Diabetes Wise

The Road Taken

This month marks ten years since my interviews for a place at dental school. It was a dream I cherished and worked towards. It was what I really, really wanted to do. Although I had a very clear idea of where I wanted to end up, I applied to five schools, to give me the best chance of getting a place somewhere. Because anywhere doing dentistry was better than nowhere at all.

My first interview was in Birmingham, and I was offered a place. The second interview that came up was in London - where I wanted to be.

I remember the day clearly, from getting on the train to ending up in a McDonalds, the closest place to hand, drinking regular coke because my blood sugar was low but I was too nervous to eat anything, including glucose tablets. I remember meeting my brother, already a student in London, afterward. We went up to Regent Street, where the Christmas lights were in full blaze and I remember thinking how this was the city I wanted to call home. I didn't want to be a faceless stranger in the crowd, I wanted to be a Londoner.

Two weeks later, a frosty morning in early December, I was woken up by my parents waving a letter bearing the university stamp. I didn't waste time in considering whether the envelope was thick enough to contain an offer. Without even getting out of bed, I tore it open.

And that was the first moment that shaped my future.

The offer of a place at my preferred school meant the interview trail was over. The grade offers I might get elsewhere could not reasonably be expected to be any lower, so I withdrew my outstanding applications and accepted my London offer, examination results pending.

The next decisive moment in shaping my future came on August 20th 1998, the day I received my Advanced Level Exam results. For the first time in my over-achieving life I didn't care about the actual grades. All I cared about was meeting the grade requirements set out for my dental school place.

My dad summed it up nicely six years later when he recalled how I'd phoned him and, rather than telling him my grades, I'd simply said "I'm going to be a dentist."

In retrospect, it's a poignant statement. I didn't have any idea on that day how hard it would actually be to get there. I had no reason to. I'd never struggled academically and although I'd been ill, it had somehow never got in the way of me achieving what I wanted to.

Now, ten years on, I can't help but reflect on the path I chose. The road I took.

Not dentistry.

I love dentistry. It is a job that you can't do well, if at all, if you don't love it. It's too intense, too involved. And I never did really struggle, either academically or clinically, as a dental student either. I emerged from six years of university with an enormous debt, and two degrees. I don't regret any of that.

What I wonder about is how life would have turned out if I'd not chosen London.

Don't read this wrong. I also love London. The seventeen year old on Regent Street is still alive and well inside me. I adore this city, with all its history, its winding streets, its icons of architecture and transport. I'm so glad to have called this place home for so many years, and enjoyed all the opportunities this nation's capital has to offer.

But this month also marks eight years since my life changed.

Being diagnosed with epilepsy had a profound effect on my life. Frequent seizures bring real life to a stand still. I became afraid to go out. My seizures brought out the very worst in some other people, whose lack of understanding and treatment of me drove me deep in to depression. The cruelty I endured is difficult to think about. Impossible to put in to words.

But most of all, I could no longer be sure of becoming a dentist.

I'd taken it for granted, since the moment I opened the brown envelope containing my exam results in my high school car park in August 1998. The thought of not achieving my dream, of failure, was devastating.

You know the ending to this story. You know that I did make it through.

It's looking back on the struggle, all the extra effort, the cruel treatment I received, that makes me reflect on the path I took.

If I'd gone to study dentistry somewhere else, what might have been? Would I have avoided catching meningitis, and so avoided developing epilepsy? I know I can't answer that. No one can. But since, unlike with diabetes, I can trace my diagnosis back down a path of specific turning points, it's natural to question it.

Epilepsy is a tiny part of me now. It remains engraved on to my medical ID bracelet. I still don't hold a driving license.

I still meet people who question. Critcise. Discriminate.

The stigma is still firmly attached.

What if? I can't help but wonder...

 

Returning to the Scene of the Crime

Today's post, for NaBloPoMo, was always going to be a challenge to write, not only because I rarely, if ever, post on a Saturday, but also due to a hectic schedule. I had a full work-length day attending a course to update my knowledge and kills in sedating patients followed by plans that would take me directly out this evening with no time to stop to make much of a blog post.

What I wasn't really expecting was to hit on a subject I wanted to write about that in itself would present such a challenge. I've been mulling it over on my journey home, and can only hope I don't come across sounding ridiculously emo.

The course I was attending was based at Queen Mary's, University of London in Mile End. QMUL is the university attached to the Royal London Hospital at Whitechapel, in which I spent some time last year, about 10 minutes away.

It only struck me when I was waiting for a train on the northbound East London Line underground platform at Canada Water, that this is the first time I've used the East London Line since that day. It's not hard to let to let 16 months pass without using this particular line. It's currently the shortest on the network, serving just seven stops between Whitechapel and New Cross. But realising that this is the first time I've re-made that journey made my stomach lurch. I can't find the words to describe it properly. It made me catch my breath for a second. It just made me feel weird. I knew it was irrational a daft. After all, it's not like the day was going to have the same ending. But sometimes you just can't help the way you feel.

Arriving at Whitechapel station, I found myself hot footing it up the stairs to the District Line platforms above and jumping on a train to go one single stop eastbound to Stepney Green. True, I was several minutes closer to my destination, but it was beautiful, clear and sunny November morning, I was running a little early and the extra walk would have made a great start to the day.

Instead, I found myself in Whitechapel station, my heart pounding crazily in my chest and totally unable to accomplish the simple task of walking out through the ticket hall. I found myself physically unable to revisit of the scene crime, of which only a brief and sanitized version is really described here, the truth hidden and excused by my unconsciousness at the time.

I don't ever have much reason to visit Whitechapel these days and could quite probably go through the rest of my life avoiding it.

But sooner or later, I need to make myself go back there.  Life after all did go on, no matter how close it came to being a different story.

Do you want a seat with that?

A familiar scene in a Jubilee Line Underground carriage this afternoon:  two women boarding the train at the exact same time, each from one of the two sets of central doors. Just one free seat in the central section. Each locks eyes with the seat then briefly with each other. A three second mental struggle ensues before the seat is claimed by the speedier mover. The doors bleep loudly to warn of their closing followed by the winding noise as the train begins to move and accelerates into the blackness of the tunnel.

The defeated party, I leaned back against the perch seat in the wheelchair/pushchair area adjacent to the seat I'd missed out on. Pulling my bag across my body, I rummaged inside for my test kit. My thoughts had turned to the calibration alert my pump had given me some half an hour earlier and to the Sicilian Lemon chocolate bar in my bag I was hoping to eat.

I unzipped the case, popped the lid from the test strip bottle and inserted a strip. As I readied my Multiclix, I heard a voice:

"Oh I'm so sorry. Do you need a seat?"

It took a moment fro me to realise that the person was speaking to me. The person who'd narrowly defeated in reaching the seat on my right.

I smiled my thanks, but shook my head. "No, I'm fine thanks."

And I was . The result was 6.4 (115)

A 1.8 unit bolus later, as I unwrapped my chocolate, I got to wondering.

Did she have no idea what I was doing, but presumed it to be something medical and something that therefore made me in some way less able to stand and more in need of her seat?

Or perhaps she did know what I was doing, and perceived it to be a fiddly, difficult procedure that would be easier to perform while sitting down rather than an almost thoughtless, effortless task than I could probably do in my sleep.

Or did she know what I was doing, know that it represented diabetes and so perceive me as in some way disabled, or less capable of standing on a speeding tube train?

Don't get me wrong. In the day and age where heavily pregnant women are often ignored in packed carriages, and  where I frequently struggled to get a seat when I had my leg in a plaster cast, the fact that someone is considerate enough to offer their seat to someone else, even though I didn't need it, is refreshing.

But I really hope her reasoning wasn't the last one.

How To Save A Life

There is no doubt that I owe something to the London Ambulance Service.

The EMTs and Paramedics who make up their number have attended to me and treated me, or scooped me up and carried me off to hospital, more times in the last few years than I really care to think about. Enough times to make me feel simultaneously very grateful and just a little ashamed to be so needy.

For the most part I have very little recollection of these encounters and of the people who are summoned to rescue me when I've fallen off the side of the narrow line we tread. By the time the guys in green are racing to my side, I've invariably lost my grip on reality through a blood sugar that is far lower than it should be, through a seizure or for some other reason entirely. I hate that I can't get the moments that I lose back. That I'll never know if I was combative, rude and abusive or just plain funny. I'll never know if my dignity remained intact whilst I lay on a dirty London pavement.

And I'll never know exactly how close I came to never recollecting anything again.

Now that's a very scary thought.

It's not surprising that I take some comfort from the fact that in the hands of these professionals hypoglycaemia, which has perhaps been the commonest cause of my need for assistance ever since my first ambulance ride some two decades ago, is easily treated. So easily treated that these guys actually regard it as a favourite job.

How do I know that?

Because I'm a long-term sometime reader of the blog Random Acts of Reality, written by LAS EMT Tom Reynolds. And I read it here.

Where there is an up, there is almost always a down. For me, it came in a very public place as I was reading the book version of the blog, Blood, Sweat and Tea. I'll have every recollection of my loss of dignity as the tears fell when I read this entry, that I had not read online.

There is so much that can never be known. It is an assumption to think that this was a deliberate omission of insulin, and an even bigger one to suppose that it was driven by a diabetes releated depression, although they also seem like obvious conclusions. The only thing that seems certain is that the high blood sugar dictated the outcome.

It's a reminder that another effective way to save a life, to save many lives, would be to eradicate this thing altogether.

 

I Guess Everyone's A Suspect

I was travelling on the Northbound Jubilee Line, being watched. At first it was furtive, surreptitious glances, out of the corner of her eyes. The sort of glances that are pretty commonplace on public transport. But they soon progressed to an unabashed stare and eventually she was virtually craning her neck to look at me.

I peered down at myself, to check that I hadn't accidentally left the house wearing my breakfast down my front or, worse, wearing my underwear Superman style. I wasn't.

Less than a minute passed. She turned to the girl travelling with her. "What is that?" she said, quite audibly.

This wasn't a curious 'Well isn't that strange, I wonder what it could be' enquiry. The edge to her voice betrayed that she wasn't asking her companion a question; she was confiding her fear.

The travel companion's eyes flashed at me with a slight panic that was also evident in her voice as she said "What, that thing under her clothes?"

A couple of other heads in the carriage whipped round to look.

I knew what they were thinking.

The train rattled noisily into my station. I diffused their panic by slipping off.

When I got home I stood in front of the mirror. I saw my pump in my pocket, a loop of tubing going to my tubeguard and tubing snaking from there up under my clothes. On my arm the Guardian sensor was just visible, its grey wire feeding up under my sleeve. The outline of the transmitter on the back of my shoulder was clear through my shirt. The Guardian monitor was clipped into the mesh pocket on the side of my backpack. I reached into my backpack to look at it...

It doesn't really surprise me that people were suspicious. The terror threat has been dragged brutally back to the forefront of everyone's minds - not that it was ever far away - by today's foiled terror plot, the banning of aircraft hand baggage and ensuing airport chaos and the raising of the UK threat level to critical.

And I clearly remember how just over a year ago, after the 7/7 bomb attacks and subsequent Stockwell shooting, a friend told me, with genuine concern, to make sure I kept my pump well concealed and most importantly without the tubing hanging out while on public transport.

Because, I guess, these days everyone's a suspect.

Changing Buses at The Elephant

Travelling on London's public transport in the 35 degree heat we had last week is not fun. None of London Transport - with the exception of a few of the modernised suburban rail links - is air conditioned. The tube in particular is a nightmare. Would I be being too graphic if I described being packed in like a sardine with your nose in some unknown sweaty commuter's armpit, and the risk of getting stuck in a tunnel at any time? Probably, so I'll gloss over it. But that is why I choose to travel by bus in the summer as often as possible.

But then, so does half of London.

And changing buses at the The Elephant is bad enough at the best of times.

For starters, seven different routes use my stop. There are so many chances to miss the bus I need: It flies past a line of those already stopped, not realising I want to get on; it stops right at the back of a long line of waiting buses and pulls away before I've reached it; oh, and half the other people at that stop want my bus too, and there simply isn't room for all of us.

Changing buses at The Elephant in 35 degree heat whilst on crutches is particularly bad.

Changing buses at The Elephant in 35 degree heat whilst on crutches and hypoglycaemic is impossible. It's a proven fact.

And you know, sitting down on London's pavements isn't a good idea. I love London, but you only have to visit any other city in the world to realise how dirty it is. Yes, especially The Elephant - if you visited the link above, don't be fooled,  it is currently little more than a giant tatty roundabout, with a hideous red shopping centre at its heart.

Perhaps I looked a peculiar site sitting there with the Guardian periodically wailing like a banshee and tears of frustration - at being low again, at being unable to accomplish the simple task of getting on a bus to go home - streaming down my face, throwing the contents of my bag into a heap in a desperate search for glucose tablets.

The only good thing about The Elephant is that anything goes.

So I'm sure nobody really batted an eyelid.

7th of July

I'll always remember where I was when I heard. And how I felt.

I'll always remember the frantic phone calls, the quest for information, the need to know that everyone I care about was safe.

I'll always remember how it felt to travel on the tube the followig day. The same but, somehow, completely changed..

I'll always remember standing in Tavistock Square. The image of that bus will be forever seared into my mind.

But most of all I will always remember the victims: the dead, the injured, their friends and loved ones and the emergency staff who dealt with the aftermath.

And, finally, I'll be forever grateful for the timing of my own travel to Russell Square.

We're just one year on, but London will never forget.

Snow in the Sunshine

There is something very bizarre about snowfall in the sunshine. It belongs in the mountains, where bright sun and a fine snowfall can add up to perfect day of skiing. But in England, in London particularly, snow only ever comes from leaden grey skies that simply look cold.

I'm sitting here right now though, watching the fat flakes float delicately, aimlessly to the ground, occasionally whipped into energised swirls by the breeze. The sunlight is dancing on the surface of the Thames, that runs higher than I'm sure it should, and refelcting off the glass of the Canary Wharf offices, enchanting and blinding me by turns. It doesn't look cold, but my red nose and frozen ears from ealrier attest that it is struggling to push above freezing.

The snow represents the last remnants of winter, but the sunshine tells me to hang in there... spring is just around the corner.