Wednesday, February 01, 2006

My Opinion on Cheryl Botzet

There are maybe a lot more things I could be talking about as a writer. The James Frey controversy, which has been done to death; JT LeRoy, who had me going for awhile there, too. (I even emailed with he/she/it, several times. Poor JT! With all he's been through, he can't help being flighty... But I digress)

But. The issue at hand, folks. My Statcounter tells me I am getting a huge array of hits from visitors wondering what I think about the Ariel Botzet tragedy. Now, I am no one special, just another mother of a child with Type 1 Diabetes. And Ariel's story is so horrible that I can hardly bear to think about it. (In fact, rather than watching the Dateline NBC story about her, I watched Bowling for Columbine, figuring it would be much more cheerful. :o( I already knew as much as I felt I could handle about Ariel's story.)

But with this much interest in my opinion, I am going to tell you what I think.

First, some background. Ariel was a beautiful eleven-year-old girl with Type 1 Diabetes.

She lived in Las Vegas with her mother, Cheryl, because her parents were separated. In 1995 Ariel was diagnosed with Type 1 Diabetes. From what I have heard, I've concluded Ariel was on NPH and Regular--not an unheard of insulin program, but not the one we used, and anecdotally, better control is gained on Lantus/Humalog or a pump. Our son was never on this regimen. But the regimen was not Ariel's problem. Although I don't like this regimen personally, I can't blame Ariel's death on the clinic.

In February 2004, Ariel became ill with flu-like symptoms. She began vomiting and continued to do so over time. I have heard reports that say Ariel was ill from anywhere from a night and a day, up to four days. And I haven't read the court documents, so I don't know which is accurate. When Cheryl finally took her to the hospital, Ariel was in serious Diabetic Ketoacidosis, a complication of ongoing high blood sugars that can lead to brain swelling and death... which tragically happened to Ariel.

Postmortem tests revealed that Ariel's Hba1c readings (a measurement of glucose in the blood over time) over the last 18 months hovered from between 13-16. That means her blood sugar AVERAGED in the 330-360 range. Now, I'm not saying we don't see numbers in the 300s. We do. Then, we check for ketones, check our son's site, and bolus a correction. If the blood sugar isn't coming down within an hour, we rip out the site, place a new one, and do an injection to correct the high number. (Our son's a1c's have hovered between 6.1-7.1 since diagnosis.) And if there are ketones, we call the clinic. (We have not had more than trace ketones. Even if there's a bad site, Lantus does a good job of keeping them away. He still uses a partial dose of lantus along with his pump.)

When our son is in the 300s or, more particularly, the 400s, he doesn't feel like himself. He is irritable, angry, and unreasonable. If Ariel's blood sugar averaged in the 300's, that means she was regularly in the 400s. When my son is in the 400s (it's happened once, at a swim team tryout, when he "sneaked" Girl Scout cookies and didn't tell us... and he felt bad enough he never did that again), he can't feel his legs. He becomes combative and hysterical. So imagine how bad this little girl felt... so much of the time.

Cheryl claimed she had "lost" Ariel's glucometer and couldn't get a new one. She also said she had "run out" of insulin. either of those situations would send me screaming to the drugstore or to the clinic. And regardless of Cheryl's financial situation, the state-sponsored insurance will cover insulin and glucometers, and drugstores often have specials for a free meter after rebate. Or go to the damned clinic. They'll give you one.

And supposedly, the little girl's blood sugar was tested TWO TIMES A WEEK. We test eight times a day. At the bare minimum the child should test four times per day.

I heard somewhere else that Cheryl stated Ariel was taking care of her own diabetes. Sorry, but Ariel was only eleven. And if I learned that my son was testing TWO TIMES A WEEK and that his a1cs were in the 13-16 range, I would not permit him to take care of his diabetes. I would hover there and watch each blood sugar test. This blaming the victim stuff the defense attorney pulled was just sick.

Now, I am sure that Cheryl Botzet is just ill with horror over what happened to her daughter. But I have to wonder at why theydidn't have meters around their home. And when a child is vomiting, that is considered an emergency at our endocrinology practice. We are to call the emergency clinic, immediately. Vomiting is often accompanied by Ketones, which can turn dangerous and deadly. Also disturbing is the fact that the clinic says Cheryl repeatedly refused to be trained in her daughter's care, saying she didn't need any help. Ariel's dad said she looked poorly on the day before her death, but why didn't he test her blood sugar, or call the clinic? Now as the noncustodial parent, he shares less responsibility, I would think, but where was CPS in all of this? There are enough question marks in this case to make the head spin.

As a parent, however, I am hesitant to say that the mother was guilty of murder. Criminal neglect, perhaps. But murder suggests a premeditation I don't see in this case. And while I am not saying, "there but for the Grace of God go I", because I can't see being that willfully ignorant of my son's diabetes, it also scares me to think that we parents can be prosecuted for complications of our children's diseases. Sure, I'd like to think we could head off DKA before it starts, but if we don't (during an illness, particularly) we could be headed to the ER. And what about Dead in Bed? God forbid, if that happened to one of our children, would we be prosecuted?

Well, I'll be the first to admit that I don't know that much about the case. I first heard about it just after our son's diagnosis, and it scared the hell out of me to think he could die, so I avoided a lot of information about the story. Now I know that there are many steps between a high blood sugar reading and a death from DKA and I can see many differences between myself, the parents I know, and Cheryl Botzet. I surely don't know everything about this case. The upshot is, this child should not have died. Many adults failed this child. It makes me ill to think she suffered so much before and during her death. I would have gladly taken this child into my home and taken care of her.

I'm out the door now, but anyway, there's my opinion. Have at it, kids.