Diabetes: 'If only I had a working pancreas...'
EDITOR'S NOTE: May is the third anniversary of the GLOB Master being diagnosed as a diabetic. University of North Carolina Medical Student Kaitlyn K. Rogers wrote this essay for the New England Journal of Medicine to demonstrate her issues regarding diabetes and sharing personal disclosure of this disease. SPECIAL THANKS to GLOB Staffer Emeritus Lynn Dirk for her unique scientific editing assistance to this story.
Three surgeons and a medical student stand around the operating table. An attending and a surgical resident are working on the patient's left side. The third surgeon, another attending, maintains tension on the suture as I close the long incision on the patient's right. It's the last week of my third-year surgical rotations but the first time I've met any of these men. So after the expected questions about anatomy, indications for surgery, and alternative treatments, the conversation turns to the personal: Where am I from? What did I study? Do I want to be a surgeon?
"I like surgery," I tell them, "but I'm actually leaning toward family or internal medicine."
"Really?" one of the attendings asks, surprised.
"Really," I reply as I start my next stitch. "About 80% of the time I think I want to go into primary care, and the other 20% I think endocrinology is really cool."
"Huh," the resident interjects, "I hope you like working with diabetics."
I think back to a different patient, on a different week, in a different surgeon's office. One moment she was fine, and the next she was sobbing. "If you'd asked me a week ago," she told my preceptor between gasps, "I would have said 'let's do the surgery tomorrow.' But we just found out that my son has type 1 diabetes."
My preceptor tried to comfort her. He talked about the simplicity of the surgery and the dangers of a delay. He tried to discuss the logistics of caring for her son. She cried through it all. Finally, when my preceptor paused, stymied by her continued tears, I took a deep breath and told her, "You know, I have type 1 diabetes as well."
Now, in the operating room, my response to the resident is quick. "Actually, I am diabetic." The OR is quiet as I reposition my needle in the needle driver. "I've always liked working with diabetic patients...type 1 and type 2." Another moment of silence as I place my next stitch.
"I worry about him," the mother had told me.
I couldn't help but think of my own mom when I said, "I know you do, but he's going to be OK."
"I know," she said. "It's just not the life that I want him to have."
"So, do you take insulin?" one of the attendings in the OR asks.
"Well, I have type 1," I reply, hoping that I don't sound defensive, "so I have to take insulin."
"And do you have a pump? So you don't have to give yourself shots?"
"And do you have to prick your fingers?"
"Yes. I check my blood sugar several times a day. I also wear a continuous glucose monitor that tracks my sugar and alerts me if it's high or low."
"Does that happen a lot?"
I pause because I don't know how to answer his question. It feels like being asked about a grade on a test, and I suspect that his definition of "a lot" is different from my endocrinologist's. "It varies," I finally respond. "Diabetes is one of those conditions that does much better when you can follow a routine with eating and exercise and sleep." I laugh self-deprecatingly, adding, "Clinical rotations aren't great for routine."
"Oh?" the surgeon asks, sounding intrigued. "Do you exercise?"
I finish another stitch, pulling the skin edges together in a neat, straight line. "Yes. I exercise every day. It's part of that routine thing."
"Of course, life would be better with a working pancreas," I had told the mother in the office. "My life requires more planning than your typical 20-something's. But the truth is" â€” and here I hesitated because what I was about to tell her was only half true â€” "having diabetes has never kept me from anything I really wanted to do."
My attending in the OR examines the incision, which is now three-quarters closed.
"You're sure you don't want to be a surgeon, with suturing skills like that?"
Grinning in spite of myself, I reply, "Yeah, I'm sure." I consider how much I want to say and ultimately decided to dive in. "It's just that the idea of hooking myself up to a line of D5 before every surgery so my blood sugar doesn't drop... it doesn't really appeal."
"How do you manage during surgery?" the resident asks me.
I recall my glucose level as I walked into the OR and contemplate the dry, bitter taste of prolonged hyperglycemia lingering in my mouth. "I run myself high on the days I'm in surgery," I say, "so I don't have to leave to eat."
"Thank you," the mother had whispered at the end of a long hug.
"You're welcome," I told her. "Just remember that he's going to be OK."
"You're the first person that we've actually met who has diabetes. It helps to know we're not the only ones."
"There are a lot of us out there," I responded, "but it's not a visible disease, and for a lot of reasons, people don't always talk openly about it."
I examine the long incision that I've now sutured closed, and it's the best closure I've ever done. The attending looks over my shoulder and gives a joking sigh. "Suturing skills like that and you want to go into medicine."
I laugh as he meant me to, thrilled with his praise.
"Do you want to stay for the other side?" he offers, "I'll let you close that one as well."
"I'd love that," I reply.
I follow him around the operating table, but the scrub tech steps in my way. "Why don't you scrub out and get yourself a little bit of orange juice," she whisper-yells.
My smile slips and my cheeks heat. "I'm fine," I tell her, "I don't need to step out."
"Seriously," she insists, "Go eat something. We don't want your blood sugar to be low."
I consider all the moments when I could have stayed quiet and all the details that a wiser person might not have disclosed. I worry that I've cast myself in the role of a brittle diabetic and a part of me wishes that I'd done things differently. Another part, though, thinks of the mother who feared for her son's future, of the diabetic patients who wonder if their doctors understand what it takes for their disease to be "well controlled," of all the day-to-day details that get lost in the shuffle of medical education. That part of me thinks I should have said more.
"Seriously," I tell the scrub tech and physicians. "I'll scrub out if I need to eat something, but right now I'm OK."
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