#1179 Cold Wind: Institutional Nursing

April 21, 2024Scott Benner

"Jessica" has been a nurse in a home for the elderly and a hospital for criminals.

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Scott Benner 0:00
Hello friends, and welcome to episode 1179 of the Juicebox Podcast

you didn't hear what just happened to me while I was trying to say Hello friends, but I'm going to cut it out put it at the end so you can hear it later. Why am I here? Oh, I'm here to tell you that this is another cold wind episode. I'll be talking to a person today who we're going to call Jessica. Jessica has had type one diabetes since 1993 When they were diagnosed at 22 months old. That's right, she's 32 today. Jessica is a registered nurse. She's worked at an assisted care facility with an elderly population. Currently, she's in a criminal justice based system that deals with people who have committed crimes or have significant psych issues. Please don't forget that 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 or becoming bold with insulin. Hey, the T one D exchange is looking for US residents who have type one diabetes, or are the caregivers of someone with type one they need you to take a survey the survey takes about 10 minutes your answers to completely simple questions that you will know the answers to help to move diabetes research forward specifically type one diabetes research. So if you want to help type one research, go take the survey T one D exchange.org/juicebox. It's quick, it's easy, and you'll actually help. Today today's episode of The Juicebox Podcast is sponsored by touched by type one. This is a fantastic organization that I've been dealing with for years. I go to do their speaking events. They care about people with type one diabetes, they're doing terrific work for them and I'd like for you to go check them out at touched by type one.org. Go find out what they're up to, and then follow them on Facebook and Instagram. Today's episode is sponsored by Medtronic diabetes, a company that's bringing people together to redefine what it means to live with diabetes. Later in this episode, I'll be speaking with Jalen, he was diagnosed with type one diabetes at 14. He's 29. Now he's going to tell you a little bit about his story. And then later at the end of this episode, you can hear my entire conversation with Jalen to hear more stories with Medtronic champions, go to Medtronic diabetes.com/juicebox or search the hashtag Medtronic champion on your favorite social media platform. This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since it's gonna let you break away from some of the CGM norms you may be accustomed to no more weekly or bi weekly hassles of sensor changes. Never again, will you be able to accidentally bump your sensor off. You won't have to carry around CGM supplies and worrying about your adhesive lasting. Well, that's the thing of the past. Ever since cgm.com/juicebox. Let's find out a tiny bit about you first. Jessica. Do you have type one diabetes?

"Jessica" 3:08
Yeah, since 1993 93

Scott Benner 3:11
How old were you then?

"Jessica" 3:13
22 months?

Scott Benner 3:15
Oh, no kidding. Yeah,

"Jessica" 3:17
I was I was a little tatertot

Scott Benner 3:19
that's gonna say that's young. How about that? 93,003 1323

"Jessica" 3:24
and 32. Now Wow, look

Scott Benner 3:26
at that. Good for you. How you doing?

"Jessica" 3:30
I'm with my title. I'm okay. I have some early stage complications. But I'm but since going on a POM those have kind of slowed down. What were they? Um, neuropathy and early stage renal disease,

Scott Benner 3:43
neuropathy and your feet, your hands. But but your eyes are perfect. Okay,

"Jessica" 3:48
perfect. It's just my kidneys. And I was really stressed out my blood pressure was high. And that doesn't know my jobs. And so they put me on a blood pressure mat. And guess what? Everything. The protein urea cleared right up.

Scott Benner 4:02
Oh, when they got your blood pressure under control. That's

"Jessica" 4:05
why my diabetes went better. Like when I went on a pump.

Scott Benner 4:08
How far into diabetes. Were you when that happened? I

"Jessica" 4:12
was 25 years in.

Scott Benner 4:13
Okay. Do you think? How would you categorize your care for the first 25 years your outcomes? I

"Jessica" 4:21
mean, I was on old school insulins with peaks and valleys called it's not even made anymore. It was called 90 and ultra Plantae. And regular like Lintian Ultra linty aren't even made anymore. Yeah. Did you have monitoring? Yeah, we would check my sugar four times a day

Scott Benner 4:37
with a finger stick or some other way. Yeah, finger stick. Do you know what your A onesies were when you were growing up?

"Jessica" 4:43
Back then they wanted you to ride higher. So they were between seven and eight.

Scott Benner 4:47
Okay. And you think they actually were and that's where they wanted you. Yeah. Okay.

"Jessica" 4:51
Yeah. Because they didn't want those to happen in kids because there was some study somewhere that said they wanted there was brain damage. From lows, I don't know what the new research shows, you know, because this was 30 years ago, but they didn't want all these lows, like I would get low and have seizures. Of course, every time I dropped, I would get diabetic seizures like every time I hit 40.

Scott Benner 5:15
And how often was that happening to you? Oh, God, I

"Jessica" 5:18
can't remember. But I do remember how much I hated the seizures because I would I would get tired after but I wasn't like an epileptic seizure. You know, where you don't remember. I could remember how much it hurt to jerk around like a fish out of water. I

Scott Benner 5:34
wonder if I wonder how much that had to do with the existing insulin? how it worked, because 40 is a little high to seize. You know what I mean? Although the monitoring probably wasn't terrific, either. So who would even know you don't I mean, like exactly what your blood sugar was. Right?

"Jessica" 5:47
And the meters were old. And sometimes we didn't check immediately. They just knew oh, god she seizing gave

Scott Benner 5:53
you a bunch of stuff, check your blood sugar. And now you're 40 Yeah, all right. I gotcha. Well, that's interesting. And in any other episode, we would keep talking about that. But because this is a cold one, we're gonna fast forward significantly. And you have

"Jessica" 6:08
you probably just like the background of how people how much damage they have based on the control from the backer, you know what I mean? Well,

Scott Benner 6:15
I just, I want I want people who are talking to know who they're talking to, and what kind of understanding of diabetes you have. Because we're going to be talking about it moving forward. And you know, this should just know who you are a little bit. I don't know about like, you know, I just followed the course of your conversation. So I if, you know, some people are fine, they don't have any complications. But I just want to know, you know, a little bit about when you were diagnosed, what you know, and what you've been through, you know, two different jobs of yours we're going to talk about today, let's do them in chronological order. So the first one is, tell me about what your job was in the nursing home. So

"Jessica" 6:48
I was a registered nurse, meaning, you know, of course, the duties of a nurse, she would do assessments, admissions, administer medications, monitor for side effects of medications, basic registered nurse duties that people are aware of that you would see in a regular hospital. It's just these are elderly, frail. Sometimes we'd get younger patients, sometimes with diabetes complications that could no longer take care of themselves, because they were, too they were falling apart from bad care, or just sheer self neglect, you know, earlier in

Scott Benner 7:21
life than you would expect. Okay, so there's kind of two different kinds of age groups. You see, you see older that you expect to see in a nursing home and you see slightly younger who have had enough medical issues that they've they've ended up there a little more quickly than then the older people. Just let's first of all, just talk about nursing home care to begin with. Let's say I bring my parent there. They live there. Now I leave, they take a couple of medications a day. They've got some, I don't know, they've got some exercises they have to do they live in in a room basically by themselves, right? The room, what's the room? They

"Jessica" 7:57
would actually I've been in one facility that will only work there for a month, but my predominant facility was three years. They'd have four roommates.

Scott Benner 8:05
How large was the room? Well, it

"Jessica" 8:07
was like you'd have a bed. Probably 10 feet a room and then another bed. Wow. For being across the hall. That's it? Yeah. We they fit for people. Yeah. So

Scott Benner 8:16
east, the West in between beds. Yeah. And north to south. And they

"Jessica" 8:20
were it was like you could hear everything. When you're doing care. There was only a curtain. You'd have up to four people or at least two. It depends on your insurance, though. If you had better insurance, you had a single room. You were on Medicare or Medicaid. You had all the roommates.

Scott Benner 8:37
Gotcha. So more money gets you fewer roommates in this first place. But not privacy. Does it get you better care? More money? No,

"Jessica" 8:46
because you still have nurses are still taking care of 26 or more patients.

Scott Benner 8:51
So 26 Plus patients on the floor? How many nurses to those 26. One,

"Jessica" 8:58
I would have 26 patients I was responsible for how long was your shift? Eight hours? Three to 11.

Scott Benner 9:08
One nurse for eight hours for 26 people. They all need something pretty consistently or no?

"Jessica" 9:15
Yeah, everybody's completely debilitated with multiple comorbidities. Okay.

Scott Benner 9:19
How do you even manage that? Like do you just run from buzzer buzzer? Or do you just wear to you do what you need to do and try to get to people for the extra stuff when you can. 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 since CGM. Ever since cgm.com/juice box, 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. This episode is sponsored by Medtronic diabetes, Medtronic diabetes.com/juice box. And now we're going to hear from Medtronic champion Jalen.

Speaker 1 11:03
I was going straight into high school. So it was a summer heading into high school was that particularly difficult, unimaginable, you know, I missed my entire summer. So I went, I was going to a brand new school, I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people what type one diabetes was. My hometown did not have an endocrinologist. So I was traveling over an hour to the nearest endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown.

Scott Benner 11:37
Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 11:42
I honestly I just held back I didn't really like talking about it. It was just it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just kept it to myself didn't really talk about it.

Scott Benner 11:57
Did you eventually find people in real life that you could confide in, I

Speaker 1 12:01
never really got the experience until after getting to college. And then once I graduated college, it's all I see. You know, you can easily search Medtronic champions, you see people that pop up and you're like, wow, look at all this content. And I think that's something that motivates me started embracing more, you know, how I'm able to type one diabetes, to hear

Scott Benner 12:22
Jay Lynn's entire conversation stay till the very end, Medtronic diabetes.com/juice box to hear more stories from the Medtronic champion community.

"Jessica" 12:33
Do what you need to do, and then get to the extra stuff if like they're on the floor, of course, because they bring their buzzer and weren't tended to quick enough, I would have to stop what I was doing attend to that somebody had chest pain we had somebody with or in the case of diabetes, a hypoglycemic episode, you'd be tending to those emergencies in between juggling the basic stuff like administering medications and assessments.

Scott Benner 12:57
Is there any advanced doctoring going on? Like, having a problem that isn't quite figured out yet? Do people actually try to diagnose what's going on? Or is it just there's orders from their doctor about medications? And we do that thing, and that's it?

"Jessica" 13:12
Um, well, if there is a change in condition, we would get them further care, we would call the doctor and say, hey, this person is exhibiting this, but typically, it's just you get admission orders from the hospital, because they would come from a hospital typically, okay, you know, because they, the hospital would determine they needed further care along with the family. Sometimes they would be directed MIT's from family, it just depended on the situation. They would get their basic orders, like basic, everybody got the same basic admission orders. Yeah. And then they would get their basic medications that they were prescribed by the doctor, and then they'd be seen once a month. If they were on Medicare. I can't speak on the private pay. But Medicare patients can only be seen once a month. And then, which was kind of challenging for some patients because they were so sick and their conditions were rapidly changing. Once a month wasn't enough. Yeah. So everything would be done by phone.

Scott Benner 14:07
Okay. And that would be through the nurse and through the facility, not because you're not asking the patients to speak for themselves at this point about their health, right? No, okay.

"Jessica" 14:17
Everything's done by the nurse.

Scott Benner 14:19
So then you're counting also on the nurse understanding what's happening and, and relaying it properly. Yes. Simple things like medication. I'm supposed to get something at noon. How likely is it? I'm actually going to get it at noon? We

"Jessica" 14:31
had an hour before or an hour after window to give medications. I would be given nine o'clock meds at 1030. Okay, but that 11

Scott Benner 14:41
I gotcha. Because your verse rushing around. You're literally just can you tell me if there's 26 rooms in a row? Do you go get all the medication for 20? Sounds like you wouldn't, you'd probably go back and forth over and over again. Right? Because you don't want to waste things up.

"Jessica" 14:54
Right? You don't want to miss anything or have a meta or No, I know some nurses would do the 26 but the thing is then if you have to hold a medication because their blood pressure or something was low, then you'd be picking through the cup trying to figure out what met it was okay. So I would just go back and forth and pop the pills out of the container, right? Because they came in little med cards. So I would just do that as I would go. But you're going back and forth, back and forth, back and forth to the med cart to the rooms.

Scott Benner 15:21
What about a simple thing? Like a person who's wearing an adult diaper? They wet themselves? How long could they sit in that before it can get handled? Sometimes

"Jessica" 15:30
I'd have one scene for 40 patients, and nurses can help a scene out but of course, we had our nursing duties to tend to write our medical care, but I'm a cena with 40 patients, they'd be waiting for hours.

Scott Benner 15:43
Tell people what Cena means. Certified Nursing Assistant. Okay. Now, my mom has passed now, but she spent the last couple of years of her life in an assisted living facility. A certified nursing assistant, in my personal experience was some poor kid with a part time job. Or some lady who was working her second job or something like that, running around like crazy. And if you ask them any question, they didn't know the answer to anything they were they're performing tasks. And that was it. Am I undervaluing that? Or Is that about right?

"Jessica" 16:17
That's about right, because they don't have a lot of clinical knowledge. A lot of them I had some really good ones that do basic things like keep the head of the bed up on a tube feeder, when you had those CNAs that had basic clinical knowledge. Like some of them would say, you know, this dizziness isn't normal. I'm not going to get them out of bed, because I'm going to go call the nurse. So some of them had more common sense than others.

Scott Benner 16:39
Okay, so the good ones could do a little more thinking, yeah. And

"Jessica" 16:43
then they would be able to tell the nurse when something was going on. Yeah, we had some of them that knew the signs and symptoms of like low blood sugar and are brittle diabetics. They'd be like, You know what, you're acting funny. I gotta I gotta get the nerve

Scott Benner 16:55
to get the nurse to tell me something. These these people and you difficult job being asked to run around like crazy for 26 people for eight hours. These other poor people are changing diapers and bowel movements and cleaning people up afterwards. Crazy good paying job, right? You drive a Lamborghini, you were making like a million dollars a year. Now? What is that? What is one of those scenes make?

"Jessica" 17:17
When I worked at the nursing home? About 1314? an hour?

Scott Benner 17:21
Yeah. So for $13 Now I get to change people's diapers all day. Right? What am I? What a joy. Okay, and you're completely anonymous. Jessica. So what were you making?

"Jessica" 17:32
I was making 30 Originally, and then I went pool as they call it. So I went up to 37 an hour

Scott Benner 17:39
30 to 37. And not just and you'd only been doing it for three years. Yeah. Did you consider that a reasonable compensation for what you were doing? No,

"Jessica" 17:48
no, the amount of tasks I had to do in liability I had on my license with that many patients, it was not reasonable.

Scott Benner 17:56
Explain that part to people liability on your license. What is that? So

"Jessica" 18:00
what would happen is if you provided poor care, you could be or something adverse happened based on the quality of the care you provided. They could file a complaint of your licenses, the state, the state with an investigate your license, and you could actually lose your job. Okay. And your license your livelihood, if there was an incident that something happened, which could be a lot of different things. So with 26 patients, I can't monitor all the minor changes. I can't prevent every wound from occurring, because I can't turn everybody every hour. People are getting bedsores. That's a liability. People are falling. That's a liability because I've had, it wasn't my patient, but I know one woman whose patient fell and died. Okay. And she was in hot water because they're like, Well, what did you do to prevent the fall?

Scott Benner 18:48
That was on her? Right? And then there's a layer above you, like there's the administration of the facility, and then the owners the ownership, which you don't know or see the administration's under as much pressure as you are? Right, because they want

"Jessica" 19:02
to pass the state inspection to get funding from CMS, the center of Medicare and Medicaid Services,

Scott Benner 19:08
okay. Okay. Even at your 37 at your highest number. You're 37 How much cash in your hand at the end of the week did you have? I

"Jessica" 19:16
was working part time. So I was working about 12 hours a week. So 37 times 12. I'd have to do that math, which wasn't very much,

Scott Benner 19:25
but you had full time you'd still be making 37. Right. Okay. Okay. Did you feel like the administration had your back as a nurse? No,

"Jessica" 19:36
they were clueless. They walked around like no idea what was going on.

Scott Benner 19:39
But there are people who previously had your job though, right? The deal when

"Jessica" 19:44
did the director of nursing the administrators typically a business person, they have to be a licensed nursing home administrator, but their background is business and finance. So

Scott Benner 19:55
it seems to me like your job is the difference between spinning plates and Being told if they fall and break, we're gonna sue you or you're gonna get fired or something like that. And the plates being on a shelf and just it's like, oh, it's your job to keep the plates there. Like, I can keep those from falling, meaning eventually the plates are going to fall. Like you just you can't avoid it forever, right. 26 older, frail people with a lot of comorbidities, you're running around like a lunatic. And this the place make money? Yes. Like, could they have hired two people for an eight hour shift is what I'm getting at? Yes, yeah. Okay. So this is a cost cutting thing. Would you say? A person in that situation living in that situation? Is it just like, I hate to say it like this, but is it storage? Like is the idea like, Listen, you don't have a lot of time left, we're just going to do our best here just so you don't suffer and that you're getting what you need. But like we're not, you're not looking for quality of life. At that point, right. In

"Jessica" 20:56
theory, you are always looking for quality of life, because that's how the patients maintain their well being. But the way the system is set up, you can't provide quality of care or quality of life, right? I couldn't do range of motion like you're supposed to do. I couldn't sit everybody up. You know what you're supposed to I couldn't turn everybody like you're supposed to the basic nursing stuff you learn in fundamentals in nursing, I couldn't do because of time, because of time constraints Exactly. Like in nursing school, they recommend people that can't sleep, try something like a warm lotion and BackRub like, you know, nice tasks like that. But the elderly appreciate. Couldn't do it. Like everything, just open them up on pills to get them to fall asleep. Instead of trying non pharmacological intervention. Just dope them up on pain meds and put them to sleep that way. Yeah.

Scott Benner 21:43
Yeah, I had to stop them from doing that to my mom. At one point. I was like, Hey, I think my mom's high all the time. What are we doing? And it wasn't what she was looking for either. I even thought like stuff that they would say like, oh, there's a community room she can go down to, we're not going to help her get there. Or you know, whatever. Yeah, like, but if she can get there, great. And then if she walked out in the hallway and made one wrong turn, they'd be like, Your mom doesn't seem to know where she is. Like, it's a big, like, expansive corridors, like she just got there. Like, I wouldn't imagine she'd know where she was, you know what I mean? And then they act like, well, so she can't go to the community room. Is everything felt like an excuse to limit or not do something? Yes, yeah. Do you really mean and when stuff didn't happen? It was kind of hilarious. So in my mom's room, at the first place, she was there's, you know, a cord, your pole for a bell, right? Goes to the nursing station. So my mom falls in the bathroom, and she pulls the cord. But it doesn't work. It never alarms, the nursing station, nothing happens. So luckily, my mom was trying to go to the bathroom and tidy herself up right before she knew somebody was going to come in. So she only spent about 10 minutes on the floor. But she was 10 minutes kind of folded on herself not in a precarious position. But luckily for her someone was coming in. So she got found pretty quickly. And that made me Of course, call the place and say look, you know, she pulled the bell, the Bell didn't work. And she was oh, no, you know, we'll we'll check into that. Then no one ever gets back to me. And then I press it. And it's like, oh, yeah, the wall. So there's a problem with the bail system, but we're getting it fixed. And I was like, Okay, great. But I called back in two weeks, is the bail system fixed? No, I'm gonna call you in seven days is the bail system fixed. Now this went on and on and on until I really got upset and pressured it, we're gonna get somebody out. We can't get somebody out here because of COVID. And I said, you can't get somebody out there to fix the Bell system because of COVID. I was like, that doesn't make any sense. What is COVID have to do with any of this? And then they didn't have an answer for that. And then finally, one day, I was in my car. And Jessica, you don't? I mean, you know me if you listen to the podcast pretty well, but you don't know me know me. Scott in his 20s didn't have a good temper. So it's got as an adult as okay. But I get a call one day I'm sitting in my car, I pull over to the side of the road, and a person gets on the phone and says, Hey, we just wanted to let you know, when your mom fell. People didn't come not because the Bell didn't work in her room. The bell in her room works fine. And I went, Okay. And I said, Why didn't they come? And she said, The Bell didn't work at the nurse's station. So the system works fine. It's just at the nurse's station, there was a problem. And I went, No, this system doesn't work fine. If one and it's a walkie talkie if one of them works and the other one doesn't work. The walkie talkies don't work, because now your mom's walkie talkie works. And we had this inane conversation that went on for a couple of minutes until if I'm being honest, I screamed at her and hung up the phone. And I believe part of what I screamed was fix it and 24 hours or I'm calling the state. And then 24 hours later, they it was fixed. It was amazing. Yeah,

"Jessica" 24:57
well, this is a little outside track, but I was Allstate. I did it for eight buttons. I was a state licensing surveyor for nursing homes. With that I was going through and making sure they were following the licensure guidelines. And something like a call bell not working could be a tag, like you said, yeah. Because that puts the patients in danger. Anything that puts the patients in danger, it results in a fine. Yeah,

Scott Benner 25:20
as crazy as that all was, by the way, and by the also in the time that that that whole conversation was going on, like I told you weeks into a couple of months, they put literally bells, like you would see on a desk like you remember, like old movies, you'd walk in, there wasn't somebody manning the desk, and you ding ding the bell, they put those in their rooms next to their bed, I'm like, Well, how does that help her in the bathroom? Like, I don't, what are we doing so they were literally ringing a bell to get people. For a while, it was pretty horrible. Anyway, to me, the amount of times that the person I was on the phone with the amount of times that she insisted that if one side of the walkie talkie worked and the other side of the walkie talkie worked, and you were holding the one that worked, the system worked. That told me everything I needed to know about that place for the rest of my life. She had something in her mind that she thought would keep me from being able to sue them. And she was not going to she wouldn't say the system wouldn't work. If both sides didn't work. She said your mom's worked fine. She just kept saying that. And it was I was like, Okay, well, I'm I'm, obviously the truth isn't going to come out here. Let's talk about people with type one diabetes. In that setting. What is being done for them? Your type one is just how you'd want to be taken care of tell me the whole thing, really. So

"Jessica" 26:41
what would happen is you would be on AC HS blood sugar checks, meaning before meals and at bedtime. So you'd get checked four times a day, just like I did in the back in the day when I was first diagnosed. So they're doing an old school, right? Yeah. And then they would be on what's called for insulin a sliding scale. I don't know if you know what that is from. Okay, so from when your daughter had it, I don't know if she was on a sliding scale

Scott Benner 27:08
she never has. But I've talked to 1000 people have done it. So yeah, so

"Jessica" 27:12
it works like you know, zero to 150, no insulin 151 to 200, you get x amount of units, 200 to 250, so many units, and so on and so forth. And the scale typically stops at 400. And then at 400. You give 11 units, just a example number, and then you call the doctor immediately. Okay? So it's like, you're not getting meal coverage, you're just getting so many units.

Scott Benner 27:42
So could I, before a meal be under a certain level, and they would even give insulin for the food? Correct. So if my blood sugar is 149, and you won't give me insulin, typically no. Okay, in most sliding scales, but I'm about to eat. So you come back to me before the next meal, where I'm assuming you find my blood sugar in the three hundreds, and then I get insulin for that.

"Jessica" 28:07
Yes. Oh, so it's kind of like you're good at breakfast, because you get your Lantis you know, at night, which typically it was a lot of our facility use a lot of land tests. Okay, that was what was on formulary. You know, and this was it's just it goes off the formulary, right, so you get your Lantis typically a bedtime. And then you'd usually get enough Lantis to where your blood sugar was great at night. So you were almost like feeding the Basal, you know, because you wake up great overnight, and then they would expect that sliding scale to cover you for breakfast, or the blanches to cover you for breakfast, which we all know Basal rates isn't supposed to cover a meal, yeah, you would only get meal coverage after like a month or more a bad blood sugars, then they might give you two units for a meal, like a very small amount for meal coverage. But that was only when the sliding scale failed.

Scott Benner 29:01
So were most of those people living with higher blood sugars, correct? Yeah. And that affects their ability to be happy, I would imagine. And if they're in the middle of healing, that also slows that down.

"Jessica" 29:13
I would just, it's not conducive to their well being. Right, right.

Scott Benner 29:17
But it's not a consideration. Nobody says Mary has a wound on her arm. Let's try to keep her blood sugar tighter so it heals more quickly or so that we don't talk about like that. No,

"Jessica" 29:27
we just do wound care like the wound care that the wound care dock orders, but the diabetes perspective is never considered in that. Yeah.

Scott Benner 29:34
So these people are basically being treated like an old car that's falling apart that we can afford to replace. So we'll just fix whatever falls onto the ground and then hope the bumper stay stuck. And if it doesn't, we'll glue it back on until the door handle falls off but we're not trying to we're not trying to renovate the car I guess is what I'm saying.

"Jessica" 29:54
They're not sure I don't know what the ANC goal is of the ADA. Now, like I said, My date was below seven. I think it's still below seven. We weren't shooting for that. It was just like you said, just repair on their agency came back at eight, we might modify the insulin, depending on the patient, right. But they weren't shooting for an agency of 5.5. Yeah.

Scott Benner 30:16
Do you know if I asked you what the average amount of time is a person stays alive after they enter a facility.

"Jessica" 30:24
We have patients that were there for 10 years, but those ones were generally had less conditions. They might have just had like severe disability like muscle weakness and wasting, and they were private pay. So the private pay ones lived a little longer, because most of them were less sick.

Scott Benner 30:39
Okay, so private pay people that would indicate I had, I can't live at home by myself anymore. I don't have family to live with. And I've got some cash so I can afford to move into another place. So they show up a little sooner. But they're not as sick when they get there. Yes. Okay. The sicker you are when you get there, the less time you have. Correct. Okay. How would you feel if your diabetes was managed the way there's this horrible, that's the sliding

"Jessica" 31:09
scale is what we did back in the day, when I was first diagnosed. And my dad recently looked at my logs, and he goes now I'm surprised you're not dead today. And he was he's that type A, like personality, like perfection. Yeah. But we didn't have half unit syringes. And I was, you know, 22 months. So you're guessing game based on one unit and eyeballing a half a unit on a syringe. So he like I said, he looked at those numbers and said, How the hell do you not have much bigger problems? Yeah, yeah. And he tried his absolute hardest, like to have a normal childhood, yet have good numbers.

Scott Benner 31:48
Jessica, if I Google, how long does the average person live in a in the next word that populate self populates in Google is America but the second one is a nursing home. That's funny, and I don't I think it's a pretty average question I'd ask the current average length of stay in a long term care facility is two and a half years. Yeah,

"Jessica" 32:13
that sounds about right. If you look at admission dates on the computer, and then adapt date.

Scott Benner 32:17
Yeah, that's on NJ that's from nj.gov. Probably because I'm in New Jersey. So Google fed me back something local. There was tough, because you had that thought when you're when my mom went in, like, I felt like, oh, like it felt like you're on a countdown. Like she can live two and a half years. Honestly, it worked out almost, you know, almost exactly like that. So then the question is, is society doing something wrong? And are they doing it just because of money? Like so if all those people no matter how beat up they were, if they all had their own nursing care and could see a doctor more than once a month? Do you think they'd last longer than they do? Yeah, yeah. Okay. Is that a reasonable thing to ask? And as you're a person who's got type one, you worked in that setting, even if all the money was available, and the facility was willing to spend it and put all the nurses in there? Like how much would that change their lives? Do you think?

"Jessica" 33:12
significantly? Really? Okay, yeah, because no one feels good at 300. We'd have patients writing in the three hundreds all day. But then it's like I would do that previously in life, because we had didn't have CGM in my mid 20s. I was on Medicaid. So I didn't have a CGM. So I purposely write high, because I couldn't feel my lows. And I pass out at work right at that I passed out at the nursing home twice. Okay. And that was scary. They almost dial 911 for one of them. You know why? Because you can't have the nurse go down.

Scott Benner 33:44
So I laughed, because there's not one more nurse there to help you. That's the part that made me laugh.

"Jessica" 33:51
So luckily, I had one nurse that was able to help with the dementia Ward, which was like harder because the people would refuse care. You know, I'd get hit all the time that they took me off the dementia Ward upon my request, because it was just too crazy. But yeah, I passed out and my coworker slapped me across the face to get in response to pain, literally, like, slap me frontwards and backwards. And then she forced us down my throat like I could suck with a straw just enough to get the juice out my throat out of it. Wow.

Scott Benner 34:23
So I tell you keep your blood sugar higher. And but now that monitoring exists, you were CGM. Now. Yeah, yeah. And I love it. You don't keep your blood sugar 300 anymore. No, no. Okay. Is there any way in that setting that you could manage someone who couldn't help themselves? The way you're managing now?

"Jessica" 34:47
No, not what the number of patients I had that average 26 divided by eight. I can't I'd have to do a calculator. How many minutes you had to care for them, but it was less it was like 15 minutes if that okay. If I'm only seeing you 15 minutes a shift, I can't manage you as tightly as I, as I could. Yeah. And then we're not trained in pump therapy. Most people don't come in on pump therapy. And depending on the state, Medicare, Medicaid, or Medicare might not cover pump therapy. So the facilities take away anything that would provide tight control, because they don't want the liability of somebody accidentally overdosing on insulin with a pop. So

Scott Benner 35:27
did you ever see an older adult who just really understood their diabetes? And like, listen, I can do this? Or do they lose their ability to take care of themselves once they get there? Legally, we

"Jessica" 35:37
had a lot of people that were alert and oriented times for person place time situation, and they knew that they weren't being managed, and they're demanding to call the doctor. Right, you know, because they knew what was up. They knew it wasn't healthy to be 300. And have the nurse laws a fair use a sliding scale? Yeah, because they would just be on the yo yo, you're giving them no units for zero to 49, then they're up to 400, then you're slamming them with 11 units. And then they skip their meal because they're not hungry because they feel so crappy, right? No one likes being 400. And then you're slamming 11 units, and um, which I know everybody's insulin needs vary. But then they bottom out. Yeah. So they just get on this yo, yo, and I can't provide the care. But I know that they need

Scott Benner 36:22
right. That's never gonna happen. There's no fix to it. Right? Correct. Yeah, this is slightly off topic question. But I want people to have some context. Did you ever experience a family, bring an older person in get them settled? Say, hey, we'll see you Monday and literally never come back.

"Jessica" 36:43
All the time? Where they literally abandoned?

Scott Benner 36:45
Yes, yeah. So I learned how common that was from a friend of mine. And it really did shock me. So they get their parents to the facility, get them checked in, and then just ghost them. Like don't pay the bills. Don't ever talk to them again. They just disappear. Yes, yeah, that's not uncommon. Yeah. Okay. Well, we're all we're all doomed. That's fine. Least you picked a good name, Jessica. That's nice. We can be happy about that for a couple of minutes. Can I ask you the first time you realize that happened? What did you think? Do you remember the first time you realize this person has been abandoned here?

"Jessica" 37:25
It breaks your heart because we become your family, you know, and I can't provide you that same emotional support that I could if I had less patients. And those patients need a little more love. We would be hugging patients, you know, the ones that were allowing us to, if patients crying and you'd be holding their hand, but you're holding their hand for two minutes, not until they're done crying, right?

Scott Benner 37:50
You're like, Okay, I gotta go. I have to say that the people that my mom intersected with personally in her room were always terrific, always. And nobody was unkind. I always felt like you're describing like, there's, listen, there's not enough time for me to do the thing that needs to be done here. And if you want something to happen, you have to do it yourself. Like I would have to call doctors and browbeat them into just doing their jobs. Like Like, just really just push and push and push. I had a general practitioner who was mismanaging my mom's blood pressure, for example. And I finally just said to him, like, why won't you send her to a cardiologist? Like you're using a really old medication? It doesn't seem like you know, what, what's going on here? Like, why don't we give her to somebody that could help her. And then he did that. And then they were able to bring her blood pressure down. But for the months that he messed around with it, she couldn't get her cancer infusions to help keep her cancer away. And then my mom dies eventually, because her cancer comes back. But my mom's cancer comes back, possibly, because this guy messed around getting her blood pressure down. And so she couldn't get these infusions that were meant to help keep the cancer away after they've been removed. It feels hopeless. While they're there, everything about it felt hopeless. And the only thing that kept my mom from feeling hopeless, was her trying to keep up her good attitude. And that's the other thing is she's trying to keep up that good attitude. While basically most of her life is puzzle books and television and music and not much else in a tiny room, and nowhere to go. And nobody to help her go somewhere if she wanted to. So here's a hard question. And then we're going to move to your next job. If you got to the age where this was going to happen to you, you were going to have to go into an assisted living facility. But you had a switch, you could just turn your lights off and and be done. Would you turn yourself off or go into the facility?

"Jessica" 39:44
Turn myself off. You would because I don't want to die of a bedsore. I don't want to die of diabetes complications where you suffer you know like with the going to die dialysis being poked and prodded out there. Like I said, bed sores are very common in nursing homes because people are not being turned every hour like they're supposed to be. I don't want to die of drowning in my own fluid from heart failure because they couldn't get my blood pressure under control. I mean, just the variety of problems that occur. I would just like you said, I would just keep the switch off and call it a night.

Scott Benner 40:23
And even personal like, affirming personal interactions with family, there are too few and far between to be meaningful right.

"Jessica" 40:33
Now families like we had one lady where her debt hurt songs only concerned if she was eating. That's it. Because when people stop eating, that's when you that's when you're ready to go. Yeah, so he would call me every week, at the same time. And it was my shift. It was I don't remember if it was a Monday or Tuesday, but he would call and I would just tell him, it was a five minute conversation. Your mom is eating, I pull up the screen about 25 to 50% per meal. And he'd go is she taking her supplement? Because we'd have venture shakes? You probably know what venture shakes are. Yeah. You know, we've all seen them on the TV, is she taking her ensure at least Yes. And eventually she was eating 10% of a meal. You know, it got less than last minute she passed. But the song appreciated just a nurse, like calling him and telling him, this is how your mom is doing.

Scott Benner 41:24
So he could understand what was happening is horrible for everybody through by the way, I'll tell you like, I'd go visit my mom a lot. And by mom, I'll be back I'll see on Friday, like but you know, you go out the room and you close the door. You just stand there for a second and you're just like, oh my god, I can't believe I'm leaving. I can't believe I'm leaving her here. I feel terrible. She must be doing the same thing on the other side of that door that I'm doing right now. She must be sitting there thinking, oh my god, I can't believe he left. I can't believe he's not going to be back till Friday. Like, you know, it's just, it's tough. Listen, I'm sure there are plenty of people who have quality of life at the end of their life. But for the ones that don't, it isn't great. So okay, so they're not getting good care for their diabetes. They're the it's just like I said, you're just you're gluing the mirror back on when it falls off. But we're never going to, we're never going to pull the car over for an hour, pull all the mirrors and bumpers and doors off, strip it down payment and start over again. It's just let's see if we can keep this thing together. As for as long as we can drive it down the road. Your next job, where did you work at the next place? And is that where you are now? Yes. Okay. It is

"Jessica" 42:27
a forensic psych facility, which is state operated and run for patients that have committed a crime and they go there instead of jail because they were I don't like the term crazy, but they were crazy and were mentally ill at the time of their crime. Okay. I won't say the legal status because that could identify the state but as a particular legal status.

Scott Benner 42:48
Okay. All right. So people ended up there because either they were mentally ill and committed a crime or mentally ill temporarily while they committed a crime or said that they were once they got the court and the court believed them. That's pretty much how you end up there. Okay. People who have killed people. Okay, yeah. So from murder to something

"Jessica" 43:08
like maybe attempted murder or vehicular manslaughter. Okay, we had one guy that had bipolar disorder, and was driving a car recklessly and harmed a person,

Scott Benner 43:19
I think. All right. So you're running the gamut there with that situation? Now, are these people they're there for their? For the the mental health side of it. They don't necessarily have physical problems, right?

"Jessica" 43:33
Correct. But we do get people with physical problems, right? Because, like right now we're taking care of it. We have a type one on my unit. Okay.

Scott Benner 43:41
So let's talk about that. That specific situation, type one diabetes on that unit? Vi I guess first of all, how many people are you taking care of in a shift? How long is a shift?

"Jessica" 43:51
12 hours? You have two nurses for a house of 20.

Scott Benner 43:56
Well, that's better. Are you getting paid any better any worse? Slightly

"Jessica" 44:00
better, but I have more experience. Now. I'm making about 40 an hour now,

Scott Benner 44:05
making 40 for having more experience. You don't get a VIG for them having murdered somebody and you still have to help them. That doesn't work. Okay. Are you ever frightened for your own safety?

"Jessica" 44:16
Sometimes? Yeah. Because Because these patients have committed a violent crime they murdered somebody one time they lost their marbles murdered somebody one time. What if they go What if their mental illness start cycling again? Are they going to become violent?

Scott Benner 44:30
And you are in a room with them? They're not restrained or anything like that, right? They're just, they're living. Yesterday,

"Jessica" 44:36
I had three guys almost beat each other up. I had to get like one I had to pull off and say you go sit down in your chair. You put your shirt back on and sit down. I was firm. I mean, maybe not the most therapeutic but these two guys needed somebody blonde and short right? So I was like, put your shirt on it sit down.

Scott Benner 44:56
First of all, why is your shirt not on and secondly, stop hitting it. What do you You know what they were fighting about some

"Jessica" 45:01
girlfriend thing there was a bunch of girlfriend drama and they were playing a card game and the other guy was mocking him because he lost. So one guy was mad because he stole his girlfriend and and the other guy was mad at the same guy. Because he was mocking him over a card game. These

Scott Benner 45:14
guys have girlfriends. Yeah, like

"Jessica" 45:17
gruff six units.

Scott Benner 45:18
Oh, the girls that are other women in the facility. They're not people coming to visit them that are their girlfriends. Sometimes they are really, okay. And how many people in a room in that situation? Usually, like if

"Jessica" 45:29
we have visitation that's pre scheduled, we have a staff supervising of course, because they're not allowed to like, be too personal, like a peck on the cheek, maybe one peck on the lips, and then that's a wrap. Okay, you're not allowed to sit there and get touchy feely with each other. Right. But on other units, we have six units total, I work on the intake unit, the initial admission unit. So it's a little wilder,

Scott Benner 45:51
because they haven't settled into their lives yet. Correct. And once they settle in how many people live in a room? Are they singles are there multiple people in those rooms, on

"Jessica" 46:01
the intake room at singles on the intake unit, because patients are too unstable. And then on the regular units, that's about two per it's two people per room.

Scott Benner 46:10
Two people per room, okay? Okay, varying age ranges, very young, very old.

"Jessica" 46:16
We've got 18 all the way up to their 60s, sometimes seven days. And if

Scott Benner 46:22
that 18 year old, murdered somebody and had a license, they'll live there the rest of their life. It's

"Jessica" 46:28
a privilege system. I won't go into that. But they could be released early, kinda like probation. But they're still under the jurisdiction of the court. You know, they have to follow the rules of their release. If they don't they come right back

Scott Benner 46:41
to the hospital. Places always full, never an open bed. Right

"Jessica" 46:45
now we got a few open beds, but we're filling up again, we've got to get people moved along to the release unit. But that's all up to the courts.

Scott Benner 46:52
There's this cycle throughout the year. I don't know how this is gonna sound but you know, I run a pretty big Facebook community. And there are certain times a year that people are a little less stable than other times of year, like Thanksgiving to New Years is one of those spots, for example, like do you see that? ebbs and flows?

"Jessica" 47:11
Yeah, because the holidays are hard on people because like, daily can get visits for the patients that do have families in the area. But we had a couple people, one guy who was just passing through,

Scott Benner 47:21
and he did committed a crime, and now he's there. Yeah, he's got a 10

"Jessica" 47:25
and a half year sentence. And he served about six of them. And but a holidays, he's just calling his family. He's not there enjoying the cranberries and no stopping. And, you know,

Scott Benner 47:36
is there a moment when somebody's been there long enough that you see them as the person they used to be? Like, do they get to a point sometimes where you're like, oh, my gosh, like you don't even belong here anymore? Like, how does that work?

"Jessica" 47:51
Well, hopefully they get their meds right. Not everybody is severely mentally ill some of them just had a psychotic break. Like we have a postpartum depression case that really breaks my heart because she was postpartum and couldn't get the help that she needed, you know that. So she was temporarily insane. She wasn't fully but we keep her on her meds to keep away any signs of depression, but she's not on heavy duty meds, right, like antipsychotics, then we've got other patients where we hope to get through any psychotics up where they're good. And they, they're completely normal. Yeah, like they can talk coherently. They know what's going on, they're not hallucinating anymore.

Scott Benner 48:27
So they almost feel like they're experiencing that place the way you are. Yeah. And I

"Jessica" 48:33
also live with a serious mental illness. And they're, like me, like functional and you're like, Wow, you could go get a job if you wanted. You're

Scott Benner 48:42
having not made that mistake away from being me. And do you ever feel like and I'm having made your mistake away from being you ever think about that? Not that we're here to dig through you a little bit.

"Jessica" 48:54
I'm like, you always wonder like, wow, how did I get so lucky to have the treatment team that I did? That didn't let me down? Right?

Scott Benner 49:00
Because that's, that's how you see what's happened to them sometimes? Yeah. Okay. All right. So if one of those people has type one diabetes, how are you managing for them? Oh, we'll

"Jessica" 49:12
call him. Paul. We got two patients. I've managed one of them's now on a different unit. But we'll call the one guy Paul. Paul was managed with a sliding scale, like in my long term care facility, right. His numbers were so up and down. He was like, we weren't sure if he was a brutal diabetic as they used to call it. Yeah. Or if we were just mismanaging it. I thought the facility was mismanaging it because I know how to treat Type Line, right? I know how to use Lantis and carb counting and correction factors. Again, just a sliding scale. Yeah. Yeah. And you couldn't eat snacks, but he would eat snacks because what would happen if you need carbohydrates uncovered? They go up. So we weren't covering it and the guy was hungry like in between meals. He wasn't like overweight. He was very active actually. And poor Paul would just skyrocket. But it was like, Sorry, dude, I can't give you when someone, you know when I would feel bad because I know I just Bolus whenever I want to eat right? Yeah. But we don't have that option. It's just before check the blood sugar before meals, bedtime and as needed. Like if they're showing signs or symptoms of hypoglycemia. Well, I gotcha. So I just Paul, though, I have nightmares of him. By his sugars were so badly managed, he'd go to 40 to 401 day. And

Scott Benner 50:36
it doesn't matter because we're not actually actually proactively doing anything. We're just doing something on a schedule of when the meal comes up. That's it. I mean, I can't imagine that this is much different. There's no answer to this question, either. We can't let Paul have his own medication, right? He can't be in charge. Even if he was younger and not sick. You wouldn't put insulin in his care, I imagine. No.

"Jessica" 50:58
And it was sad because we wanted him he was also illiterate. Okay, English was not his first language. So poor Paul was different language speaking without revealing what state I work for. And it was like the one doctor wanted to put him on a pump. We don't have a patient with a pump. But we had another patients to the facility to get on a libre, right? Because he said, I want to be on the best control possible. So he successfully sued the state to be on a libre, because they're very, you know, they're more expensive than checking the sugar four times a day. Yeah. But he had to sue the state to get that right.

Scott Benner 51:34
Is that a thing? He actually did? Or did his family step in and do it for him? He had his

"Jessica" 51:39
lawyer do it, him and his lawyer because he knew that this tech was out there because his family told him about it. And they watch TV, right? So they can see, they see. And they watch cable where all the ads are. I saw libre

Scott Benner 51:49
ad last night during the Oscars. So they're watching it and they see

"Jessica" 51:53
this tech, and then they're like, why can't I have that? And they were like, Oh, well, we're not going to pay for it. So he sued, and he got it. It was otherwise he'd have to pay fight pay him out. But now

Scott Benner 52:03
that you see the blood sugar constantly, are you doing anything about it?

"Jessica" 52:07
They referred him to endocrinology. Is he

Scott Benner 52:11
getting better care now is the CGM answer.

"Jessica" 52:14
I would say it's a big proponent, because you can see that we would never do something as advanced as carb counting, just because a lot of my nurses are not trained in it. They don't know how to carb count. Half of them are bad at math. The computer system doesn't permit that. Okay, like the medical record, the one we use does not permit that carb counting with the correction factor and all that. It was horrible. Because I mean, it's numbers. We saw how bad they were. Just

Scott Benner 52:42
to get did you just say half the nurses are bad at math? Yes. Like, I mean, counting,

"Jessica" 52:50
like doing division, like I have 32 carbs and it's a ratio of one to eight, like the kid we got now. He's 18 diagnosed at nine. Right? This is a different patients. So Paul was our bad non English speaking diabetic. We have a new one. We'll call him Jonathan. Okay. So Jonathan knows how to carb count. And apparently when he was in juvenile hall, they would do carb counting. I didn't know that. But his ratio, he goes, my ratio is one to eight, which I laughed about because I'm in a one to eight ratio,

Scott Benner 53:20
like twinsies.

"Jessica" 53:24
So I was like, okay, so I go, because he's like, if I eat 32 carbs, I get four units. I goes to your ratios. One day, he goes, Yeah, what I think so. But he knew we ought to do that. Yeah. So he knew it. And he's like, why aren't we doing this for me? And I said, Well, the doctor wants to see a pattern of your numbers. He goes, You guys are just giving me numbers based on my number. You're not doing anything to manage the carbs. Why am I not getting insulin with my meals? Even if I'm 140? Yeah, same thing you asked earlier, right? This kid knows how to manage his numbers because he committed his crime in his early teens, and he sentenced to life. But he knew how to manage his sugars, which was really hard because he knows what's up. And I'm sitting here, I know what's up. And he's just, we're not giving him the care of it he deserves or the care he was receiving before. He's 300. I was like, I looked at my coworker yesterday is we give this kid 11 units because he was 318. He goes, You know, I'm like, this kid's gonna be blind by 30.

Scott Benner 54:25
So you know, what's happening? Does the administration understand it? I

"Jessica" 54:29
have nothing against nurse practitioners, but they're not endocrinology specialists. They're not an endocrinology and T. They're a generalized nurse practitioner. Yeah. So they start simple. And then they might refer them to endo if they can admit that they're not doing a good job. But it takes a little bit of their ego away, Jessica,

Scott Benner 54:47
for people who might listen to this and say, oh, yeah, sure. These people don't know. But look at the places they're working. This is where we house people that we've given up on or who have, you know, committed crimes, but you could go be a nurse in a regular hospital. No trouble, right? Yeah, yeah. Your credential. Do you understand? You could handle it? Yeah,

"Jessica" 55:07
I've worked in a hospital before. Right. Okay.

Scott Benner 55:10
I just, you know, not I don't think that by the way, I just imagined it's possible that some people could be listening and thinking that you're the nursing equivalent of the lady that makes the fries. You know what I mean? Like, but that's not the case like you, you're an RN, just like everybody else.

"Jessica" 55:26
I'm an RN, just like everybody else. Now, sight gets a bad rap, because we're not the heroes. But we treat the patients that nobody wants society's throwaways. Because mental illness still has a strong stigma attached to it. Of course, my patients have committed heinous crimes, but I still treat them with the same level of respect that I would somebody that hasn't committed a crime, they get the same amount of love and care that my long term patients did, or that I wanted to go to my long term care patients. I get upset when they're sad. I get upset when their blood sugar's aren't being managed, you know, I feel like that bad for him and pity. But I have empathy for my patients, despite them doing horrible thing.

Scott Benner 56:04
Yeah. When you offer them compassion, do you see them change? Sometimes?

"Jessica" 56:08
Yeah. You know, like I, the one guy that got into a fight yesterday, he asked to go outside for a walk. So I took them outside, you know, to help them cool down. And he appreciated that we just talked for a little bit. I told them, hey, what you did was not appropriate, he reflected on it. And he cooled off. He appreciated that.

Scott Benner 56:26
It makes me wonder, it's not what we're talking about. But it makes me wonder if like, maybe if somebody would have done that for him when he was younger, or something if maybe like his situation wouldn't have changed. I know some people's mental illness is unstoppable. But I wonder how many times people are kind of pushed into situations as well. Anyway? Well, I'm gonna say again, what I've been saying at the end of these cold wind episodes for a long time, I don't know why I thought this was a good idea. But I can tell you, they're actually really popular. So people enjoy listening to these conversations. I think it's because I mean, for me, like, again, you didn't say anything here today that shocked me. But it's still eye opening for someone to say it out loud. You know, you're gonna send your mom to this place. And let's be honest, this is the end the you know what I mean? Like, if you think they're, they're living like a pony running in a field, that's not probably not happening, if they have health concerns on top of that, they're going to be managed as well as possible. But, you know, possibly by one nurse every eight hours for 26 different people, which sounds. It sounds like you must have gotten there, taking a deep breath started working. And before you knew it, it was eight hours was over. Yeah, but I can't imagine there was even like a half a second in there anywhere.

"Jessica" 57:44
Don't you didn't like I said I would have to ride it. 200 Because otherwise I pass out. I was clocking 24,000 steps a day. Just take as you're running

Scott Benner 57:52
around like crazy. Yeah. About them. Is there anything I haven't talked about or asked you about that? I should have something that no,

"Jessica" 57:59
it's just like I said in the psych facility, the blood sugar's are managed just as bad as long term care. And it breaks my heart because I got, like I said, the 18 year old I don't want him blind. Yes, he did something horrible. But he's actually like, nice. And I would never wish diabetes Complications upon anyone.

Scott Benner 58:18
Yeah. Well, listen, if we're going to house people, it's got to be compassionately at the very least, I mean, I know you can't do something, if one of my nurses just judges me for what I've done. And they don't want to help me anymore. But they will. But they're just I'm going to get bare bones from them, because they're not as compassionate maybe as you are. But you also have, it's interesting, isn't it? You have a personal reason to be able to maybe understand their situation a little better. I mean, you can share your thing if you want, but I'm not asking you to, but like, you have a bit of a connection. Is that right?

"Jessica" 58:46
I would say so. Yeah. Because I live with it. I am actually all job more medicated than some of my other patients to keep my condition stable. And I function very well. Nobody knows. I told that to coworkers. And they're like, I would have never guessed. So I managed to pull off the stable appearance.

Scott Benner 59:06
Are you stable, you just appearing stable?

"Jessica" 59:11
At least at least at work.

Scott Benner 59:12
One day, you don't think one day that the like, somebody is going to look over from the other bed and go didn't used to be my nurse

"Jessica" 59:22
when I wasn't taking because I go up and down taking my meds because there are pain to take. And I also have to face living with a really bad disorder. It's a story. I'm more apt to take care of my diabetes in the mental illness. Yeah.

Scott Benner 59:32
Well, this has been something I really do appreciate you coming on and, and sharing this with me. It's a it's a unique perspective. And it's also kind of nice to hear that no matter what we did for my mom. I don't know if this makes it better or not. But at least I know I wasn't missing something. But this is the situation what I saw happening is really what happens that she wasn't being treated any more poorly than anybody else was when she was being true. and poorly, I might opt for the switch to so you know, Jessica. Alright, thank you very much. Hold on for one second for me, I want to talk to you at the end here bio. Okay

Jalen is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes define you. And that is what the Medtronic champion community is all about. Each of us is strong and together, we're even stronger. To hear more stories from the Medtronic champion community or to share your own story, visit Medtronic diabetes.com/juicebox And look out online for the hashtag Medtronic champion. Thank you so much for listening. I hope you enjoy my full conversation with Jalen coming up in just a moment. A huge thanks to a longtime sponsor touched by type one, please check them out on Facebook, Instagram, and at touched by type one.org. If you're looking to support an organization that supporting people with type one diabetes, check out touched by type one. 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 sent 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 ready to level up your diabetes care. The diabetes Pro Tip series from the Juicebox Podcast focuses on simple strategies for living well with type one. The pro tip episodes contain easy to understand concepts that will increase your knowledge of how insulin works and so much more. My daughter has had an A one C between five two and six for since 2014 with zero diet restrictions, and some of those years include her in college. This information works for children, adults, and for the newly diagnosed and for those who have been struggling for years. Go to juicebox podcast.com and click on diabetes pro tip in the menu or head over to Episode 1000 of the Juicebox Podcast to get started today. With the episode newly diagnosed we're starting over and then continue right on to Episode 1025. That's the entire Pro Tip series episode 1000 to 1026. 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. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. And now me trying to say hello friends. Hello friends. Hello friends Hello Hello friends and welcome to episode 1179 of the Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com