Insulin and Eugenics... I am upset. This is a rant.

As a type 1 diabetic, I am often very angry. Usually this is secondary to hypoglycemia or an ability to eat something because I inadvertently left my insulin at home.

But today I am upset because I am running out of insulin and I only have $600 left in student loans until late February. Why is this a problem? Because as someone with good medical insurance, my doctors have always prescribed me humalog and lantus, which are bloody expensive without a prescription (and are actually still really expensive with a prescription and insurance: $50 each for what I need in a month). But as a medical student I don't have time to go see a doctor to get a prescription to get my bloody f***ing insulin. I am really upset because as I speak I have about enough humalog (lispro, short-acting insulin) to get me through to Monday, after which I guess I'll start employing a poor man's metformin: large amounts of acetaminophen and straight hard liquor. Your liver transaminases skyrocket, but you've effectively bludgeoned your body's best organ so badly that it stops going through with gluconeogenesis. Oh, and a ton of aerobic exercise makes your body more sensitive to the effects of lantus (glargine, long-acting insulin), so I guess I can look forward to dropping a few pant sizes and... cirrhosis. Lots of preventable, freaking cirrhosis.

I don't know what I'm supposed to do. There must be type 1's who are busier than me and have less time to see doctors. And I know there are type 1's who don't have health insurance because this country is absolutely terrible. So how can I get insulin at a reasonable price without having to see a doctor? Because, honestly, I've had diabetes for over ten years and I know my body's personalized ways of dealing with this disease in a way that literally no other health professional could understand. I know the tricks. I know the secrets of my metabolism. My A1c is always under 7.0 and my hypoglycemic events are now well controlled. I know what I'm doing.

SIDENOTE... no wait, MAIN POINT: I think it is absolute bullshit that people need prescriptions for something that their body erroneously stopped producing. Almost everyone else around me is making insulin, but just because my body f***ed up when I was thirteen, I have to spend thousands of dollars on a month's worth of high quality insulin? What kind of justice is that? Answer: it's not. It's wrong. It's condemning people to a constant economical disadvantage on top of the disease they've contracted who's co-morbidities will likely kill them if they don't control the aforementioned disease. In a country where medications aren't regulated to make them fairly priced (hell, I think they should be bloody f***ing free but I realize I'm incredibly biased) and health insurance is severely limited, we are essentially killing off diabetics. I realize that many type 1 diabetics can make it to reproductive age without dying first, but I've seen a 24 year old diabetic with f***ing gastroparesis--that's really severe neuropathy. And now that I've gone through OB-GYN, it becomes apparent that type 1 diabetics with A1c's of 13.6, like this 24 year old, would never be able to carry a healthy child to term. She will likely never produce any children because why? Because our health system is unjust? What sick kind of world is this?

And you know what's worse? The type 1 diabetic population that is under insured and hurting the most is minorities, specifically blacks. And you know what's f***ing insane about that? DIABETES IN AFRICAN POPULATIONS HAS NO DISCERNABLE GENETIC COMPONENT. Whereas caucasian type 1 diabetics usually have some weird HLA inherited predisposition sh*t. And yet, at least in Chicago, those people will be preferentially allowed to live with a disease that could be greatly reduced within the human population if only they were put to the slow and painful death that awaits most uninsured type 1 diabetics.



[edit]: Okay. So I calmed down a little bit. Let me just say that I recognize that a lot of white people don't have health insurance either. But at least in Chicago, economics and race are obnoxiously linked in a way that has already started to upset my psyche. So I'm sorry about that. The truth is, all type 1 diabetics are in an equally unfortunate place in a society where close health maintenance is ludicrously expensive.

And also, I don't think I do a good job of separating my emotion's from the job. Especially other type 1 diabetics so far along. Seeing another black, 24-year-old, type 1 diabetic, laying on a bed in the emergency department, clutching at her stomach and moaning for morphine, secondary to gastroparesis and then her resultant addiction to painkillers, really upset me I guess. I want to help them but I know that it's literally too late because you don't recover from severe autonomic neuropathy. You just suffer until you die. From something completely preventable.

I guess this whole thing bothers me, not just because on the whole diabetics are treated very poorly, but because I'm now a healthcare professional, and I am surrounded by physicians every day, but I don't think I can just ask them to write me a prescription for insulin because I'd rather go to work than call the doctor's office to set up an appointment, then call the dean of student affairs (another physician), and then the clerkship director (also a physician), and then drive to god knows where for a fifteen minute conversation with the doctor to write me a prescription so I can save $350 for something that almost everyone in the world doesn't think about.

It's upsetting. If I had my way, everyone with a type of medical/biochemical deficiency would be able to get whatever they need for next to nothing because that's what equality is. Hypothyroid? You get thyroxine, no problem. Chronically depressed? We'll get you an SSRI or maybe even some SNRI's if you're lucky and need more norepinephrine. Diabetic? We'll get you all the insulin you want. Because giving you anything less than that is a crime.




So this is where I read that Diabetes in blacks and asians is often idiopathic: http://www.aafp.org/afp/1998/1015/p1355.html
Although since I am both caucasian and african, I won't know if I have the idiopathic form until either A) my entire genome gets sequenced (I hear it's only $1000 now!) or B) they look for islet cell antibodies in my serum.

Watches

Since early last year I've been dying to get a watch. I do not know why I associate professionalism with watches, but let me speculate:

1. Pulling out a phone to check the time is "disrespectful" (your older professors will assume you're getting a quick round of "words-with-friends" in).
2. Being successful but also professional means having functional bling. If I get a doctor's bag, it's going to be the most abstract Vera Bradley pattern I can find. If I have an excuse to have a watch, it will be like a crazy beautiful watch. It won't be like I'm "dressing" up (which would be unprofessional) because I actually need a timepiece (... well I mean technically. I think I can make the argument that I need a time piece).
3. It just feels like a doctorly thing to have. I want to be standing over a patient, taking their blood pressure, their heart and respiration rates, and instead of staring at a wall, I want to be looking somewhat at the patient so I don't seem distant. I also feel like there are a lot of portraits of doctors looking at their watches while assessing a patient's vitals.
4. Also, most obvious: being late is unprofessional. You can lose "professionalism points" from our clinical reasoning course by being late to lab. So yea, punctuality is professional.

Consequently, I've been obsessed with finding a watch. Stylistically, I'm pretty "out there," so the challenge is to try and find something that expresses my personality but doesn't force my personality onto others (or worse, offends people). I also don't want to drop much more than $100, so I went to overstock.com because it's really difficult to find cool watches for women. I guess time is more of like a "dude thing." I don't know and I didn't really care, until, after scrolling through about 500 watches I see this atrocity:

Not only is this thing disgusting, it also asks a very important question: why isn't there a "whimsical women's doctor theme white leather watch"? I do not think I want to put on an air of "whimsicality" when I begin rotations next year, but dammit, I want a doctor's watch made for my womenly wrists!

Well, I have since searched overstock.com for a doctor's watch, and they don't have any. I tried searching for "professional" watches, and of the 40 results I got, 39 of them were men's watches. The one female watch was for "professional divers." Which I guess is cool and stuff because hey! I would've never thought women could descend to the same depths as men due to their whimsical womenly constitution's and other almost-trivial-but-still-obnoxious sexist b***s***. 

Anyway, rant over. If you're curious, I bought the above two watches. The one on the right is transparent, which means I've finally gotten something that's actually my skin tone.... which is another thing I could complain about. But I won't. Since like, I'm in medical school and am like, totally busy and schizz.

Read Between the Lines

We have a pathology professor--he seems like a nice, funny man--who's voice slowly deteriorates from a standard, older person's grumble to a dying, dehydrated, lip smacking affair. It's his third hour of lecturing. I get it. You need water. I understand this.

WELL THEN GET A DRINK OF WATER.

I should explain. I can't stand several things in this world of a billion annoyances. But the thing that bothers me a lot and is also quite common is hearing. people's. mouths. Mouths are disgusting, disgusting places. In general I can't stand the sound of people eating. This bothers me to no end. I have had to yell at people to stop, I have gotten into so many annoying fights with my little sister who--is an amazing person--but who needs to understand that I simply can't stand listening to other people eating and no, I will not get over it. F*CK that. I AM ACTUALLY ENRAGED RIGHT NOW. Because I am sitting in class and my professor, teaching pathology--an amazing course--keeps making eating sounds over his goddamn microphone. I swear to God I might leave. I want to leave. Maybe I'll put in headphones.

I have put in headphones. I no longer want to pay attention in class, however, and am pretty upset. The only other times I feel this irrationally upset, I am usually PMSing. I know it's irrational, but I am clearly having a physiological response. My breathing is shallower, more rapid--my chest is tightening. I may pass out. 

Worst of all, this is now affecting my note taking. BECAUSE HOLY SHIT, when something doesn't make sense, I get slightly upset. When I am already upset and things don't make sense, I break down.

Medicine is not for the easily incensed.