knew enough to get by and pass my test and do things in an adequate way. I wasn't good at it. And so I just avoided it because there was things that I was more passionate about, like But I was good at
Scott Benner 45:00
what do you think the difference between what the average person believes a nurse and understands and knows? And the reality of what they understand? And like, what do you think that gap looks like?
"Dani" 45:13
Hmm. I think that that's a hard question to answer because I think that there are varying degrees of prepared versus like, there are people that can skate by nursing school and not actually know the information. And there are people that like, really spend a lot of time and really study and maybe can't articulate it very well. But you know, that they know the information deeply. So I think that that's a hard question to answer entirely, because I think that it is varying on the level of what people know, and what their experience has taught them.
Scott Benner 45:38
Maybe the question should be, how should we be defining what a nurse is? And what they and what they know? Like? Do you really mean like, because I'm trying to put myself in the, in the perspective of an outsider looking in? And, you know, to me, I mean, I used to say this a lot on the podcast, but I think there are some things we don't question. You know, doctors, you just you go with what a doctor says, anybody connected to the medical field, you go with what they say, I know, people who are receptionists in doctors offices, and act like they're smarter than they are. Because I work in a doctor's office and people go away, do well, a doctor's office, you know, that kind of thing. We do that for teachers, a lot of times, sometimes we do that for police officers, we do it for people in positions of authority normally, right? You know, so like, I'm sick. First of all, I'm sick. I'm not coming to the hospital for fun. So I'm rundown, I'm not thinking straight. I'm scared, I'm worried about money, worried about my job, all the things, I'm worried about my kid, I got all those things going on. I get there, I get to the magic place where the wizards live and the people who helped the wizards. And then I get there to learn that you're not a wizard. You're 22 You just wanted a job? And you don't you avoided diabetes at school? Because it was confusing. Now? Yeah.
"Dani" 46:56
I mean, like, I'm the first person to save that. And now I live and breathe it every single day. So I couldn't avoid it anymore.
Scott Benner 47:03
Yeah. So like, what would it help? What would people need to know do you think would help them balance their expectations and get them a better outcome in a hospital setting? That's the question. Well, what what should my approach be?
"Dani" 47:17
I think just knowing like, you know, there is like standards of a curriculum that are required from an educational board review to like, allow you to take the NCLEX, the NCLEX is going to have like, there's a new NCLEX now. So I don't know exactly how many questions it might be the same sort of go me because I didn't have to take this one. But it used to be anywhere from 75 to like, 200 questions about a wide variety of things, it's going to be covering, like babies all the way to, like geriatric patients. And it's gonna cover everything from the brain to musculoskeletal situations, like it's, and pregnant people, like, you're gonna have so many random things on there. And if you're only gonna have 75 questions that you're tested on particular license, like I took my mind was, I do remember my passing 75 questions, but like, people can know, just like, you need to know just enough about a wide variety of things. And then it's up to the nurse like to understand like, later on, like, as you grow, and in your profession, like you are able to get certifications, but like that is self accountability of like, wanting to grow professionally, and like, be a certified nurse in whatever area that you're in and continue your education and development so that you can be the best that you can, but like, really, people have this general knowledge. And like people, even if you're in a specific area, you're gonna have passions that you're and things that you're good at, and things that you're bad at. And so maybe this is not their strong thing. And especially in the ER, people know, like, a lot of things have, like a lot of things, but they don't know, like, not everyone, but most of them know a general amount about a lot of
Scott Benner 48:58
different things, just not a lot of specificity. Right. But
"Dani" 49:01
if you go to the endocrinologist, like if I go to the clinic, they're going to know a lot about diabetes, where I would hope they do.
Scott Benner 49:07
Okay, so I was gonna say, Does this extend to the doctors in the ER, like, Are there are there doctors in that er that you look at and think if I fall over, please don't take me over there.
"Dani" 49:17
Yes. Yeah. Like, I know that they're like, my pediatricians that I work with even the like ones that are fellowship trained in emergency pediatric emergency medicine. I swear when we if there is someone that comes in that is pregnant because they just see the sign that, you know, says that there are children that come here, they lose their minds, like they don't like OB patients like that is not for them, but they're really good. A lot of them are really good at taking care of kids like but they're going to console like a cardiologist. If a kid comes in with a heart issue. They're going to console endocrinology when we have a dk a kid every time because they want the expert in that specific area to make sure that they're giving them the resources so that they can give this patient the best care that they can receive.
Scott Benner 50:06
Okay, but there are doctors you wouldn't want your kid to go to.
"Dani" 50:11
Yeah, there's ones that I would rather see. And not like I happy with who took care of my child when we were there. DKA. So does the doctor know that about themselves? I don't know, like, and I will say like one of the I had, I ended up with two providers taking care of my child like, one of them. I'm really glad that that was the provider that took care of my child. He is incredible and so thorough and so compassionate, but he is slow. And so like, when we are really busy, it's really frustrating. Like to be a nursing staff. He's going to take really great care of his patients into a really, really good job. But we are not going to be there's going to be a waiting room and it's going to keep growing, which, which decreases patient satisfaction. So then you're maybe not going to listen, like there's the flip coin of that.
Scott Benner 50:54
Yeah. How about just knowledge like, are they're, like, not just slow or fast?
"Dani" 51:00
Yeah.
Scott Benner 51:00
Do they know they're not good at it? Yeah, I don't know how I can force you to assess that. But do you think they know? Or do you think they're like they're pretending? And they're like, I don't know what I'm doing. But I gotta look like I know what I'm doing? Or do you think that they are just they think they're out there slaying it, and everyone else is looking and going, Oh, my God, like, we gotta like, don't send this one over there. Oh, killer. I'm trying to understand if people understand who they are or not.
"Dani" 51:27
Yeah, I think that it is varied. And I think that some people are introspective enough to say, this is not something that I love. And it's not something I'm passionate about. And so like, because I just know that I'm not as equipped to care for this patient as maybe. Dr. Smith next to me, who really loves this type of patient. Like I have a colleague who's like one of our providers whose child was diagnosed shortly after, and like, she loves taking those kids now because it means something to her like, she feels like she's making an impact. I think it's because of her child's like that. She feels more passionate about it now than she did before that happens. So
Scott Benner 52:11
you're very nice person you won't like put yourself in other people's like, minds and tell me what they think. Which is, which they call generalizing in case you want. Yeah,
"Dani" 52:21
yeah, I know, I'm really good at generalizing. I have opinions. But
Scott Benner 52:25
but you're being fair. You're younger than me, too, right? Like by a lot. But I also
"Dani" 52:31
like can be introspective enough to know that I, again, don't know everything about everyone. And like, my opinions are my own. And they may or may not be right. But they're the ones that I view the situation. And
Scott Benner 52:42
yeah, absolutely. But I was saying about the age thing, because like, I just didn't come from a gym, I don't really care. What could be nice to people if I don't want it. So yeah, when I'm being nice. I'm doing it on purpose. And when we're having conversations like this, I don't see the value in being nice. Like we're trying to get to the bottom of something. Do you know what I mean? Like so
"Dani" 53:06
I mean, yeah, I see what you're saying, for sure.
Scott Benner 53:09
But a couple generations behind me, you guys are just nicer.
"Dani" 53:13
Yeah, I, I will say like, there is a level of holding back. Because it's professionalism. And like, I know how to, like I tried to present myself well, but like, I will tell you like when I say that there, my co workers are adequately prepared. I know that they can step up and do the job if we really need them to. But I have a lot of co workers that are incredibly lazy. And I might not tell them to their face that they're incredibly lazy, like, out of being nice, but they're just lazy. And so they'll just delay things, which affects patient outcomes, because they're being lazy.
Scott Benner 53:44
So sometimes when I'm in that, in that ER room, and and things are taken too long on two hours, and I'm like, there's no reason for this to take that long. I'm right there just out there sitting there staring what looking at their email, is that right?
"Dani" 53:58
Sometimes, I will say that that's not always true. Because like you have to wait for the data provider to put the orders in. And if the provider then gets like sidetracked and does something else like, like I literally cannot like the way that things generate, like I can't pull medication out of the Pyxis if it's not available because you didn't put the order in ultrasound, maybe they have two other patients that need to be seen. So like it's not, not always but like there are definitely some times where I'm like, there are some of my colleagues. So I'm not speaking about myself, but there are some of my colleagues from like, What the hell are you doing? Like this patient, like, yesterday, I grabbed somebody else, like I had a colleague that was encumbered with something far more critical and there was a DKA patient there, but we had a patient that was trying to die like this patient was the other patient was not actually in DKA but it was like soft and slipping. Yeah, like me needs insulin but like, you know, it can wait but like let's get it going because like there's two other people that are available. To get this signed off and get it started while there, the nurse that was assigned to that patient was legitimately encumbered. So there was a delay in care, because they were, you know, saving someone's that was dying. So yeah,
Scott Benner 55:13
but but do some people just slip through the cracks? Like are there like, are their doctors and nurses that are just like, you know, crackheads, and you just like, do you look at them and think like, I How did you even like pass the test? How did you get here?
"Dani" 55:25
100%? Like, are there lights in your head? Like, wake up? Okay.
Scott Benner 55:34
Yeah, absolutely. All right, and do and we have some people who are very knowledgeable, who are have bad bedside, but you're gonna get good care. There's people vice versa. There's like, there's all different kinds of people. Does it balance itself out? Or does it lean to the wrong side?
"Dani" 55:50
I hope that it balances itself out. I hope that it does. I generally genuinely think people that work in pediatrics have like a different perspective than people that work with adults. And maybe that's like a little bit harsh. But I think you have to have some level of patients that you don't have to have with adults. And like, I think your level of patients with adults is like my level of expectations when I'm taking care of adults is that you're going to curse me out and you're going to like, be mean and rude and disrespectful. Even though I'm literally here trying to help you. And like, kids are just better, like kids are so much easier, even if they have parents in there like kids, if they're upset and crying like they have a legitimate reason to be doing. So the majority of the time. I think that that lends itself to like being able to be a little bit more empathetic and compassionate as a provider like and someone caring for that kind of patient. I see. I see. I have been cursed out one time since I've in the five years that I've worked there and I got cursed out almost every single time that I worked before with adults so with adults every day somebody let you have it in one way or another and yeah, absolutely mean or just Kersey both like sometimes mean sometimes shore sometimes, like legitimately wanting to get something like that I just don't have the resources or bandwidth to support
Scott Benner 57:06
right can they get personal? They like like your looks or something like that come into play or anything that ever Oh, totally okay. Oh my god. So sorry. So basically can go got you imagine you're working as hard as you can. And on top of somebody all that somebody's like talking about your thighs or something at the same time. And you're
"Dani" 57:34
like, Yeah, I like we'll never forget this one patient whose name I cannot use quite like when I was a new grad like working on this cardiac step down for her. She was just mean to everyone like so mean. Like, I was definitely the youngest person on my floor. And she would just like let me have it for being so young. Like you snarky little brat like you think that you know everything at 20 years old, like get out here. I like she would come out with her walker and just like, oh, he ended up yelling at me. Oh.
Scott Benner 58:05
And that's part of the job, right? Yeah. Okay,
"Dani" 58:08
got it. I understand. I mean, she was mad because you're not pushing her morphine fast. So that, you know, no, okay, you mad at me? That that's just it is what it is right now. Ma'am.
Scott Benner 58:18
I had somebody else. Tell me something recently from a pediatric er perspective that threw me off so much. I'm going to ask you the same question. You see kids come in OD on things that their families leave around the house. That every day, that's a thing that happens constantly, right?
"Dani" 58:35
Every day, every single day. You know, I guess there's, I don't have to talk so I can't speak to this, but there's a tick tock challenge. Don't take too much Benadryl that can kill you. Also, it makes you hallucinate and be crazy. Like I feel like Benadryl right now is like the thing. Thailand, like I'm not exaggerating yesterday, like we had three overdoses yesterday. Intentional, and like abusing drugs like you know, we'll get kids that come in that smokes or do marijuana within whatever way that they do it. Usually smoking but I know people take edibles and whatever.
Scott Benner 59:10
I'm just thrilled that you said do marijuana. Go ahead to
"Dani" 59:13
marijuana however, whatever way you do it, I don't know. I'm not. I'm gonna guess I learned a lot from these teenage kids like things that they told me I'm like, I am learning a lot about drugs right now. No,
Scott Benner 59:25
I'm gonna guess you don't do marijuana by the way. You said that. I like being reservist. I have never done it in my life. Yes, No, I've never done it so so it's a funny way of saying it.
"Dani" 59:35
Yeah. Like
Scott Benner 59:36
so edibles late like little kids get a hold of edibles laying around the house. Yeah, we'll get like two or three year olds in there that like you know, have some brownies and their highs. They're just little kids are high as a kite. Right?
"Dani" 59:47
Well, they're just like, pass out like for hours like Yeah, yeah.
Scott Benner 59:53
What happens there? Do you report the family there to social services or how do you handle that? Yeah, it
"Dani" 59:58
actually depends on like, Yes you do make a report Social Work handles that but like what degree DHS follows up is really variable. You know, if somebody is positive for marijuana and they're breastfeeding their child there's actually like higher levels. THC in breast milk because it binds to the fat like that is how Oh, THC is like done so like the there are higher levels in breast milk. A better
Scott Benner 1:00:21
way to do edibles. Yeah, in breast milk.
"Dani" 1:00:25
There you go how some smokes marijuana still. Eats edibles.
Scott Benner 1:00:31
You're fantastic. Okay, so, you know, I mean, listen, when Cole was like, a year and a half, two years old, it was Halloween. And we were carving pumpkins, and I left that knife on the floor, and he kicked it. So we got to cut in between this the webbing of his toes. We take him to the ER, it's terrible. Yeah, social services was called on us for that. Yeah. And I was like, Oh, okay. Like, it was a scary moment. I remember, like, wait a minute, like, you're gonna take my kid because I was carving a pumpkin with him. Like, that's weird, huh, I think it's a great thing.
"Dani" 1:01:02
I mean, we screen every child that is under the or two and under for child abuse. So there's like a 14 spaces is what it's called. And it, you know, helps us identify potentially kids that are slipping through the cracks. And, you know, that's a really good advocacy piece of things.
Scott Benner 1:01:17
But do you pick kids up weekly, daily?
"Dani" 1:01:20
I don't know what the data is supporting from that. So I couldn't speak to that, like on a
Scott Benner 1:01:24
but you've had it happen to me you've screened so I thought this kid's being abused. Actually, my child, this is really embarrassing, like,
"Dani" 1:01:31
right when we rolled this out, one of my co workers, the short version of the story is my child had a bruise on her face. She was just starting to like walk at that point in time. And so like, you know, like when they're just walking and getting bruises on their face, but it flagged as positive for that particular screening because she had gone in for croup. Yeah. And I screened positive for my own child,
Scott Benner 1:01:51
right when we went live with that. So and even though you work there, they report it.
"Dani" 1:01:55
It's literally on her chart. I can see it on there still, to bear. We have kids that come in there. And like if it's explained, and like I'm not hiding it, like this is what happened and right. You know, she's just walking and starting to like, she hit her head on a table like, yeah, like, I was supervising her. But she is a klutz right now because she's
Scott Benner 1:02:14
just paddling. That's where the word comes from. But yeah. And
"Dani" 1:02:18
so like, it's an explainable like situation. That just happened to like, she hit her face just on the wrong spot that just kind of flag that screening. Yeah.
Scott Benner 1:02:26
And so now the good thing is, it's written down in case it happens again and again and again, then we can correct Yeah, see, see the pattern? I got patterns? Yeah. Okay. All right. Oh, God, do you wish you weren't a nurse? To wish you would have picked something else? No, I
"Dani" 1:02:40
think that I like what I do. Now, I've gotten to do a lot of different kinds of nursing. And I've done some other nursing that I've really enjoyed. And I really can't imagine doing anything else. And I am really, really grateful for the opportunities that it's afforded me and people that I've met and things I know, like, it makes me a better human, to have to learn how to communicate more effectively. Like, I don't think I would be good at business because I think it's taught me how to be empathetic in a way that you can't be empathetic otherwise, yeah, I'm glad I'm a nurse,
Scott Benner 1:03:14
I'll tell you a secret. It's not really a secret. I'm telling you. My wife just started a new job, okay. And for her entire career, my wife's an old person, she's 50. And so for her entire, she's not that old. Oh, my God, I don't know, she looks don't tell her that. She's actually younger than I am starting a new job. And for her entire career, she's put a premium on being kind to the people that work for her. And to help them progress and to learn and to grow and to move up. And over and over and over again. Throughout her career. It has been held against her. And and, you know, by people above her when they're looking at my wife for her advancement, it will be listed as a detriment not a positive that Kelly cares about the people who work for. Like, I've seen it numbers of times. Right? Right. But she just started a new job yesterday. And it's a great position. It's one of those like, career cumulative things like this is exactly what she wanted to be doing. On her first day, the person that hired her said, we knew immediately you were the right person for the job. And keeping in mind 75 people
"Dani" 1:04:30
applied for this job. Wow. Bravo, Kelly. Oh,
Scott Benner 1:04:33
very cool. I'm super excited for but one of the things the women's The woman said was, we're very focused on our employees being treated well. And it was clear that you knew the technical aspect of this job and had that lifelong experience. And on top of that, were willing to put in the extra effort to be a good people manager. And so my wife finally got paid back for what she's been doing for, like three decades now as a professional person, but for the first three decades, it it hurt her pretty consistently. Yeah,
"Dani" 1:05:09
I think I can relate to that, like in the military, I'm, I've always been kind of a sensitive soul and has not always served me well in the military because I have moments where I cry more than most. And like, as an ER nurse, that's not something those people tend to be a little bit more harsh, I guess is the right word, like just direct maybe is a better way to describe it. And so, I mean, it's, it's, those two things have really encouraged me to be more direct, but I don't think that I still lacked the empathy, which is valuable. And I think like you again, you have good managers and bad managers. And I think the way that you say things matters to people, it does impact them. So
Scott Benner 1:05:49
I'm gonna finish with this. First of all, ask you, is there anything we didn't talk about that you wanted to? And then I'm gonna ask you one last question.
"Dani" 1:05:55
I don't think so. I mean, I'm sorry, we didn't talk a ton about diabetes. And it was more about
Scott Benner 1:05:59
No, you're misunderstanding this is all. If this goes the Well, the way I expect, people are learning how to navigate the medical system by listening to this conversation, which will help them immensely with their diabetes, like, listen, like just because today, we talked about Danny and her working in the ER, this is no different whether you're in an ER going in a doctor's office, or you know, in an urgent care or anything like that, to remember that you're just dealing with people, right? That's it. They're not magic people. They're not wizards. They're just people were like, you know, I think I'm gonna be a nurse, or I'm gonna try to be a doctor, just the same way. You said, like, I think I want to be an actuary. Yeah. You're not perfect. You're not a perfect act. Although actuaries are a bad example. Those people might be perfect. That's a mental illness in and of itself, but good for them. But very, very, very specific. But you know what I mean, like most of us go into things because like, yeah, this seems interesting. But 15 years later, you might be like, I don't even like this, or I'm not very good at this. But I'm stuck, I got a mortgage. So I go in every day, it's not to say that people are bad at their job, or that you're going to get bad health care, because you're going to get plenty of great health care. But you don't know who's who. So you can't just absolutely, you can't just run in and go, I'm here to take care of me. And if it's all going backwards, go well, I must be dying, because everyone here is on the exact same level and has the exact same amount of enthusiasm for this because that's not the case. And I just think people need to be reminded that sometimes it's nothing. Like, if I could say one thing to people like as patients coming in, like, you know, an advocate cating for your child, like Sorry, I'm not gonna speak to the adults, because I have worked with kids right now advocating for your child like, one, you don't see the whole big picture of what's going on in the emergency room. And like, yes, that can be incredibly frustrating. And maybe you do have a lazy nurse. And for you, I'm
"Dani" 1:07:57
very sorry that you got stuck with that assignment, like you got stuck with baby nurse. But I think taking a deep breath and saying, even if you say it to the nurse, like I don't care when people say this to me anymore, I think I probably cared when I was 22. Hey, I know that you're here and you're taking care of my kid. I just want that what's best for them. And I'm not trying to be like, giving you a hard time. But like, how can I make this better? Or what can I do to like contribute to this situation? Or like, How can I help us bridge the gap of like what I need. So like, I really want this to happen right now. And like, if you just I think sometimes people get rightfully so deeply concerned about their child, and I want them to be deeply concerned about their child, because that's who they're therefore, right. And I have other patients I'm managing, but like your child is the most important. Just remind me of that. And it helps me take his time out to be like, oh, yeah, like, absolutely matters right now. I think it helps people slow down to like, Yeah, I'm here and I care about my child, and I just want what's best for them. I'm not trying to take it out on you like, sorry, if I'm getting a little snarky, or snippy, but I want what's best for my child,
Scott Benner 1:09:06
remind the doctor or the nurse of the humanity, the whole thing? Yeah,
"Dani" 1:09:09
like you're doing the best that you can. I don't know the whole picture. But I care about my child the most right now. And you should know. That's great.
Scott Benner 1:09:18
That's great advice. In your note to me, you said that the lessons you've learned from the podcast, not from your 10 years of nursing have been valuable helping your daughter. Yeah. And so this is question asked partly. So that, you know, you can say something nice about me. But also because I want to understand what it is that a 10 plus year nurse didn't know about type one diabetes. I
"Dani" 1:09:48
mean, I said it previously I was scared. And it was just because of a lack of knowledge and lack of desire to learn from a personal standpoint, because it was something that I didn't understand. And so It has not only helped me like with the tools have like, the things they don't teach you necessarily right off the bat of like Pre-Bolus thing and thinking about fat and protein. And, you know, like, your range doesn't play like they were telling me to treat a low at 90 at the beginning, I'm like, treating low at 90, you are insane. Just got an IV. Like, you know, knowing that I can change my target range, and it doesn't have to be the same and like that my child, like I cared the most about my child when I go to endocrinology appointment, and they're doing what's best for the masses. And not everyone has the same knowledge and literacy and medical understanding and background that I do and like knows how to advocate and do those things in the same capacity. So like they are teaching at a level that is generalized because they have to because that is the way that they can reach the majority of people. When
Scott Benner 1:10:52
I say that on the podcast, I wonder, I hope it comes across the way I mean it like it's not an indictment. Like it's just it's, it's what it is, you're gonna get,
"Dani" 1:11:02
I don't think they're doing it in a malicious way either like they're doing it because I mean, I see people on a day in and day out basis, like the people that listen to this podcast, like, good on you for wanting what is best for your child. But I'm going to tell you, like some people just don't have like the bandwidth space knowledge bank, like resource level, like the gear to know that there are that there's more out there to get better.
Scott Benner 1:11:28
Yet to even imagine that there's more than what's being said. Yeah, yeah. And I take that for granted. Because that's a that's a basic personality trait of mine.
"Dani" 1:11:37
I'm with you. I want to be better, I want to do the best that I can. I assume
Scott Benner 1:11:41
that I am always doing something wrong. Right. And I don't mean that in a way of like judging myself. I mean, that I assume that there's more information that I don't have. And I mean about everything. When I'm buying something, when I'm taking care of a pet when I'm you know, trying to consider my children's health when I'm trying to consider my own health. Like I never think oh, we got it. I always think Alright, well, there's more. But there's, I bet you there's more past that. And what is that? And how do I find out what that is? Yeah, that's a like a mainstay of how my brain works. Yeah. Can I ask a disconnected question to see? Yeah, absolutely. earlier in the episode, you said the company I work for. And I think people would don't think of hospitals as companies. But very much so right. I'm
"Dani" 1:12:34
not going to speak to like my specific role. But at the end of the day, a hospital is a business, and they are there to make money. And there are bottom lines, I know that I still have a lot to learn about that piece of it. Because it's not something that I like, I've been a bedside nurse for the majority of my time. But it's a business at the end of the day, and they're there to make money. And there's a bottom line. So yeah, it's a company in an organization. And they might be not for profit. They're there for a profit, they have to pay people and they have to pay an overhead fee, and they have to keep the lights on.
Scott Benner 1:13:06
So they also want to be careful moving forward about some of these organizations that have so much capital that they're they're basically a hedge fund operating as a something else. Don't I mean, I see colleges like that now, where their goal seems to be more about investing the money that they have, then teaching kids. And that can happen in any industry, once capital gets so big, they can start seeing themselves literally as an investment firm that happens to also own hospitals. Right? Anyway, so the reason I be wrong,
"Dani" 1:13:41
I think my organization really does care about children and wants what's best for them and the outcomes that are best from them. But at the end of the day, there's a bottom line. Also,
Scott Benner 1:13:48
also, yeah, I'm not flattening out the organization talking about it. Like it's a general, the people on the ground are normally always very, I think about that even like when people complain about like pharma companies and stuff like that. They're like them them, like, you know, most of the people that work there are people and they're trying really hard to do a good job, you know,
"Dani" 1:14:06
right. Majority of the employees there are that
Scott Benner 1:14:09
right, and there's somebody at the top is counting the beans and being like, yeah, would that make the toilet paper thinner? Like, you know, like that that kind of thing is happening? Right. But do you think like, based on that idea that they are money making ventures? Have you seen enough of AI based stuff to think that it's going to make its way into hospitals because right now, I'm involved with a company called Vision AI, it's a startup, but I'm seeing what they're putting together. And it's almost cursed for no reason. But it's being fascinating, like mine, a person I know, was having a problem the other day, right? And this problem, would they call me they described it to me. And I said, I think you need to go to the ER, but first and I opened up this vision AI poor All that I have, because I'm able to be using it now before it's widespread with everybody. And I put in not even like a coherent sentence, I said to the person, send me all your symptoms. And she sent them to me not like not even coherently like there weren't even like periods or commas. And I copied it, pasted it in the the AI, the AI came back with five possibilities of what could be going on. They were all rock solid. And the top three guesses. I was like, it's going to be one of these things, it's either going to be a drug interaction, or it's going to be a mass. And like seriously like that, clearly. And I said, Go head off to the hospital off the hospital did a brain scan came back it a little more testing said, Hey, you're having a drug interaction? And that was it. I was like, Oh, my God, the machine knew. Like, like, at what point? Do we stop worrying about how long the doctor takes to get back with its orders? like at what point are we going to start asking machines and then having doctors be overseers of the information that comes back?
"Dani" 1:16:05
I think that you're spot on. I think that technology is always advancing, and we would be amiss not to use that type of technology, and integrate it and it's only going to propel things forward. And I'm really, like, hopefully positive, like you got to have guardrails on it to make it safe. Of course, yeah, we would be remiss not to like I know that efficiency has increased as a result of technology. But even in the diabetes realm, I was talking to one of my other providers the other day, like, the way that ai ai has extracted information, and helped us create data from that that's meaningful is only going to allow us to like not have to spend the time as human beings doing that. And now it's generated. And so then that will propel us forward to the next step of whatever AI can contribute. So yeah, I
Scott Benner 1:16:52
have this idea of theory that people are going to become technicians in healthcare, and no longer the repository of information because that's really a doctor as a person who's taken years and years and years to learn a lot of things and interactions. And this plus this plus this could mean this, this and this. And here's how we'll figure out if it which one of those it is right. That's all it is. It's it's a process of elimination. Yeah, I'm pretty right about that. Right?
"Dani" 1:17:21
I will tell you that I see my providers, even the ones that I think are brilliant minds, looking things up on up to date.
Scott Benner 1:17:30
Right, it's Yeah, being a doctor is process of elimination. It's it's starting off with some knowledge honing in and then eliminating till you get the answer differential diagnosis till you get the answer. And so we're counting on reasonably intelligent people. Which by the way, I've seen a study recently, it says that the most intelligent people are not the people who become doctors. They're still very intelligent, but they're not at the top of the anyway, that's not important thing. Yeah. So. So we're asking, intelligent, well educated people to make these decisions and whittle us down. And you can see that it works great. In some situations, you break your arm you go in. Now, there's a flowchart where, yes, the arms broken, this is the kind of break here's how we're going to fix it, boom, six months later, your arm feels better. Hey, tada, that works great, right? We're really good at stuff like that, hey, my hands are always cold. My hair's falling out. We're not as good at stuff like that. Like, you know, and, and you might have to go to a doctor for years and years and years. 15 minutes here, 20 minutes there before suddenly, there's this epiphany between you and the doctor and the notes and everything where somebody goes, Oh, my God, you've got whatever. Right, right. And now I think it's going to be possible for your literally like a portal, a web portal, you're going to be able to go to the hospital and say, hey, my AI doc says, This is what's wrong with me. And then go through that process and their AI Doc's gonna look at it and go, yeah, it agrees, then you're gonna have a technician who we used to call a doctor, go over it and go, I concur and move forward, and you're gonna get through that process. So much more quickly. Interesting to an answer. That's how I feel like it's gonna go. Interesting.
"Dani" 1:19:11
I think that you still have to have the human aspects because you still sometimes need, you know, like, you talk about like thyroid or like, you know, a glucose level, like, you're still going to need the human being to say, it could be that we need to do XYZ to figure out that you have diabetes or your arm is broken,
Scott Benner 1:19:29
or Yeah, no, I agree. I mean, I think I genuinely believe that. Obviously, a person is going to be necessary. I mean, for the foreseeable future that I can understand. Right? But absolutely, but I know generation two, I don't think I'll be alive to see it without it. Right. Right. But I I don't know that. We're going to need them to do all the work.
"Dani" 1:19:48
I agree. And I think we would be a mess. I mean, you think about it from like a telehealth perspective to like people can call a doctor on the phone. Yeah. Like, you know, videotaping. I will also say I've done In telephone triage at one point in my career, it's really hard to do some of that stuff. But there are a lot of things that you can rule out very easy over the phone.
Scott Benner 1:20:06
Oh, my God. Yeah, I mean, telehealth taught us a lot telehealth. Oh, we don't really need to see you that much. I guess. I'm trying something right now to show you. And if it works out, I'll read it to you. And if not, I'm going to call this the end. But I just typed something into this vision AI portal that I have. That's actually connected to Ardens, glucose information, her lost her live glucose information. So you can ask this thing. Anything from what's my blood sugar to, you know, I'm about to eat, like, bah bah, but I just asked it a pretty obtuse question. And it's thinking, and I'm wondering what's going to happen. So hold on a second, let's figure out here. But I've already asked it things like, you know, I'm going to eat 15 grams of carbs. Or I'm gonna eat 30 grams of carbs. I think 15 of them are going to be pretty fatty. How would you proceed? And it gives, like, pretty rock solid advice. Interesting. Yeah. And at the moment, the company is I probably shouldn't say this out loud. But I've entered into an agreement with them and they're, they're taking the information from the podcast and adding it to the what the algorithm what the AI understands. It's pretty cool. Okay, so hold on. Thank you for adding valuable information. Oh, yeah. What do you say? Okay, so I haven't pre read this art and just had a spike. Now. She clearly didn't Pre-Bolus Emile, but she didn't miss by much because it shot up and came right back down again. Okay, how could I have avoided the most recent glucose spike to address most recent glucose spikes you experienced which peaked at 252 at 11:49am. Today, we can analyze the surrounding circumstances and data to provide some actionable steps. Analysis of the glucose spike one timing and previous meals the spike occurred late in the morning which might suggest it was related to your breakfast or late morning snack. reviewing what and when you ate during this time could provide insights high carbohydrate meals or snacks without adequate Pre-Bolus and can lead to spikes to insulin Bolus and timing at 11:44am and 11:40am. You administered point nine units of insulin each time that's the algorithm by the way her algorithm was Bolus. It knows all this because it has access to her Nightscout. Before that, at 11:30am, there was another point nine units that were given considering the timing of these boluses in relation to when you ate can be crucial. If the Bolus was given too late relative to when you started eating, the insulin action might have been delayed relative to the peak glucose rise from your meal, carbohydrate counting and insulin to carb ratio ensuring that the carb content of your meals is accurately counted, and that your insulin to carb ratio is accurately adjusted or correctly adjusted for the time of day will help in ministry the right amount and in some observations. The Bolus has given were relatively close in time, which might indicate either a response to food intake or an attempt to correct an already rising glucose level the amount of insulin administered suggests either a smaller meal or a corrective dose. If it was meant to cover a meal it might have been underestimated. Then it gives actionable steps talks about Pre-Bolus thing you could aim to administer insulin 15 to 20 minutes before eating bla bla bla, review your heartbreak count, continuous glucose monitoring adjustments, use your CGM trends to make real time decisions, dietary adjustments, consult a diabetes care specialist by and it gives by the way, every bullet point I just went gives a description about that underneath.
"Dani" 1:23:23
Interesting. Yeah, I will say like one thing I've noticed about AI, is I feel like it's wordy. And I know you can change like the grade level. But I've noticed I've noticed that it's relatively wordy. And I think for a vast majority of people, they kind of need more of like a one liner, two liner gut punch of like, Yep, I think that much information can sometimes be hard to consume and digest for the majority of people. Yeah, that's my only comment on AI in its ability
Scott Benner 1:23:59
to No, no, no, no, I agree with you. Like it's going to have to get more and more colloquial and, and concise. Yeah. Right. And be
"Dani" 1:24:08
like with our generation of like that. And I'm saying my generation, like I'm 34 like, I'm not, like really old or anything. But I know people want it fast and want it now. So they want to have it their way.
Scott Benner 1:24:21
I think it's coming because I mean, this is trained the way this company, you know, decided to and by the way, this isn't just for diabetes, this is for everything. Like I said I might, a person I knew was having a cognitive issue. And it boom, it was like it's either this or it's this and it was just it was just right. It was it was really incredible. It's fascinating, and these things didn't say anything. I wouldn't have said if you didn't if you would have asked me this question personally. Yeah, yeah. So and then on top of that, it's going to be trained on all of the management episodes of the podcast.
"Dani" 1:24:56
Yeah, yeah. So I'm really excited to see how technology Can you leveraged to make things better in the future? So
Scott Benner 1:25:04
I'm telling you, I'm super excited by the whole thing, so, okay, I'm gonna let you go. I've had you longer than I said I would. Danny, thank you so much for doing this with me.
"Dani" 1:25:12
Thanks so much, Scott. Yep.
Scott Benner 1:25:17
A huge thank you to one of the sponsors. G vote glucagon. Find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Ford slash juicebox. Arden started using a contour meter because of its accuracy, but she continues to use it because it's adorable and trustworthy. If you have diabetes, you want the contour next gen blood glucose meter. There's already so many decisions. Let me take this one off your plate. Contour next one.com/juicebox. A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days. With the ever since CGM you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juice box. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com
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