The drive to Children’s Hospital was fifteen minutes, just enough time to forge 90 days of blood sugar readings. Pen in hand, riding in the backseat of my parents’ car, I’d scribble fabrications into my logbook. 132. 289. 71. 320. 97. 120. 62. 205. 110. When my parents would ask their ten-year-old what he was doing, I’d say, “Homework.”
Peering at me on the exam table after he’d flipped through my log, my endocrinologist would say, “Ryan, your numbers look okay… but I don’t see any patterns. Let’s check your hemoglobin a1c and decide what changes to make.” Hemoglobin a1c, a lab test, represents average blood sugar for the past three-months. Judge and jury, I dreaded its verdicts. Though typically, my a1c landed between 7 and 8 and close enough to satisfactory control. No changes to my regimen, habits, or lifestyle would be recommended. Responsibility would be dodged. (A number below 7 is desired to avoid long-term complications. It equates to an average blood sugar of less than 150 mg/dL. Normal blood glucose for someone without diabetes is 90 mg/dL.)
Everything’s different now. 90-day logs of every-five-minute glucose values upload directly to my doctor’s computer. An algorithm spits out patterns. I have nowhere to hide. And that’s how I like it, thanks to my time in psychiatry.
As a depressed medical student, when I looked at the prospect of becoming a psychiatrist, I thought, “I’m only surviving all the anxiety, psychosis, and mania if I figure out who I am in the process.” It was part prescription, part hailmary. Unbelievably, it worked (and I survived), but not after some revelations in my own therapy, one being I was in diabetes denial. Why? Because denial preserved omnipotence. At nine years old, I was diagnosed with diabetes and needed to believe nothing would change. At 25 years old, I went to medical school without wanting to be a doctor and needed to believe nothing would change. At 33 years old, I needed to quit medicine to be myself. Now, at 36, I am myself and my self has diabetes; there’s no denying that.
Yesterday, I drove to the lab for a blood draw. I made small talk with the phlebotomist and watched my blood spew into a yellow tube. “If you wanna stick around,”—the phlebotomist bandaged a cotton ball where the needle had exited my forearm—”I’ll have your a1c ready in five minutes.” I walked into the hallway, leaned against the wall, and waited for dread to join me, but it never showed.
The phlebotomist peaked her head into the hall and whispered, “Six point six.”
“What?” The number didn’t compute.
She smiled softly and said the number again. I almost cried. It was the lowest a1c of my life.
To livin’ a life we love,
Ryan Fightmaster, MD
