Joe's Toe

sobbing head into my embrace. I calm him. It is his toe, his left big toe. He dropped the steel hockey passing device right on it. It was immediately purple...Ibuprofen was dispensed, ice applied.

The toe had Joe slightly sidelined for a day or two. He didn't run with as much vigor. Soccer was attempted and then aborted. Ibuprofen was still being dispensed as needed.

The toe was assessed daily. The worry ensued. The assessments continued. Infection was not apparent. I have been on high alert watching the toe, watching the blood sugar numbers, questioning Joe's pain level. I have been worried, but I know that he is still young. The complications haven't set in yet... decreased blood flow, decreased oxygen delivery to the tissue...Joe's diabetes is well controlled. He is young. The complications my mind musters up aren't a reality for children. Not children Joe's age. Rarely for a diagnosis that has been less than 10 years. But, I know I have to be diligent.

A few days pass, the toe nail is now black. Joe is complaining of pain, stating he cannot participate in his "favorite subject" P.E. Now, you and I both know, this is serious. I assess. The toe doesn't look infected so I deduce that the new onset of increased discomfort is most likely due to the pressure of the blood under his nail.

A sewing needle was obtained, a candle was lit, and betadine was applied to Joe's toe nail. Joe was "down" with my proposed plan of burning a little hole in his nail bed to relieve the pressure that was the etiology of the pain. It took several sequences of immersing the needle tip in the flame until it was glowing hot and pressing it firmly to his nail bed. By the fourth or fifth time the nail bed was punctured; I felt a pop. Unfortunately, I was unable to get the needle out of his nail by pulling, twisting, and gently yanking. I told Joe to sit tight and not to look at his nail with the needle protruding from it ...that I would be right back with the pliers.

"Pliers!!!!!" ..... "What do you need the pliers for!" was his slightly flustered response.

I explained that I needed some "traction" to get a better grip on the needle to remove it from his nail bed.

Pliers utilized, needle pulled, old nasty blackish blood oozing out of the nail...Joe felt better. Over the next few days the fluid made a new track up and out where his nail meets his toe at the cuticle juncture. It was ugly. Still no fever. No purulence. No erythema. No unexplained hyperglycemia. Good.

And...for weeks...on and on the toe nail saga continues...the nail hangs. It hangs by a few chunks of unyielding tissue. The toe looks OK. I have been assessing, monitoring, worrying. The toe nail has been catching on things. The trauma had extended somewhat over this past weekend. The circumferential tip of his toe turned a light pink. I soaked it in a warm salt infused bath of water. I have been disinfecting it; then dressing it by wrapping it with medical tape, trying to minimize any further tissue damage while this nail falls off. Trying to minimize any portal of infectious entry into my son's already somewhat compromised habitus.

I did call the pediatrician's office. I discussed what I have done to date. I described the toe as slightly pink, no edema, no pus. Furthermore I reported that Joe had no fever, no increased pain, no bump in his blood sugar numbers. They agreed with all that had been done. They agreed that he sounded "good to go". They agreed that I should call if the toe got any pinker...we were thinking the new onset of pink was due to the newer trauma of the almost falling off nail catching on socks, sheets, boots, etc. Good. I just needed some back-up. Someone to tell me that I am doing "OK". That it sounds "OK"... that his fucking toe wasn't gonna get lobbed off due to my mis-management.

Fast Forward -----> -----> -----> -----> to present day.

The hardest part in the toe saga fiasco has been answering Joes questions about Diabetes and extremity care. To answer his questions about complications has been harder than I expected. For him to accept that he may someday may not be able to feel his feet at a 100%, due to neuropathy, was OK with him. The part that broke my heart was his emphatic-ness in stating "I will still be able to run and skate" and then hesitantly questioning "....right?"

Of course, I set his mind at ease and stated this is why we take such good care of his Diabetes.

When researching for this post I was caught off guard and taken back to a place where I visited when Joe was first diagnosed. You know, "the complication place". A few short days post-diagnosis I bought a book on Diabetic Complications. Yes, there is a thick, detailed book dedicated to just complications. I read it cover-to-cover in two days.

Since the read, my focus has been on pancreatic diligence and the quality of Joe's life. The highs, the lows, the carb counting, the night checks are muddled through. Each blood glucose is obtained, dealt with accordingly. Then I wait a few hours for the next blood glucose reading. I deal with it, and then I wait for the next one, and so on, and so forth... around the clock I go.... the never-ending-ness of it all. Until recently, I think I thought that, the "never-ending-ness" of type 1 care was the hard, overwhelming part in all of this.

In actuality, after revisiting the complications, the screenings for complications, and reading of our fellow D-bloggers dealing with complications the "never-ending-ness" of the care doesn't seem so daunting. The "big picture", the "why" we do it all... "the complications", well ....

*silence*

My heart, my mind, my motherhood cannot go there. I think, perhaps, that is the most difficult part. The uncertainty of it all.