A Tale of Two Losses

I lost two 'patients' in the last 3 days. What a difference it was between them, and no less tragic was either.
I'll call the first Karen, a patient with poorly controlled diabetes, a1c 12.2%, a 20 year old who also found out last month she was pregnant. This was unplanned, and though I hate to judge, I could not help myself. She still chain smoked, and still refused to check her glucoses nor was she compliant with her insulin despite my advise, despite glucoses running clear into the 400's. When she found out this week that she miscarried, she expressed relief. Now, perhaps she was putting up a façade or trying to act cool, but she actually told me, "That's good news than, I can stop my insulin and go back to pills". Now, I've seen patients more upset about losing a football game, than the level of emotion this woman showed. Perhaps it was true, the baby meant nothing to her.

On the other hand, Lisa was a patient who came a long way. I saw her during her admission for ketoacidosis and new diagnosis of type 1 diabetes. After the initial shock, they took control and learnt all they possibly could about diabetes and insulin. They were also about my age, and in many ways they reminded me of Kristin and I. I have gotten to know her and her husband well; their dreams and their fears. A couple of visits ago, she had dropped her a1c to 6.2% and was doing well, and seeked my blessings for them to try to conceive, which I gave. When Lisa called me 4 weeks ago to share the good news, I was excited and supremely happy for them. She called me today crying, sharing that they had just miscarried. I have to say I felt genuine sorrow for them; my eyes actually welled up. I made it clear to her; there was nothing she could have done differently, she tried, and I knew she did. This was one of those things. After all, miscarriage occurs in at least 25% of clinically apparent pregnancies.

I was mad, mad that this happened. And while I can't say that anyone deserves this, I was mad because I knew very well that Karen could have changed the outcomes had she been more responsible. And I was mad that on the other hand, though someone tries their darndest, these things can still happen. And no two patients were ever more different.

Nonetheless, I still lost two patients. And for one would-be mother, she lost a child. For another, she had a burden lifted off her shoulders.

For that, we shall mourn together.