Monday, July 23, 2012

When to Disclose

When I began my NP program, we had a (long) discussion about self-disclosure. We were told then, and repeatedly throughout the year, that once we’re in practice we’ll learn what we feel comfortable with disclosing. We’ll learn where our boundaries lie.

But as students, the rule they wanted us to abide by was clear: don’t disclose anything other than the fact that we’re students.

Now that I'm working, I've finally transitioned my mindset from that of a student to actually being an employee. What I choose to disclose to patients is now entirely up to me and isn’t being scrutinized by clinical instructors.

My diabetes is something I haven’t felt comfortable sharing with patients. I don’t want to create a dynamic where they’re focused on or worried about the health of the person who’s taking care of them. All they should be focused on is their own health and recovery.

(But, all of my coworkers know, just in case I ever need a hand.)

Sometimes during the summer, the unit will have a cookout. It’s a great way to break up the day, it gives patients a sense of normalcy, and it’s a wonderful time to get to know them in a more relaxed atmosphere.

Yesterday, a woman sat alone at the cookout with slow tears rolling down her face. When the tears continued a little too long, I pulled over a chair. She said she was sad, but I knew it was more. I told her I was there to listen or quietly sit with her so she’d know she wasn’t alone.

After some silence, she said: “this was supposed to be a fun time with friends, but my fingerstick was 342. Now I’m here and I can't have fun until my bloodsugar comes down. No one gets it. They keep offering me chips and potato salad and I can’t have it right now.“

 “I get it.”

“You couldn’t possibly get it. It’s like there’s a supermodel on unit when you’re here. You’re skinny and perfect and content to have a salad while everyone else eats burgers and chips.”

I held out my wrist with my medic alert bracelet. “I get it. I promise I get it.”

She stared at it quizzically, having never realized it was a medical bracelet before.

“Go ahead and read the back of the tag. It's ok.”

Her eyes lit up when she saw the word. The word that let her know that I did, in fact get it. That I knew all too well how it feels to be out of range and have to wait when you want to be having fun with your friends. How it feels to be out of range when it’s time for a meal you’ve been looking forward to all day.

We sat and talked a little bit longer. We talked about what could help her make the situation more tolerable while she waited to get back into a more cookout friendly range. At the end of our conversation, she thanked me for sharing and went over to the table where her friends were sitting.

“Hey guys, my blood sugar is a little off right now and I have to wait for it to get into range before I can eat. Please don’t offer me anything right now. I’ll eat when I can.”   

Her friends smiled and nodded, asked if she needed anything, and then they put their meals to the side not wanting to eat until she could. It wasn’t about the food, it was about the company they were keeping. She waved at me from across the patio and her tears didn’t return for the rest of the shift.

Knowing someone else gets it is the most powerful support there is. Even when it comes in the form of a making a disclosure your instructors would have cautioned you against. 


  1. Caleb's first nurse that tended to him after he was admitted at diagnosis was T1D. I didn't know anything other than that and that she pumped, but it made such a difference to us. I can relate to how this woman felt after reading your bracelet. :)

  2. Holy crap hot mama I am totally crying.

    You are gorgeous inside and out.

  3. I love this story!! I can understand why you may want to use discretion when disclosing to patients (many of them may be ill-advised and think that you have diabetes because you didn't take care of yourself, and blah blah blah, false myth after false myth), but sometimes the time is right to step out of your professional role and into your personal role. And in this case, the time was clearly right.

  4. What a lovely thing you did.

  5. I agree with Scott. Disclosure is a tough call with any medical condition [like you've said, I've disclosed to my coworkers about my asthma just in case, but it's not something I tell the kids unless they specifically ask me about something], but if it might HELP and you are okay with sharing, then good things can happen--like the story above. I'm glad you were there to see eye-to-eye with her on it when she really needed it.

  6. What a wonderful thing you did by being there and letting her know she's not alone. Diabetes can be so lonely for so many. Reaching out to others who think that no one else understands is always so powerful.

  7. You, dear sister, are AWEsome. I'm proud of you!

  8. This is heart warming! :-)

  9. Wow. I don't even think your old instructors would have believed that it wasn't appropriate to share in that situation! Nobody else could have comforted her in that moment the way you did, because you live it, just like she does.

  10. aww. what a beautiful story. thanks for sharing.