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.
Showing posts with label personal health. Show all posts
Showing posts with label personal health. Show all posts
Jan 18, 2014
You win this time, baby.
"Syncopal Event"
So a couple of nights ago I ended up unconscious, on the floor, dreaming about a duck and a witch debating over who should mow their lawn. Incredibly unprofessional.
But apparently these things are common on Ob-Gyn rotations. But I don't understand why these things have to be common for me.
Here's my track record so far: In a week of working pure shifts I observed a c-section and helped out with a normal spontaneous vaginal delivery (NSVD). I nearly passed out in one, and definitively passed out in the other--I was on the floor dreaming about ducks. That means right now the score is: seven pound neonates 2, Elora 0.
When the scrub nurse told me I needed to leave the table during the c-section because I was leaning on the patient and I was passively crossing my eyes, I gave my retractor up and I had at the time told myself my blood sugar was probably low. Type 1 Diabetes fail! I sulked out of the room--very slowly so that I wouldn't fall onto any of the nurses standing cautiously around me. And then I had found my way to a patient fridge which are really just stock piles of assorted milks, jellos, and juice cups. One chocolate milk and one orange juice down, I found a dark, quiet unused part of the family waiting room and slowly collected the sweat pooling off of my face onto the collar of my oversized, hospital recycled scrubs. Excellent example of an acute hypoglycemic event--so perfect I didn't even think about checking my blood sugar. And then I actually passed out for real during a NSVD and upon regaining consciousness enough to check my blood glucose, I was perfectly normal--better than normal… 176 mg/dl. So now everything is in question!
DID I REALLY ALMOST PASS OUT DURING THAT C-SECTION? Even my potential as a future family practitioner should be questioned. If I can't handle pregnant people and kids, then I will have to become a… oh god… an internist? I would rather die than do something that boring. I HAD SUCH HIGH HOPES FOR OB-GYN. I've more or less "mastered" (for a third year medical student) the pelvic exam (I can find your cervix! If you have one). Vaginas don't creep me out at all! Vaginal products don't really creep me out either. Senior year of high school, as a swim team captain, I had picked up, with my bare hands, a bloodied feminine napkin that some noob had left on our locker room floor. This merited me a great gag gift at the end of the season. But it also kind of made me think that I could handle a large amount of grossness associated with the female reproductive tract. I still don't think vaginas or uteruses are my problem.
Which is why I think my real problem is… babies. When I had returned to the floor station after passing out during the NSVD, and the nurse wheeled the less than one hour old baby past me, I pointed at it and declared: "You made me pass out, baby!" What the hell is wrong with me? THEY BARELY MOVE! They are pathetic. Me and a baby in an actual fight? I would probably win, right? Gah. Maybe not.
The midwife, the residents, and a ton of nurses have been very supportive of the fact that I am not, in fact, a very imposing six foot tall woman, but rather a pathetic, spineless, inexperienced medical student. Every one has stories of passing out and watching other people pass out. It makes me feel better to know that this isn't rare. But I don't want to feel normal. I want to actually be good at maintaining consciousness in unpleasant situations.
Talking with my friend, Cindy, who was also on shift with me, who had also watched this baby emerge into the world, who had also, like me, held the mom's legs back to flatten the pelvic floor and increase the size of the pelvic outlet, and who is a very small five feet tall, but who had NOT passed out, suggested something like, maybe it's not the actual sight of a baby entering the world--because they are pretty ugly looking in an adorable way--but maybe it's the smells of deliveries that really knock me out. Possible. The c-section lady had smelled pretty gross before the operation, and during it, she hadn't smelled that much better. And during the NSVD, I was literally holding up a thigh as the woman kept exhaling directly into my face. I shouldn't say anything. If I had been in labor for the last thirteen hours, yea… I probably wouldn't have spent time brushing my teeth, either. But then it was all I could smell and I felt like vomiting. And when the baby came out I kind of stepped out into the corner, leaning against the window sill. I was thinking to myself "hypoacousis: the thing that happens to me when I'm really happy/manic when driving and I have to turn up the radio all the way because everything sounds so quiet" because that's what was happening to me at the time. Everything was incredibly muffled. There was no longer blood in my ears, apparently. Nor was their blood in the rest of my body, because my arms and legs were moving very slowly. I managed to make it to the window sill and was just kind of waiting for the aura to subside. But it was a prodrome. And the next time I opened my eyes, I was staring at the ground and a nurse was propping me up against the wall with a blanket, and another was going out to get me orange juice. "I don't know what just happened," was my response to "Are you alright?" And Cindy was giving me a pity smile. The patient's family members were mildly freaking out, and I wondered if when the kid asked about her birth they'd tell her that she made a medical student pass out.
Later I would have to fill out an employee injury report, and although I had a small, 1-2 cm laceration ion the lateral aspect of my forearm, and my hand was really sore, I was tempted to write "ego" in the head of the anatomical model of the human body, and circle it to show where I was in fact, most hurt.
When the scrub nurse told me I needed to leave the table during the c-section because I was leaning on the patient and I was passively crossing my eyes, I gave my retractor up and I had at the time told myself my blood sugar was probably low. Type 1 Diabetes fail! I sulked out of the room--very slowly so that I wouldn't fall onto any of the nurses standing cautiously around me. And then I had found my way to a patient fridge which are really just stock piles of assorted milks, jellos, and juice cups. One chocolate milk and one orange juice down, I found a dark, quiet unused part of the family waiting room and slowly collected the sweat pooling off of my face onto the collar of my oversized, hospital recycled scrubs. Excellent example of an acute hypoglycemic event--so perfect I didn't even think about checking my blood sugar. And then I actually passed out for real during a NSVD and upon regaining consciousness enough to check my blood glucose, I was perfectly normal--better than normal… 176 mg/dl. So now everything is in question!
DID I REALLY ALMOST PASS OUT DURING THAT C-SECTION? Even my potential as a future family practitioner should be questioned. If I can't handle pregnant people and kids, then I will have to become a… oh god… an internist? I would rather die than do something that boring. I HAD SUCH HIGH HOPES FOR OB-GYN. I've more or less "mastered" (for a third year medical student) the pelvic exam (I can find your cervix! If you have one). Vaginas don't creep me out at all! Vaginal products don't really creep me out either. Senior year of high school, as a swim team captain, I had picked up, with my bare hands, a bloodied feminine napkin that some noob had left on our locker room floor. This merited me a great gag gift at the end of the season. But it also kind of made me think that I could handle a large amount of grossness associated with the female reproductive tract. I still don't think vaginas or uteruses are my problem.
Which is why I think my real problem is… babies. When I had returned to the floor station after passing out during the NSVD, and the nurse wheeled the less than one hour old baby past me, I pointed at it and declared: "You made me pass out, baby!" What the hell is wrong with me? THEY BARELY MOVE! They are pathetic. Me and a baby in an actual fight? I would probably win, right? Gah. Maybe not.
 |
| This is the bruise left from my syncopal event. |
The midwife, the residents, and a ton of nurses have been very supportive of the fact that I am not, in fact, a very imposing six foot tall woman, but rather a pathetic, spineless, inexperienced medical student. Every one has stories of passing out and watching other people pass out. It makes me feel better to know that this isn't rare. But I don't want to feel normal. I want to actually be good at maintaining consciousness in unpleasant situations.
Talking with my friend, Cindy, who was also on shift with me, who had also watched this baby emerge into the world, who had also, like me, held the mom's legs back to flatten the pelvic floor and increase the size of the pelvic outlet, and who is a very small five feet tall, but who had NOT passed out, suggested something like, maybe it's not the actual sight of a baby entering the world--because they are pretty ugly looking in an adorable way--but maybe it's the smells of deliveries that really knock me out. Possible. The c-section lady had smelled pretty gross before the operation, and during it, she hadn't smelled that much better. And during the NSVD, I was literally holding up a thigh as the woman kept exhaling directly into my face. I shouldn't say anything. If I had been in labor for the last thirteen hours, yea… I probably wouldn't have spent time brushing my teeth, either. But then it was all I could smell and I felt like vomiting. And when the baby came out I kind of stepped out into the corner, leaning against the window sill. I was thinking to myself "hypoacousis: the thing that happens to me when I'm really happy/manic when driving and I have to turn up the radio all the way because everything sounds so quiet" because that's what was happening to me at the time. Everything was incredibly muffled. There was no longer blood in my ears, apparently. Nor was their blood in the rest of my body, because my arms and legs were moving very slowly. I managed to make it to the window sill and was just kind of waiting for the aura to subside. But it was a prodrome. And the next time I opened my eyes, I was staring at the ground and a nurse was propping me up against the wall with a blanket, and another was going out to get me orange juice. "I don't know what just happened," was my response to "Are you alright?" And Cindy was giving me a pity smile. The patient's family members were mildly freaking out, and I wondered if when the kid asked about her birth they'd tell her that she made a medical student pass out.
Later I would have to fill out an employee injury report, and although I had a small, 1-2 cm laceration ion the lateral aspect of my forearm, and my hand was really sore, I was tempted to write "ego" in the head of the anatomical model of the human body, and circle it to show where I was in fact, most hurt.
May 25, 2013
6 days, 20 hours
Continuing on with how poorly my body handles stress:
I've developed BPPV (benign paroxysmal positional vertigo) and the skin on my outer ear (my auricle) is peeling off and scabbing over and it is thoroughly gross.
I was going to claim that I have trichotillomania (compulsive pulling of hair) or dermatillomania (compulsive picking at skin), but apparently these are serious conditions. And even though I can't sit still and not pull my hair or pick scabs while I study, I feel absolutely fine when I get up to do something else (that's a lie. I never feel fine anymore).
Regardless, my exam is in 6 days and 20 hours. I have a box of Pop-Tarts, a box of Teddy Grahams, Hansen's natural cane soda, Fruity pebbles, and a box of Quaker Chewy bars. I also have about 65 more hours of lectures to watch. So.......
I've developed BPPV (benign paroxysmal positional vertigo) and the skin on my outer ear (my auricle) is peeling off and scabbing over and it is thoroughly gross.
I was going to claim that I have trichotillomania (compulsive pulling of hair) or dermatillomania (compulsive picking at skin), but apparently these are serious conditions. And even though I can't sit still and not pull my hair or pick scabs while I study, I feel absolutely fine when I get up to do something else (that's a lie. I never feel fine anymore).
Regardless, my exam is in 6 days and 20 hours. I have a box of Pop-Tarts, a box of Teddy Grahams, Hansen's natural cane soda, Fruity pebbles, and a box of Quaker Chewy bars. I also have about 65 more hours of lectures to watch. So.......
Feb 13, 2013
BRT (It's Wednesday)
So I'm a failure at blogging. What else is new?
Regardless, it's BOARD REVIEW TUESDAY (it's Wednesday) so let's review!
There is absolutely NO WAY I can study for combined exams, study for step 1, and expect to stay alive. I've done nothing that I usually find enjoyable in the last week. To continue living this way for the next 107 days... Terrifying.
Let's take a look at a typical day:
Sadly, that's a pretty accurate description of my days.
Regardless, it's BOARD REVIEW TUESDAY (it's Wednesday) so let's review!
There is absolutely NO WAY I can study for combined exams, study for step 1, and expect to stay alive. I've done nothing that I usually find enjoyable in the last week. To continue living this way for the next 107 days... Terrifying.
Let's take a look at a typical day:
7:30 AM: Wake-up. Probably. You let your alarm ring for 17 minutes before falling out of bed.
8:04 AM: Show up to your 8 o'clock class. Reluctantly remove ear-buds when you sit down near the back of the auditorium.
12:00 PM: Congratulations! You've just survived four lectures. (Only three of them were good... and you were on pinterest for a good fifteen minutes at one point).
12:05 PM: Back in your apartment, you think about eating lunch.
12:45 PM: Nope. You just spent 45 minutes dealing with obnoxious e-mail requests and finishing assignments, last minute. Now you go to the freezer and stare at a box of ice cream. You eventually put it back and eat left-overs instead (we're proud of you, you poor bastard).
1:45 PM: It took you an hour to eat. You also had a beer. And watched The Daily Show and The Colbert Report back to back on Hulu.
2:00 PM: You're back at school, doing something "additional" to your actual classes. Attendance is mandatory, although you have no idea why.
3:45 PM: You've finished interviewing what feels like thousands of fake patients (there were only three, but your legs are weak and you're shaking all over. When you're a real doctor, you will likely see forty patients a day. Good Luck!)
4:00 PM: Sit down to study. You can't decide what to study first: Lecture notes from last week or Case Studies for step 1. You listen to your heart. Your heart tells you lecture notes.
5:30 PM: You break. Who cares about parasites? They are disgusting. And now you are hungry. Plus Diane Sawyers is on WorldNews, and you need to remind yourself there's an outside world. Make dinner while watching television. Eat dinner during commercials.
6:03 PM: You pick up your Case Studies book. You skim through 2 and a half cases and stop because...
6:30 PM: Television is on again. It's Wheel of Fortune. You're still human, dammit.
6:58 PM: You're lying on your bed playing an addicting game called Triple Town on your tablet that you bought primarily for school work. Whatever. Triple Town is legitimately awesome. It's like if Farmville and Bejeweled had a baby.
7:24 PM: You really hate yourself. Also Triple Town. You start skimming tomorrow's lecture notes.
7:48 PM: First exposures are always the worst. Hepatitis D will probably make sense to you when you read about it next week. Fifteen minutes before your exam. Go on Facebook. You have 2 notifications. Respond to notifications. Nothing else is happening. Stay on Facebook for the next 11 minutes, waiting.
7:59 PM: Check e-mail. Start G-chat-ing with Charyse.
8:27 PM: You've been reading Jezebel.com and io9.com. You finally stop when you see a medical article on io9 that you kind of understand, making you feel guilty that you're not furthering medicine at this very moment. You make a grand attempt at getting through First Aid Cases. It appears to be working until....
9:44 PM: GAH. You can't read this anymore. You only have five cases left but you don't care. You get some cheese sticks, red wine, and 25 mg of Doxylamine succinate, the finest sleeping pills around.
10:35 PM: You zoned out and somehow ended up writing something on your personal blog that shall not be named. It's angry and sad and if you didn't hate hugging people so much, that's exactly what you would want. You gently slap yourself in the face and finish your First Aid Cases.
11:08 PM: Despite drugging yourself, you're still awake. Though mildly content that you finished all your CramFighter assignments. No, scratch that. Wildly ecstatic. You remember when normal things used to make you happy. You turn off all the lights and watch Futurama until you're at the verge of passing out.
11:47 PM: Once again, you've forgotten to brush your teeth. You stumble to your bathroom to clean your teeth.
12:20 PM: You actually fall asleep. You dream of your adolescence underneath an instagram filter.
Sadly, that's a pretty accurate description of my days.
Jan 24, 2013
Good News: i'm not a heavy alcohol user.
I fall somewhere in between binge and heavy drinking. Thanks science!
Jan 15, 2013
And That's Delirium!
Recently I found out that hypoglycemia can precipitate the mental state of delirium. As a well controlled diabetic, I have a lot of hypoglycemic events, so I am versed in the various physiological and psychological events that coincide with a drop in blood sugar. However, the number of times I've been delirious because of hypoglycemia? It's hard to say--I only just discovered what delirium is (thanks clinical neuroscience!)
But I'm going to say I've been completely incapacitated by delirium secondary to hypoglycemia twice: once in the central rain forests of Costa Rica, and once again in the sixth row of Finch Auditorium at Rosalind Franklin University.
The first time--in Costa Rica, was innocent enough. I had lost a lot of weight rather precipitously. The temperature was always in the low eighties and I had to hike about ten miles everyday under the weight of climbing harnesses, bio-tags, poorly prepared, non-Skippy peanut butter sandwiches, and gallons and gallons of water. Regardless, when I returned to the states briefly to take the MCAT, I sidetracked and took a shopping trip to the Gap, only to realize I was a size four, which means I probably weighed about one-hundred-and-forty-five-pounds, placing my BMI at 20. Although still in the normal range, when you consider my amazing, incapable-of-becoming-osteoporotic bones, a BMI of 20 is deadly. Or at least deadly for a diabetic since I didn't have any excess stores of glycogen in my liver. All hypoglycemic events had to be dealt with by myself--not the glucagon my diabetic body was still capable of making.
Essentially this just meant waking up with hypoglycemia frequently and having to drink more gatorade. But one morning, I woke up with a huge existential crisis hovering around my incapacitated body. I will never know how low my blood sugar was--all I remember is that my roommates had already left for breakfast and I found myself alone in the jungle, surrounded by the creaks and caws and chirps of forest dwellers and the hot and sticky and humid air of the tropics. Oh yes, and an existential crisis.
There was a journal by my bed. I wasn't really recording much in it: we had actual journals to take down actual data--like the types of epiphytes on the branches held up by the forty meter tall trees we climbed. I had a journal to take down various soil measurements (soil is so cool! But that is neither hither nor thither). But by my bed was a journal of just short little ditties--observations really, of a rainforest. Or at least, that was all that was in it--ditties--until my blood sugar was freakishly low and I somehow located a pen and started tearing at the pages with it. I was terrified, in that moment, of death, without knowing why. I had no idea my blood sugar was low, just knew that God was holding me in his hands at that very moment, pondering whether to keep me on the planet or toss me out, into the abyss of Hades.
And I was terrified. My mind flashed, somehow, and without anything more than incredibly tangential reason, to Cat Stevens, and how he had decided to dedicate his life to god and become a muslim after he had almost died swimming in the atlantic ocean and got caught up underneath a rip tide. So I wrote a prayer, a plea, and a mantra on the quadrille lined pages of my yellow journal, demanding that god forgive me for all that I had done and to allow me to live a little longer.
Delirium had made me a sniveling religious fiend.
I eventually escaped such a fate when I--fortunately--started chewing on sugar tablets sitting next to my bed. I then made my way to a late breakfast, where my advisor berated me for my tardiness and my rather dulled affect. Oh, but if only I had known then what I know now: "I mean no disrespect, but unlike the rest of you, I just spent the last hour in delirium."
Anyway, the second delirious state happened literally an hour ago.
Having awoken five minutes before class started, I had no time to locate my test kit. But I had a headache, and I had gone to bed with a bowl of popcorn recently consumed, so I assumed that my blood sugar was the cause of the headache and thus I needed insulin. Well, within the next thirty minutes I realized that my blood sugar had probably been fine when I started feeling the chest tightening spasms of hypoglycemia. No matter! I had fruit snacks!
And thinking that I had avoided the ills of hypoglycemia, I settled in to taking notes on a lecture about epilepsy.
And here's where it gets interesting: Somewhere--about an hour and a half into lecture--I stopped being able to understand the slides I was reading on my computer. And then, shortly after that--the lecturer stopped making sense. I wanted to raise my hand at several points along the way--I wanted to clarify what he was saying because I was sure he was saying it wrong, but I didn't. Instead I just sat in awe that everyone else seemed to understand what was going on.
And then the madness truly sat in.
We switched to a new professor for a new class, and my head wouldn't stay straight on my shoulders, my neck wobbling side to side. I became obsessed with the fear that the professor would notice me in what would have looked like a sleeping position and that I'd be kicked out of class--or that I'd automatically get a 0% on my next exam. So I snapped my head up and sat up straight as possible. But it was useless, because inevitably my eyes would close and my head would fall forward and I'd look like I was sleeping again.
I tried to focus on my computer, on my notes, but they no longer made sense. I tried to play a little game on google+, Triple Town, to see if that would wake me up, but I was exhausted and I quickly closed the tab on my browser and was unable to pull up anything again. I was exhausted; not tired, just thoroughly incapable of movement or thought.
I soon became incredibly confused and scared. Didn't anyone else feel this way? Why did nothing make sense anymore. I could hear the words my professor was saying, but they didn't make any sense. I became preoccupied with a feeling that I didn't exist, or that if I did, I existed on a plane unlike the one everyone else seemed to belong to. Kind of like I was the only one who realized that this world was simply a matrix, and that I needed to find my way back to reality. But how to get there?
I needed help, but from whom?
I decided that I needed to go to either the counseling/health center at school--a five minute walk away from my current location--or to my mother, who I was beginning to doubt was actually my mom at all.
But at both locations I would have done the same thing: fallen on the ground and started yelling that this wasn't real and that someone needed to find out what was wrong with me. "Run all the tests!" I imagined yelling to anyone who would listen. There was something terribly wrong with me, I just didn't know what--but I needed to know.
My daydreams kept escalating in preposterousness until I imagined grabbing a knife and stabbing myself in the heart to regain entry to the "real" world that was hanging just outside my grasp. The thought of stabbing myself terrified me. And that simple feeling--intense fear--called my logic to attention.
What if this was just hypoglycemia? So I formed a plan while my professor kept garbling through his lecture on... what was it? ... anticonvulsants?
Fortunately, after eating a snickers bar, a twix bar, one reese's peanut butter cup, and a can of coca-cola, the delirium surrounding me started to fizzle away. I was capable of speaking, although my tone and volume were way off when I asked one of my friends sitting in the row in front of me, nearly incoherently, where today's pathology quiz was going to be administered. But I was conscious, and the fear that I didn't exist or that I existed in a parallel universe or a mirror reality, quickly became nonsensical and strange. Shortly thereafter, I was conscious enough to begin writing this, an assessment of my mental status as it descended once again into a state I wouldn't recommend for anyone. And that's delirium for you.
(a little bit more for the intrepid reader):
so delirium can be caused by anything that wholly affects the brain. usually when i have just bad hypoglycemia (so not life threatening but unpleasant), i act like i have a frontal lobe lesion: poor planning, flat affect, avolition, etc. however, the two times i've become "delirious" from hypoglycemia, it's possible that I was under the spell of global cerebral ischemia (so involving the entire brain). And while it appears that to get global cerebral ischemia from hypoglycemia, low blood sugars have to occur chronically (i.e., insulinomas), I fully believe that an hour of really low blood glucose could knock a person delirious.
(the end)
But I'm going to say I've been completely incapacitated by delirium secondary to hypoglycemia twice: once in the central rain forests of Costa Rica, and once again in the sixth row of Finch Auditorium at Rosalind Franklin University.
The first time--in Costa Rica, was innocent enough. I had lost a lot of weight rather precipitously. The temperature was always in the low eighties and I had to hike about ten miles everyday under the weight of climbing harnesses, bio-tags, poorly prepared, non-Skippy peanut butter sandwiches, and gallons and gallons of water. Regardless, when I returned to the states briefly to take the MCAT, I sidetracked and took a shopping trip to the Gap, only to realize I was a size four, which means I probably weighed about one-hundred-and-forty-five-pounds, placing my BMI at 20. Although still in the normal range, when you consider my amazing, incapable-of-becoming-osteoporotic bones, a BMI of 20 is deadly. Or at least deadly for a diabetic since I didn't have any excess stores of glycogen in my liver. All hypoglycemic events had to be dealt with by myself--not the glucagon my diabetic body was still capable of making.
Essentially this just meant waking up with hypoglycemia frequently and having to drink more gatorade. But one morning, I woke up with a huge existential crisis hovering around my incapacitated body. I will never know how low my blood sugar was--all I remember is that my roommates had already left for breakfast and I found myself alone in the jungle, surrounded by the creaks and caws and chirps of forest dwellers and the hot and sticky and humid air of the tropics. Oh yes, and an existential crisis.
There was a journal by my bed. I wasn't really recording much in it: we had actual journals to take down actual data--like the types of epiphytes on the branches held up by the forty meter tall trees we climbed. I had a journal to take down various soil measurements (soil is so cool! But that is neither hither nor thither). But by my bed was a journal of just short little ditties--observations really, of a rainforest. Or at least, that was all that was in it--ditties--until my blood sugar was freakishly low and I somehow located a pen and started tearing at the pages with it. I was terrified, in that moment, of death, without knowing why. I had no idea my blood sugar was low, just knew that God was holding me in his hands at that very moment, pondering whether to keep me on the planet or toss me out, into the abyss of Hades.
And I was terrified. My mind flashed, somehow, and without anything more than incredibly tangential reason, to Cat Stevens, and how he had decided to dedicate his life to god and become a muslim after he had almost died swimming in the atlantic ocean and got caught up underneath a rip tide. So I wrote a prayer, a plea, and a mantra on the quadrille lined pages of my yellow journal, demanding that god forgive me for all that I had done and to allow me to live a little longer.
Delirium had made me a sniveling religious fiend.
I eventually escaped such a fate when I--fortunately--started chewing on sugar tablets sitting next to my bed. I then made my way to a late breakfast, where my advisor berated me for my tardiness and my rather dulled affect. Oh, but if only I had known then what I know now: "I mean no disrespect, but unlike the rest of you, I just spent the last hour in delirium."
Anyway, the second delirious state happened literally an hour ago.
Having awoken five minutes before class started, I had no time to locate my test kit. But I had a headache, and I had gone to bed with a bowl of popcorn recently consumed, so I assumed that my blood sugar was the cause of the headache and thus I needed insulin. Well, within the next thirty minutes I realized that my blood sugar had probably been fine when I started feeling the chest tightening spasms of hypoglycemia. No matter! I had fruit snacks!
And thinking that I had avoided the ills of hypoglycemia, I settled in to taking notes on a lecture about epilepsy.
And here's where it gets interesting: Somewhere--about an hour and a half into lecture--I stopped being able to understand the slides I was reading on my computer. And then, shortly after that--the lecturer stopped making sense. I wanted to raise my hand at several points along the way--I wanted to clarify what he was saying because I was sure he was saying it wrong, but I didn't. Instead I just sat in awe that everyone else seemed to understand what was going on.
And then the madness truly sat in.
We switched to a new professor for a new class, and my head wouldn't stay straight on my shoulders, my neck wobbling side to side. I became obsessed with the fear that the professor would notice me in what would have looked like a sleeping position and that I'd be kicked out of class--or that I'd automatically get a 0% on my next exam. So I snapped my head up and sat up straight as possible. But it was useless, because inevitably my eyes would close and my head would fall forward and I'd look like I was sleeping again.
I tried to focus on my computer, on my notes, but they no longer made sense. I tried to play a little game on google+, Triple Town, to see if that would wake me up, but I was exhausted and I quickly closed the tab on my browser and was unable to pull up anything again. I was exhausted; not tired, just thoroughly incapable of movement or thought.
I soon became incredibly confused and scared. Didn't anyone else feel this way? Why did nothing make sense anymore. I could hear the words my professor was saying, but they didn't make any sense. I became preoccupied with a feeling that I didn't exist, or that if I did, I existed on a plane unlike the one everyone else seemed to belong to. Kind of like I was the only one who realized that this world was simply a matrix, and that I needed to find my way back to reality. But how to get there?
I needed help, but from whom?
I decided that I needed to go to either the counseling/health center at school--a five minute walk away from my current location--or to my mother, who I was beginning to doubt was actually my mom at all.
But at both locations I would have done the same thing: fallen on the ground and started yelling that this wasn't real and that someone needed to find out what was wrong with me. "Run all the tests!" I imagined yelling to anyone who would listen. There was something terribly wrong with me, I just didn't know what--but I needed to know.
My daydreams kept escalating in preposterousness until I imagined grabbing a knife and stabbing myself in the heart to regain entry to the "real" world that was hanging just outside my grasp. The thought of stabbing myself terrified me. And that simple feeling--intense fear--called my logic to attention.
What if this was just hypoglycemia? So I formed a plan while my professor kept garbling through his lecture on... what was it? ... anticonvulsants?
Step 1: Get Food
Step 2: Wait to Feel Better
Step 3: Feel Better? If no, go to Mother
Step 4: Feel Better? If no, stab self in heart
Fortunately, after eating a snickers bar, a twix bar, one reese's peanut butter cup, and a can of coca-cola, the delirium surrounding me started to fizzle away. I was capable of speaking, although my tone and volume were way off when I asked one of my friends sitting in the row in front of me, nearly incoherently, where today's pathology quiz was going to be administered. But I was conscious, and the fear that I didn't exist or that I existed in a parallel universe or a mirror reality, quickly became nonsensical and strange. Shortly thereafter, I was conscious enough to begin writing this, an assessment of my mental status as it descended once again into a state I wouldn't recommend for anyone. And that's delirium for you.
(a little bit more for the intrepid reader):
so delirium can be caused by anything that wholly affects the brain. usually when i have just bad hypoglycemia (so not life threatening but unpleasant), i act like i have a frontal lobe lesion: poor planning, flat affect, avolition, etc. however, the two times i've become "delirious" from hypoglycemia, it's possible that I was under the spell of global cerebral ischemia (so involving the entire brain). And while it appears that to get global cerebral ischemia from hypoglycemia, low blood sugars have to occur chronically (i.e., insulinomas), I fully believe that an hour of really low blood glucose could knock a person delirious.
(the end)
Jan 4, 2013
Going Over
This is awesome.
This is also terrible.
But still kinda awesome.
Child psychopathology is actually super fascinating. Unfortunately, lecture has gone over by 24 minutes. This might be a record.
Regardless, usually I wouldn't care. I love it when classes go long--if they're interesting. But today something else is amiss. My blood sugar is low (it's 55 mg/dL). And I need to go get a Coca-Cola.
OH! Class just broke. Great!
This is also terrible.
But still kinda awesome.
Child psychopathology is actually super fascinating. Unfortunately, lecture has gone over by 24 minutes. This might be a record.
Regardless, usually I wouldn't care. I love it when classes go long--if they're interesting. But today something else is amiss. My blood sugar is low (it's 55 mg/dL). And I need to go get a Coca-Cola.
OH! Class just broke. Great!
Jan 2, 2013
Compliance & Threats
Currently I am in Clinical Neuroscience. We are being lectured to about sleep disorders, specifically sleep apnea. The guest lecturer appears to be in the range of 40-60 years of age.
Concerning sleep apnea, there is a fairly successful treatment: continuous positive airway therapy (CPAP). Unfortunately, compliance with CPAP is pretty low. Only 46% of patients use the therapy, and of these persons, only 70% use it on a regular basis.
The lecturer urged us to tell our patients: "You're going to die in the most horrific way imaginable then list all the complications of uncontrolled sleep apnea."
This was one of my major complaints for my previous endocrinologist: vague threats. I can understand why doctors would want to do this--it is really frustrating when you're trying to help someone when they're not trying to help themselves. But I wonder if there isn't a better way to tell someone that they're killing themselves. Would this involve asking them about their life goals and how non-compliance will negatively affect these goals? I think it does.
Regardless,
I suppose doctors are among the few people that can tell you--in disturbing and exact details--how you're going to die without you freaking out and calling the cops.
Concerning sleep apnea, there is a fairly successful treatment: continuous positive airway therapy (CPAP). Unfortunately, compliance with CPAP is pretty low. Only 46% of patients use the therapy, and of these persons, only 70% use it on a regular basis.
The lecturer urged us to tell our patients: "You're going to die in the most horrific way imaginable then list all the complications of uncontrolled sleep apnea."
This was one of my major complaints for my previous endocrinologist: vague threats. I can understand why doctors would want to do this--it is really frustrating when you're trying to help someone when they're not trying to help themselves. But I wonder if there isn't a better way to tell someone that they're killing themselves. Would this involve asking them about their life goals and how non-compliance will negatively affect these goals? I think it does.
Regardless,
I suppose doctors are among the few people that can tell you--in disturbing and exact details--how you're going to die without you freaking out and calling the cops.
Dec 31, 2012
Manic Depression
[Warning, explanation: this is the most personal blog post I've written so far, so if being close to people makes you uncomfortable, you can skip this. But it's medically related, technically]:
Psychiatry Class. 9 AM. Dr. S is giving an cursory
lecture on various mental conditions. He gets to mania. He starts listing off
characteristics. An entire row of students in my lecture hall, turn around to
stare at me.
Am I manic? Perchance.
Like many mental conditions, you have to have a certain
number of listed signs/symptoms in the DSM to be able to classify yourself as
anything. But I do have some symptoms
of mania:
Hobbies. I have many.
It’s break! And I’m attempting to catch up on some
hobbies that I’ve set off. In the last year I’ve refined my skills in jewelry
making and sewing—maybe almost to a commercial level. We’ll see (I’m trying to
make a dress for the medical school’s big dance and if it ends up well I’ll put
up pictures—thousands of them).
Also in the last year, I’ve managed to get into prop building, upholstery, and REALLY INTENSE INTERIOR DESIGN. Also glass cutting. Last year there was broken glass everywhere because I was breaking bottles to make sea glass. NOW there’s broken glass everywhere because I’ve been cutting up bottles to make beautiful plant containers. Progress!
Unfortunately, I’ve had so many projects, I’m forgetting about many of the little ones I’ve started, or finishing things late. I said my histology quilt would be done by the end of first semester. It’s still not even half way done.
But it is still a huge boost to my self-esteem to be able to do things. Even if they’re just silly little things like being able to sew a button or make a good dinner from limited ingredients.
So below are a series of things I've made or done this break (or in the two weeks proceeding it):
here's my instagram!
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| garter belt (for garter flasks...?) |
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| making Snake Juice from the television show Parks & Rec |
 |
| flannel infinity scarf, flannel fabric flower in hair |
 |
| just the most beautiful colors of thread |
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| jewelry with porcelain beads, sea glass circles, and freshwater pearls |
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| name tag coasters (that can double as wallets!) |
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| a new form of jewelry for me. |
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| beer cap magnets |
Nov 10, 2012
That awkward moment when diabetes is kind of cool for once.
[Note: There are some gross photos to follow. If you fall easy to nausea, I suggest not reading this post.]
Alternative title: Microbiology: it's happening on you.
Having diabetes is the absolute worst*. Yesterday, for example, I took to much insulin with my bedtime snack and two hours into sleeping I woke up in a hypoglycemic panic, and before I could grab the glucose tablets by my bed, I began hallucinating: a giant centipede with a human face--a human face without eyes, nose, or mouth--broke into my bedroom!!! Intense!!! And terrifying!!!
Anyway, so usually diabetes sucks. There's the lows and there's the highs (this isn't figuratively, this is literally, as in my hypo- and hyperglycemia). Regardless, thanks to diabetes I've also been given a small arsenal of medical tools to tell me how my body is doing. Usually they're quite mundane. But in certain circumstances I can use them to . It's like having constant access to back-alley, outpatient lab services.
Seven days ago I sustained a large, second-degree abrasion to my left knee. Hilariously, I didn't treat it because we had just learned about skin infections in Micro and I wanted to see if I could catch something hilarious like staphylococcus aureus. As a diabetic I am technically immunosuppressed.
Regardless, my knee ended up scabbing really badly. [gross pictures to follow]
*Diabetes isn't the absolute worst. But in my own life, it is.
Sep 25, 2012
Gotta Catch 'Em All
 |
| I only have to collect heart, kidney, liver, and lung disease before I win something! |
Got my flu shot today. It was actually awesome for two reasons: 1) it was the first time I ever got to check yes to the question: "Are you a healthcare worker?" and 2) needles just keep getting smaller! It was literally painless.
It was also, somehow, free. So thanks America, for always having my back (it's the least you could do after you presumably gave me asthma.... we need cleaner air damn it!!!) But still, Walgreens' Pharmacy, specifically at my Walgreens, is always a pleasure and has re-instilled my faith in health care.
Now I just need to find a family physician... to deal with my multitude of health problems (see above).
Sep 19, 2012
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