Previous posts have highlighted our Diabetes Program as well as the plight of one our patients suffering from uncontrolled diabetes and its far-reaching ramifications. Amidst the tsunami of hyperglycemic patients who present to our center, there is no shortage of such cases. Here's another...

A couple of weeks ago, while organizing and re-stocking our ambulance, I received a call from my brother-in-law, Diego. He is the pastor at the church in our neighborhood (and husband to my wife's older sister). We have a (somewhat unimaginatively named) program at our clinic, "Pase Pastoral" (Pastor's Pass), that empowers local church leaders to aid community members with the greatest need (i.e. the sickest + poorest of our neighbors) in rapidly obtaining healthcare at our facility in a very streamlined manner. We provide our community collaborators with a small laminated card for distribution (example below).

When an individual in need is identified, they are provided with a "pass" and directed to our center. Upon arrival, these patients are given priority and any associated cost with their care is waived. Diego had called because he had exhausted his supply of passes, but had someone he thought should be seen. I made note of the individual's name and instructed Diego to send his patient our way.

We use an iPad based EMR (electronic medical record) and each patient chart has a patient photo. The beneficiary of Diego's "Pase Pastoral" had been seen in our system previously (most recently in 2020). His photo in the EMR was that of a rotund thirtysomething. Entering the exam room, I found a now 41 year old man who looked very dissimilar to his chart photo. He appeared to have aged at an accelerated rate and was quite literally half the man he used to be. Graph of his bodyweight from prior encounters included here.

Of more immediate import, our patient was acutely critically ill. Tachycardic. Hypotensive. Febrile. Labs remarkable for a blood glucose of 654mg/dL, lactate >4, and an elevated anion gap. He reported generalized weakness and a productive cough. His presentation was consistent with DKA (diabetic ketoacidosis) and sepsis. He proved to be a very worthy recipient of a "Pase Pastoral."

Our nursing team quickly established IV access. Continuous cardiac monitoring was initiated. He received fluid resuscitation with crystalloid IV fluids. Broad spectrum antimicrobials and insulin were administered. DKA resolved, vitals normalized. Ultimately, he was discharged in much improved condition with close follow-up arranged in clinic. He was also enrolled in our Diabetes Program. We are optimistic that we can dramatically alter the trajectory of his health and life.

Amidst the deluge of wildly uncontrolled diabetic patients, at times it seems that our efforts are inconsequential and painfully insignificant. However, for patients such as the one featured here and their families, our efforts -made possible by our generous supporters- are of paramount consequence and extreme significance.

With your help and God's grace, our hope is that our patient will no longer be "half the man he used to be" and will, in time, be made whole again with renewal and restoration of his vigor and vitality.

"He gives strength to the weary

and increases the power of the weak."

~Isaiah 40:29 (NIV)

Photo by Hamed Foroutan on Unsplash