An endocrine emergency takes place right next to an endocrinologist, but she cannot do anything about it. Why?
Endocrinologists have all resuscitated patients and dealt with common medical emergencies, as they must train in either internal medicine or pediatrics prior to sub-specializing. But when you spend all of your time in a subspecialty, you don’t routinely practice the other skills. Endocrine emergencies are limited to adrenal crises and episodes of DKA, not heart attacks and strokes.
I thought about this a few months ago as I was walking to the ENDO conference. Attendees were given bright purple tote bags, and the streets were flooded with purple. I laughed to myself thinking that despite thousands of doctors milling about, how useful would we really be in an emergency that wasn’t involving hormones?
I met a lot of different people over the four days that I was there. One was a physician from Europe hoping to train to be an endocrinologist and he hung out with me and a group of friends the whole time. He noticed my insulin pump over dinner one night and we had a long discussion about it, as they are not commonly used where lives.
He and a co-worker of mine went sight-seeing around San Francisco the next day, which involved a heavy amount of walking. A few hours into it, they were at a street corner waiting to cross and he suddenly went pale and started speaking incoherently. My friend who was with him, and who is an adult endocrinologist, feared that he was having a stroke or maybe displaying signs of encephalitis. She sat him down and called 911 because he was completely unstable and deteriorating rapidly.
EMS showed up and immediately tested his blood sugar. It was 31 mg/dl. It turns out he had Type 1 Diabetes. He had not told any of us about it, even after I had spoken very openly about my own diabetes the evening before. He was not wearing medical alert jewelry, but he did have a messenger bag full of glucose tabs. The only problem was that he went hypoglycemic so quickly that he was unable to verbalize that they were in there and she did not know to look.
How ironic that one of the few emergencies that endocrinologists are really good at dealing with happened right in front of one and she was still unable to help. People cannot help in an emergency unless they are equipped with the right information. Despite being a doctor in the company of doctors, he felt so self-conscious about his diabetes that he was uncomfortable sharing it.
He learned his lesson the hard way. Luckily for him, he got glucose in time and then started to think more clearly about being open about his health.