Not Pumped Up

I had a big emotional break down a few nights ago. After weeks of being more attentive to my diabetes than I have ever been, I think it all caught up to me and I felt incredibly overwhelmed. It was probably the first time I had overtly/wholeheartedly/unabashedly felt sorry for myself, which is ridiculous considering the horror stories I see at work on a day to day basis. Every fiber of my being felt heavy with the burden that is managing this disease. Over the course of an entire day I grew teary at random intervals, with no real trigger to be recognized. 

It is odd the way it started, considering I had been so very positive in the days preceding the collapse. I felt so good in fact, that I actually wanted to wear the trial Omnipod pump that my diabetes educator had given me. This alone is a huge accomplishment -- a few months ago I couldn't have been paid to even consider wearing one. So I stuck it on my abdomen and wore it proudly under my scrubs, almost bursting with pride that I had taken this decisive step. I soon forgot it was there, wearing it throughout an overnight call, sleep, and showering. No big deal.

But it was a big deal on the third night, when I had to change from scrubs into real clothes in order to meet my old college roommate for dinner.  After trying on the outfit I had originally planned to wear, I looked in the mirror and could only fixate on the small alien life-form attempting to rip itself from my abdomen from underneath my tank top. I threw a cardigan over it, but each move in the mirror seemed to accentuate the pump's presence. I quickly changed into a second outfit, then a third and a fourth. Feeling dejected, I put on the first outfit and walked downstairs. I looked at my husband and burst into a torrent of tears. He, of course, did not notice the pump. I blamed this on him being a typical male who doesn't notice anything, and was still convinced I looked like I was growing a second head from my torso. I was devastated that this Omnipod, the one pump I was excited about using, had let me down. The Omnipod felt omnipresent -- I was unable to escape it. I hated it all of a sudden, and had to fight the urge not to rip it off before going out to dinner.

I pulled myself together enough to have a really nice time at dinner with my old college roommate, one of my very best friends. We a great talk and I shared with her that I have been going to therapy in order to get a grip on my diabetes. She thought it was a great idea, as she recalled what a stressor it had been for me in college when I had to talk to my parents about my lack of control or in the days leading up to a doctor's appointment. After all of this, I mentioned the pump and how I had completely lost it before meeting her, and she confessed that she hadn't noticed it all at. I will not tell my husband this, as it would be admitting defeat :) But I was happy to hear that my pump hadn't become the giant plastic elephant in the room. Even though my loved ones hadn't noticed, I learned that the Omnipod wasn't as idyllic as I had hoped and am now considering other pumps that are a bit easier to hide. I know I do not need to hide my diabetes anymore, but I would still like to wear a form-fitting outfit without feeling like a walking diabetes billboard.

Despite the fact that my night made a bit of turn-around, I found myself very sad and teary the next day at work. I think maybe I was just tired - physically, mentally, emotionally. The holiday weekend brought along some vacation days and I spent a large part of it sleeping. I feel better about things again, and know that I will keep moving forward with it all. I just have to take it one day at a time.

Intensive Care

So I started turning over this new leaf during a month with a very easy schedule, allowing me to focus most of my energy on my little diabetic tasks. But this past week, I started working in the Pediatric Intensive Care Unit and am finding it increasingly difficult to maintain the hardcore regimen I started (granted, by "hardcore" I mean four on-time readings per day, as I had previously been doing none).
The reason for this isn't because I'm falling off the wagon. I am very aware that I need to stop and do a reading and go get food...whereas before, I would simply not think about it because I had ignored it for so long. But when my patients need an order for a medication, or a parent is calling me to the bedside, or I have to go down to MRI to oversee sedation...I put those tasks first. And when I'm finished them, I find myself in such a rush to make it to the mandatory noon conference that the glucose reading gets lost in the shuffle.
The irony of it all hits me sometimes...working so hard during the day to take care of my patients but putting my own health on the back-burner. Several of the people that have treated me over the years (Endocrinologists, diabetes educators, etc) have heard this and compared it to the old airplane safety warning that instructs parents to put on their oxygen masks first and, only after they have their mask on, aid small children. But this issue at work is a small part of my larger problem with diabetes, in that the danger doesn't feel imminent for me if I wait a few hours to do a reading or bolus my insulin. However, if I ignore the patient who needs his respirator settings changed or who is screaming in pain and needs morphine, the consequences are felt fast and strong.
So this week I pushed through it all as best I could. I carved out more time to take care of me, without sacrificing patient care. Hyperglycemia hasn't been the issue lately because I have been taking such good care of myself. But now, I have to worry about the lows. It happened just last night while on-call. We were doing "night rounds" in the unit, which entails going from bed to bed and reviewing the patient's chart and changes for the day. A group of the on-call residents, fellow, and several nurses work together throughout the night rounds. I was starting to feel hypoglycemic but we were half-way through so I started thinking that maybe I could stick it out instead of interrupting the rounds to go check my glucose and get some juice. Then I realized that if I didn't take care of it, I wouldn't be clear-minded enough to take the best care of my patients and keep track of the changes we were making. So I announced to the group that I had to go check my blood sugar, and then left. No one made it a big deal, everyone supported it, and they were shocked with how quickly I returned with my juice in hand. It really wasn't a big deal, but could have been had I handled it differently.
In conquering my old challenges (ignoring readings and being persistently hyperglycemic), I find myself coming across many new ones (many more episodes of hypoglycemia secondary to my better control, finding time to do it all). But I'll conquer those, too. One at a time.

Review Meeting

I recently had my "mid-residency review meeting" where I sit with an attending faculty member to go over my evaluations, test scores, performance and any other concerns. It is required of all of us once a year. This came roughly a week after the start of my so-called "diabetic awakening". One of the sections on the mandatory checklist for the supervisor is our personal life and any related issues. This particular attending knows me decently well as I recently worked with her on an almost daily basis for a month straight. She started to brush over the topic, assuming that everything was fine considering she knows that I am recently married, recently matched into a fellowship, and seemingly quite in control of my life. I think if this meeting had happened one or two weeks earlier I would have found it extra distressing - being that I was not at all in control of my health but unable to share it with anyone. However, at this point in the meeting, I almost cut her off and dove right into the fact that I was finally getting my health back on track by seeing a therapist and a diabetes educator. I touched on the fact that I had felt like a hypocrite considering I am about to become a Pediatric Endocrinology fellow and dictate the course for other diabetics. I expected her to mull over this point, but she laughed. She laughed at me! And then she shared that she has been a physician for decades, has known for years that a close member of her family was diagnosed with breast cancer and another with colon cancer...yet she hasn't seen a physician for routine mammography or colonoscopy (or a regular checkup) in almost 20 years. The most shocking part about this was my OWN reaction. I found myself reflexively saying, "Oh Dr. X, you really should go in!" instead of saying, "I understand." I was embarrassed by my reaction, but successfully backpedaled when I realized my mistake.
I made the connection that people handle various health stressors in the way I have been handling them, and you have to search from within to overcome it. Doctors and family telling you what you should be doing makes little difference. Doing it with them (if possible) is a better way to go. Had I been a close friend to her or in her age bracket, I might have offered to make our appointments together for moral support. This is a friend role, but it can be modified to fit the physician-patient role. In this journey of my own I am trying to take extra mental notes to put to use when I am challenged by future patients with these same issues. I want to be able to say, "I have been where you are, you can work your way out of it, but you don't have to work alone."

Secrets

I have been analyzing my relationships - past and current - since I began these sessions. It has always been significant to me that I have had many gay friends (male). This, in itself, is not peculiar. But what is fairly unusual is the fact that I was friends with three of them (at different points in my life) before they came out of the closet to anyone. The first was a good friend of mine in high school who dated several of my girlfriends. We remained close after high school and during one my visits to see him at his college, he came out to me after a party. We sat in the blistering cold on a random doorstep on the streets of Boston, and through heart-wrenching tears he told me about the feelings he could not longer suppress.
The second was a guy I had befriended early on in my first year of college. Through many late-night chats he ultimately revealed his inner struggle to be the person he always had to hide now that he was away at college. We were sitting outside near the intramural field in the heat. He had never told anyone else that he was gay. After this, he had to work very hard at being open with others, but it got easier with each person he told.
The third was my absolute best friend in medical school. We were oddly close, leading me to believe that perhaps we could be more than just friends. But over time, when we remained close in every aspect but the physical, I started to see the signs. We took a trip to Mardi Gras together toward the end of our second year of friendship, and it was in the wee hours of the morning on a deserted New Orleans street where he stopped me and shared with a shaky voice that he was gay. At this point, I wasn't surprised by it. I found myself relieved and unburdened, for him AND for me. I felt as though I had been carrying his secret for him because I knew him better than anyone. I was sad because I knew how painful it was for him to voice what he had tried so hard to push down, but I was thrilled that he was finally going to start living freely. He only told a few people at once, but eventually the rest of the medical school class caught on. He was horrified that the group of male friends he sometimes hung out with - a group of jocks with a tough-love attitude - would make life horrible for him. But they didn't. They continued to accept him, and it made my friend stronger than ever.

It wasn't until this week that I looked back at all of these relationships and found the common thread that ties them together. Perhaps I had so much in common with these guys who were living a double life because I was living a double life, too. They hid their emotions and suppressed their feelings because they feared social retribution for being gay. Not to say that my warped handle on diabetes is anywhere near having to deal with being gay in our society, but we dealt with our differences in much of the same way. Maybe I was drawn to these closeted gay men because I could trust them to understand me, even if I didn't divulge my secret. Maybe they sensed the same in me.

Currently, all three are openly gay and truly happy in their own skin. They are successful in life and in love. They no longer carry the stress that comes along with hiding and lying. I believe I am on my way to shedding those stressors, too.

New Beginnings

I've created a new blog in honor of my new beginnings with diabetes. I expressed today how this journey into vocalizing my latent feelings regarding diabetes feels like being diagnosed all over again, because I don't believe I ever really went through that "mourning" period properly. Those emotions got pushed down or away, only bubbling up in sporadic bursts that were quickly suppressed again. It sometimes feels as if my insides are churning...trying to turn the bitterness of my years of noncompliance, the sourness of potential complications, and the sweetness of taking control of the situation into something palatable. Or even just tolerable. And even though I am motivated by my newfound control and sudden energy secondary to normal glucose levels....it is an exhausting endeavor.