Fogged Up

Thinking back on this past 10 months on the pump, things haven’t been too bad. I wasn’t sure what to expect or if I would prefer pumping vs. injecting but I have to say the convenience has been great with my pump. Having access to insulin constantly has been great. Previously I would have to excuse myself to go to my bag, get out my insulin pen, load a needle, find some skin to expose without making anyone around feel awkward, load the dose, inject, make sure I didn’t bleed, remove the needle, cap the pen, and put everything back into my bag. While there seemed to be a lot of steps involved, I typically could do this in a very short amount of time. Today I only have to press a few buttons on the pump and I’m done.

I have enjoyed this relative anonymity without making it a bid deal. Many people haven’t even noticed when I load a dose of insulin from my pump. At a glance, it probably looks like I’m just checking my phone quickly. Being the introvert I am, this has been great. I have also been able to catch pending lows by paying attention to the trend graph provided by the CGM as well. One of the best features of the pump has been the ability to stop all insulin delivery; something the injections aren’t able to provide. I often correct the inevitable low blood sugar before it gets too low and before warning “BEEPS” go off.

Everything has been going well until recently. As a part of one of my recent rotations, students are required to read about a relevant topic related to a current patient and to present it briefly to the team. Typically, speaking in small group settings is not difficult for me. It does not induce fear or anxiety thankfully. On this particular day I began speaking from the notes I had made the previous night about syncope and the diagnostic steps regarding the work up but they weren’t making as much sense to me. I thought I had a decent grasp on the material but I just wasn’t making things clear. Rambling and taking frequent “uh…” pauses quickly ensued and I could tell I was losing my audience. I was in a fog.

“What the heck is wrong with me?”, I thought. “You have to focus and recover this thing.”

BEEP! BEEP! BEEP!

I immediately recognized the sounds and knew this was exactly the wrong time for this to happen. I stopped speaking and immediately checked my pump to find my blood sugar at 54 and dropping. At this point everyone was looking at me and seemed confused. The gig was up. I had made it 2 weeks without telling anyone here I had diabetes but at this point everyone knew. When I announced my current blood sugar situation the puzzled looks all turned to surprise/concern and chocolate chip cookies were immediately made available. Doubting the group’s concern was never my issue but like I have said before, I just don’t like talking openly about diabetes.

I don’t offer my diagnosis up freely because most people live with their diseases silently until they are in a medical office. You don’t introduce yourself at the company Christmas party saying “Hi I’m Mike, the husband of Sarah from accounting and I have hypertension!”

….thanks Mike…

After apologizing for my incoherent rambling the team seemed glad there was an explanation for my confusion. Two chocolate chip cookies later I was feeling better and we were all able to move on.

Not that the experience was life changing or something that I look back on wishing I could have curled up into a corner to disappear but it did change things. By showing a little vulnerability I showed my humanity. While traversing medical education (and in everyday life) there are ups and downs. I read about heart failure and feel like I have a good idea of what is going on, only to be reminded by an experienced provider that the book is not always the way something presents in real life. It can be a humbling experience to be told you are completely wrong. Trying to put the confidence face on and push forward is something I have gotten better with but this is often done by keeping others at an arms distance.

Some of my best interactions with strangers have come with personal connections and this experience was no exception. After I showed some vulnerability our team has actually been closer, more open, and supportive of each member. There is a big lesson here, and one that introverts like me often have a tough time accepting. While there is a time and a place for everything, sometimes showing the real you can open doors you have not considered. It can bring support and camaraderie for everyone involved. Don’t wait to be forced into it like I was with the “BEEPS”. Take a step in faith and see what happens. You may get more from it than you think.

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