Understanding the Endo

 

Welcome to the official Diabetes Blog Week at Diaturgy! D-Blog Week, started by Karen at Bitter-Sweet Diabetes four years ago, was instrumental in getting this blog up and going, so I owe her a debt! It's also so much fun to participate in the community every year, all choosing the same topics.  Not content to leave well enough alone, however, I worked in a surprise; I kind of took today's prompt and turned it completely around.

Today's prompt: Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one's daily life with diabetes? On the other hand, what do you hope they don't see?

Dear Endocrinologist:

This week is Diabetes Blog Week, and today’s assignment is for us to write a note to you telling you what we wish you’d understand about us in terms of the toll diabetes takes on our lives. It was perfectly timed, because I saw you today for the first time in six months. I was the first appointment of the day, and for once, I didn’t have to wait for an hour or more.  My numbers were both exciting and disappointing this time. Exciting, because the A1c I did in February was 7.1: a life-with-diabetes record. Disappointing, because thanks to breaking my elbow, pain medication, a stressful semester and no real time to exercise, I’m back up to 7.6. Endocrinologists often seem to go into “airport security” mode; with older data, they try to solve the problem that has already happened and been dealt with rather than the unseen problem ahead; my broken elbow is mostly likely the shoe bomber of incidents; stupid and scary and probably not happening again, but I guess I’ll take off my shoes at the office now.  I do wish you’d appreciate the utter unpredictability of my life and work a little more; I can’t just “take on fewer responsibilities” for my health; I take the schedule I’m given. When the office says, “so, Mondays are good to book six months from now?” That’s two semesters away, so damned if I know my schedule. It’s always going to be a crapshoot.

Here’s the thing, though. I’ve already written a “what you should know” post. It’s here. It’s comprehensive. I’m not interested in writing a version of it again.  I don’t want to draw a line in the sand and see you as an enemy, an impediment to my progress.

I feel lucky, in many ways. I feel like you do listen to me. You know I’m planning a wedding, and you asked how it was going, and whether I was stressed about it. You know what I’m up to in life and you seem genuinely concerned about my well-being. So I’m going to deviate from the assignment today, because today I’m going to try to understand you. For the first time, now that I’ve been a professor for two and a half years, I think I really can.

We had all of our difficulties when I was a teen, and into my early twenties. Some of the biggest issues were during my own college years. I felt you didn’t understand me, or my life. You said you couldn’t understand why I “couldn’t just do this,” a twisted rewrite of an awesome diabetes social media slogan. I felt like one of a zillion patients. You didn’t have time for me, to truly understand. You don’t know what it’s like. You don’t have diabetes. In a way, I was both happy and resentful when our relationship finally got better, clicked and soared; when I got the pump, when my numbers came down radically, when you felt I finally got serious about my health. Why only like me when I'm a "good" diabetic?

Replace “health” with “class,” though, and I could be one of my own students.

You see, I know what it’s like to have a demanding schedule, and to have 120 people whose progress I’m tasked with following over the course of a semester. I know how hard it is to sit and meet with everyone, to truly track progress; to give more than the most cursory comments about improvements to development, analysis, and grammar, because there’s NO TIME. If I met with each of my students for 15 minutes a week, that would be 30 hours with no breaks, let alone all the teaching and the prepping and the marking.  All of my comments, besides on drafts that nobody has time to write many of, can only deal with old data; how to fix a paper that's already been handed in for marks.

I know it’s loads more fun to work with a serious, passionate, excellent student who gets me and my subject; we talk, we fly and I don’t really have to do that much “work.” I know how much nicer it is to have a student who actually wants to improve. I know that I catch myself thinking, even with students who have English as a second language and horribly stressful home lives and illnesses and who deal with raising young children while being young themselves and are one step from poverty, “I don’t understand why you can’t just do this.” After all, I can do this. Look at all the studying I’ve done. Look at all the other people’s words I’ve learned and analyzed. Look at how good I am. I'm a model student, and I chose this course of study.

But you didn’t, my students. You didn’t choose this. English isn’t a major at my college. It’s a requirement. It’s difficult for many of my students; it’s not natural to their bodies. It’s not a first language, either literally, or metaphorically. Instead, it’s a hurdle they’ll have to deal with for the rest of their working lives. And, for me, in the end, it all comes down to the numbers: did they pass, or fail? I can only give so many marks for trying and working hard; in the end the work has to show, and measure up to an arbitrarily set standard. Many of their systemic language issues are such that I have no chance of fixing them in 15 short weeks, though I drill and drill.

I care about my students. I care deeply. I try my hardest to listen, to understand their lives and to make them easier. I know, however, that I need to be met halfway for true success, while I live in fear of failing someone who is truly in need. I’ve become a counselor for 17-year-olds, 30-year-olds, 60-year-olds whose life experience is beyond mine, whose problems I may never truly understand, but I know one thing, and that’s my subject. I know it as much as anyone. And I try to do my best with what I have and what my students give me. I’m only human, and I might flounder around a bit, but I’m doing my honest best.

In the world of teaching, I am you; I am my endo. But, while I have my students for a semester or two, and keep in touch with a few of them, you have stuck with me, through thick and thin, for the better part of a decade. You have seen me not care, and you have seen me come through the other side. Thank you.

So enough about you needing to understand me. Because, today, I needed to understand you. And I think I finally do.

-Ilana

Di-ronic

This began with an "empty cartridge" alarm waking me up at 6am on a Sunday. My apologies to Alanis. Warning: much like the original, many of these situations do not fit the technical definition of irony (however, I think this song might have a higher percentage of actually ironic incidents than the original).

A young girl, turning thirteen

She gets diagnosed…on her best friend’s birthday

Getting low but not drunk

From your chardonnay

It’s a death row pardon

But you still have to pay

And isn’t it Di-ronic

Don’t you think?

When you exercise

And your blood sugar strays

You eat utter crap

Oh and NOW you’re in range

When the media say

Type 1 and 2 are the same

And who would have thought

It figures

Mr. Play It Safe

Was afraid to drive

He tested every time

Just so he’d stay alive

One day his BG crashed

He’d only gone for a block

The news said – treat him with insulin

He’s in diabetic shock

And isn’t it Di-ronic

Don’t you think?

It’s like everyone

Thinking you should be fat

It’s some clueless guy

Asking can you eat that

Your endo knows you less

Than #dsma Twitter chat

And who would have thought

It figures

And D has a funny way of sneaking up on you

When you think everything’s okay and everything’s going right

But D has a funny way, of helping you out when

You think everything’s gone wrong- it makes you the person you are today

An immune system

That’s just making you sick

The nurse judging your whole life

From one finger stick

It’s like you’ve got one strip left

And all you get’s “Error Five”

It’s nearly dying of a low

From the substance that keeps you alive

And isn’t it Di-ronic, don’t you think?

A little too Di-ronic – and yeah I really do think

You do the same thing,

Get a different result

And you always think

That it must be your fault

Your D’s juvenile

Though you’re now an adult

And who would have thought

It figures

Well you never sought

But now you can’t hide

The province pays for pumps

But not the insulin inside?

“Oh, it’s not that bad;”

Well it’s just your whole life

And who would have thought

It figures

And D has a funny way of sneaking up on you

And D has a funny, funny way,

Of helping you out

Helping you out

Happy Blue Friday!

For those of you who haven't heard of it, Blue Friday is a weekly awareness "event" where blue is worn in support of diabetes awareness. It's pretty easy to do, especially when it's your favourite colour. Well, I'd like to show you how committed I am to Blue Friday; for me, right now, every day is Blue Friday!

Happy Blue Friday, everyone! Fortunately, although my diabetes won't go away in a few weeks, this cast will.

-Ilana

Sweet Sixteen/Broken

Today, my diabetes turns sixteen. It could drive a car (while I still can't, partially because I'm afraid of low blood glucose levels while driving) if it passed the written. Sweet Sixteen is both appropriate and ironic when it comes to diabetes; I've certainly spend the past 16 years "sweeter" than I would have been otherwise.

I always see my Diaversary as a time of reflection on the battles of the past and my hopes for the future, as well as providing myself with cake for the present. It coincides with the birthday of a friend who I've known longer than I've known D, but whose birthday always gets co-opted by memories of going to the party on my day of diagnosis, thinking I couldn't eat the cake anymore. I was one of those lucky few who got to be out and about on my diagnosis day, caught by a screening check and not by a hospital. Now, though I have intimate acquaintance with hospitals for the various specialist appointments (I joke that I use my OHIP, or health card, more than most people use their credit cards, but thankfully I almost never have to pay the bill that results) it's almost never an emergency, and never a D-emergency. I'm doing well. There was that time I needed an IV in freshman year. That time in 2005 that a freak storm and a stage light required getting my head stapled back together (and you think the fact that it was an unpaid internship was bad!)

And then there was last Saturday and Sunday (the 9th and 10th).

Friday night had been great. I had been out all day with friends (it was my spring break, soon to be literal) and was coming home with Dan after discussing save-the-date card designs with a designer friend. I was really excited about the concept, happy, and a little smug to have this wedding-planning thing in hand, snagging our 10th dating anniversary date for the wedding. Pride comes before a fall, apparently. I stepped off the bus, and on to a sheet of black ice that had thawed and re-frozen due to the day's temperature fluctuations. With my foot taking so big of a step onto nothing and me holding two bags, I was unprepared and didn't have a chance. Every single ounce of my weight concentrated on the first point to hit the pavement; my left elbow. Dazed and in horrifying pain, I eventually struggled to my feet because I thought Dan was going to panic if I didn't. I slowly followed him home. I shouldn't have let that one taxi go by, but I couldn't imagine that I was actually broken. It had never happened before. Even if my elbow was clicking around, my coat was on and I couldn't see anything.

I gingerly took my coat off at home to inspect the damage. No cut, no bruise, but, as Dan helpfully observed, "your elbow isn't in the right place anymore." Called a cab and to the hospital we went, coat draped over me like a misshapen fur stole. I couldn't stop shaking until I was mercifully given heated blankets in Emerg, but I kept it stoic, laughing and joking with everyone involved, refusing to scream even as a joke (and most of that was before the morphine!) My elbow was in two pieces apart from each other. I needed surgery for the first time in my life. I was terrified, and am still afraid that ugly scarring will have to be hidden during my wedding photos.

After coming home from the hospital. Ignore how bad I look. I have reasons.

I was sent home from the hospital with a cast. Total cost of everything, besides painkillers: $30 for the sling. Thanks, Canada! (Well, it was your ice that dropped me.) The surgery was the next day (I thought there would be more of a wait, but the surgeon has a slot open). I was really worried about being put under, but the worst thing was the IV hurting a bit and the feeling of claustrophobia under the oxygen mask. Everyone was super nice, though  was sad they said getting my cast signed wasn't good for it. The ONLY reason I had longed for a cast as a child and I couldn't do it? Bah! The rest of the day, after I joked with the nurses, was a haze of nausea and pain.  I was going to go in and teach the next day, but I had to bow out. I then taught all my other classes, graded, and went to meetings and rehearsal, holding on by a thread. It's been some of the worst pain I've ever felt, and continuous. I have one prescription painkiller left, which makes me...nervous.

The worst thing is the helplessness, the length of time it takes to do everything, and the tiredness and frustration. I am left-handed, so I've needed to learn to write a bit with my right hand, and type what I can't. Typing takes forever and is utterly exhausting because it's one-handed and I'm in a terrible position the whole time with a useless limb in the way. I don't like being dependent or weak (story of my life with diabetes, magnified). I don't like having my shoes put on, my hair washed, my meat cut. I don't like that I can only play half my part on bells, though many are amazed I'm playing at all, or that I came back to work so soon. The problem is that I'm so behind in grading now, and when I do, it takes forever. I feel like I'm running a marathon just typing this. Everything D sucks with one arm. Testing BG? How do you squeeze the finger properly? Putting in a site with one arm? Someone has to pinch for you, and it better be on my right side or it's really hard to get to. Even clipping my pump on is a pain.

I go back for a new cast on Tuesday. I hope my arm looks okay and that D (or my stubbornness) isn't causing slower healing; my numbers have been pretty good, all things considered. Beiing broken sucks, but at least I know that, next year, this will almost for sure be a thing of the past, while my other "brokenness"-my trial, my sentence, my experience that has helped shape me and make me what I am- will be celebrating its Sweet Seventeen, even though I still won't let it get behind the wheel. Though I am broken, at least this break is curable; it will heal thanks to love, understanding, get-well cake, a fiance who puts together my taxes and a lack of predators.

It's a rude beginning to a new D-year, but I'll take any excuse for love and cake. Theoretically, things can only improve from here, right? (This had better not jinx anything!)

Exhaustedly Yours,

Ilana

Low

Yesterday, as I was rushing from work to appointment (one hour on transit) to rehearsal (another 30-45 minutes), I felt that old, familiar, sinking feeling. Low blood sugar. Insufficient blood glucose. A hypoglycaemic incident. Whatever asinine thing the media decides to describe it as, such as "a diabetic attack" or some such vague garbage.  When Diabetics Attack is the name of my proposed reality show. I'm sure it will be very popular.

When my BG goes low, sometimes I feel like I'm about ready to attack. I don't think things through as well, or consider complexities and implications. I get angry and irritable and greedy. It's suddenly all about me and there's no charitable thought towards others, as long as I've "got mine." I feel like I'm dying out and I'm scared. It's what I imagine being a member of the Tea Party to be like.

Low blood glucose is a little like being drunk, in the worst possible way, with added hands shaking, cold sweat, and the feeling that your life force is draining out of the soles of your feet. Your head rushes. The glucoaster roars downward. Your pulse pounds. Tunnel vision becomes inevitable. Standing becomes an unimaginable feat. Powering yourself up a flight of stairs? There are 100-pound weights around your ankles. When someone who has never experienced real hypoglycaemia describes the experience of not eating for a while and feeling hungry, irritable and a bit shaky and week, I can only smile, both because I'm happy they've never had to experience the real danger, and because it's a polite but very muted understanding of the event. When I'm really low, there is a danger signal in my brain that says "No really you are going to pass out and die this time for sure." But there's another part of my brain that says "don't be late you have to get where you're going what's wrong with you are you going to let this stop you you weakling." (When I'm really low, my brain does not use punctuation; there's no time.)

I made my way through the molasses that was the air, past the people collecting for Second Harvest (in my tunnel vision, I couldn't stop to take out money; with my lizard brain it seemed too painful to listen to them talk about people who needed food). It was rush hour, but I managed to slump my way into a middle seat on the subway. I was so thankful there were no elderly people or pregnant women or obviously-disabled people around; nothing makes me feel guiltier on the subway (besides rushing by a talented busker, charity collection, or person down on his/her luck) than not wanting to relinquish my seat to someone "needier" when I look so hale and healthy, but my invisible disability is killing me at the moment. I hope everyone sees my shaking hands and the colour drained from my face, which is already very pale, and doesn't judge.

My trusty grape Dex. (source: Dex4.com)

Luckily, I had provisions with me. I ate two granola bars in quick succession, and popped open my glucose tabs, eating about five. I forced myself to stop after that, though at that point everything in the train car still looked edible. It's like that Troy McClure "educational" film about the meat industry on The Simpsons: "Don't kid yourself, Jimmy. If that cow had the chance he'd eat you and everyone you care about." I don't know if it was just my own low-induced paranoia, or reality, but suddenly I felt judgmental eyes on me, the girl who had just wolfed down two granola bars and what likely looked like a tube of candy. I turned the tube outward so anyone who was looking good see that it had a medical tagline printed on it.

I could stand to lose a few pounds, but I'm an average size. Taller than the average woman, big-boned, a decent weight for all of these factors. It's actually a major thing for me to say this, because I'm actually the first person to call myself fat. If I can tear myself away from self-judgment for a minute, though, I can say that I'm certainly not "officially" fat or obese. I have always been self-conscious about my weight and the size of my frame, however, and I was wearing a fairly puffy coat, it being the last gasp of February.  At the moment where I started panicking over the perceived judgment of my fellow subway patrons (remember that blog that mocked people eating in the New York subway?) I came to a bizarre realization: I am more self-conscious about treating a low in public than I EVER was about taking a shot in public, or testing my blood in public.

Has that happened to anyone else? Is that strange?

Treating a low in public is different from performing a medical operation. For all intents and purposes, to others, it just looks like you're stuffing your face and, if you're on the subway, that you can't wait the 15-30 minutes to get where you're going. I couldn't. To give you some idea, after over-treating with the two sweet granola bars and 5 glucose tabs (probably 80g of carbohydrate), going to rehearsal, not taking any correction bolus at all, and coming home, I tested, thinking I was probably at least 10 if not 15 (instead of being somewhere between 4-8). I was instead barely up into the normal range, at 4.2. This was actually worrisome; just how low had I been? It's hard to test on the subway, especially when squished into a middle seat, so I hadn't, as there was no way that could have been anything but a low.

Eating isn't causing my diabetes, I wanted to say loudly. It's saving me from it. I'm so used to people judging people with diabetes over food that I feel ashamed to "overeat" in a public space, even if it's necessary, even if my diabetes isn't the "weight" kind.

And that, I have to say, makes me feel pretty low.

-Ilana

Crunch

"Now, we place great trust in our devices. We try to believe that they will never fail us. We place our lives in the hands of plastic and metal and batteries and medical research, sure that they will work; sure that they will always deliver some sort of base measure of performance. Like latitude and longitude. We know this isn't true. Plastic fails. Metal fails. Batteries are spent. People get sick. People die."

Those lines, from a post I wrote months ago, resonated with me in an unfortunately personal way last night.

It all started with a crunch.

In my insulin pump, there is a cavity in which a cartridge sits, and gets pushed up by a plunger, very much like how an insulin pen works. The cartridge is attached to tubing, which is then attached to me. There are a lot of plastic bits, and usually they work like clockwork, to use a figure of speech. (Or do clocks work like pumpwork?) 

(Plastic bits. Source: http://www.americandiabeteswholesale.com)

You're not really supposed to cut corners when it comes to diabetes, but the amount of "stuff" and the waste and the cost sometimes add up to doing so. There are varying degrees. Everyone I know reuses blood-testing lancets, sometimes for months. Technically we should be using sanitary wipes and changing our lancets five times a day, but almost anyone who has dealt with this condition for more than a few months tends to say "screw it" and go for the convenience and lowered cost. On the other hand, however, nobody is able to reuse test strips (unless you count my fantasy invention that doesn't exist). They are expensive, but you are stuck with them. Certain things are more and less affected by reuse. Needles blunt, but sometimes it takes a few times. Infusion sets are one-shot-only, but can last for more than the three days you're supposed to wear them, though you might get reduced efficiency. There seems to be an online bragging-rights contest to see who can successfully wear their CGM (Continuous Glucose Monitor) sensor the longest; I've seen over two weeks. Of course, I haven't tested this, as Canada is, shall we say, so behind the game in this technology that I'm not even sure I'm allowed to type those words.

To put it as bluntly as a blunt lancet, diabetes is a cost-benefit analysis. When I went on the Animas Ping, I was enrolled in a government program (the Assistive Devices Program) that pays for a certain amount of pump supplies every three months. It was my goal to be able to afford all the internal supplies on that amount (I still had everything else to pay for, after all!) I struck a few compromises. No automatic inserters; manual were cheaper. (That was okay; the idea of the automatic spring-loaded infusion set kind of made me nervous.) Confidentially, my rep whispered to me that I could reuse the cartridges once. This, PLUS the discount I managed to negotiate, was enough to get me under the line. (I have never felt so much consumer power as when I was being courted by pump reps; they want those lifetime customers!) It's amazing when you're negotiating for and calculating cost/waste savings for little plastic bits that your life just happens to depend on. Sometimes I reuse the cartridges once. Sometimes, in a pinch, more than once, but I try not to. I've generally had very good luck.

Yesterday, my luck went "crunch."

Yesterday was Super Bowl Sunday. We had family over and my dad made an absolute feast of Baltimore and San Francisco-themed food. My pump ran out of insulin before dinner and I didn't want to move from my hard-won seat, so I re-used the cartridge (for the first time, though, as authorized). As I was twisting the parts together, I heard a tiny sound, a little "crunch." It seemed a bit strange, but after inspecting and tugging on the parts to make sure they were sufficiently bonded, I thought nothing of it, and proceeded to indulge, Super Bowl Party-style.

Hours later, after catching the Puppy Bowl at midnight, I was feeling less than stellar. I had been taking little corrections through the evening, so I wasn't sure what it could be. Heartburn from the crab dip? I tested myself and almost lost my eyeballs to shock. My number was 32.2. That's 580 for you Americans. Not only was that amazingly high, but it was a number I hadn't seen in years. I couldn't remember when a number that high had last appeared on my meter, but it was certainly before I had gotten a pump. What a failure-tastic number. People go into the hospital with a 32.2. I took a correction bolus, but it still nagged at me. I hadn't actually eaten a ridiculous number of carbohydrates. I had taken quite a bit of insulin. 14? 16? okay. but over 32?

Suddenly, I remembered the crunch. I unscrewed the cap of the cartridge area...and found insulin pouring out of the top of the cartridge. My life preserver had sprung a leak. I found myself swabbing the proverbial deck, cleaning expensive, wasted insulin out of the cartridge well. A penny saved, in this case, was not a penny earned. However, it could have just as easily happened with a new cartridge. I switched both cartridge and tubing (there goes 12 more units of insulin to prime it) and corrected again. Now, the waiting game. How much insulin had I gotten from the last correction? Was I going to come down? Was I going to crash? A sleepless night was my fate, testing every half hour. 26...22...these horrible numbers were victories. I was sick, I was tired, and I was sick and tired of this.

I'm sick of the fact that one tiny little "crunch" might be enough to send me to the hospital. That's not even the smallest, stupidest thing that can happen. Plastic fails. People fail. Metal fails. The economics of people and plastic and metal are on shaky, shaky ground. Life seems to be a series of these tiny failures; it's a ridiculous balancing act, with the rope made out of plungers and cartridges and tiny metal filaments. A pancreas held together with duct tape and hope.

In the past month, my hope has been tested; I have been both the highest and the lowest since I started the pump.  Last month, a two-hour trip home from a night out ended with a mile-plus walk in heels after helping a sick friend off the bus. When I realized I felt awful, I checked myself at the next bus stop and found I was 2.1 (a little less than 38, for the Americans). Instead of waiting another maybe half hour for a bus, my partner made the smart and executive decision to pile me into a cab. Of course, the middle of the night seems to attract horrible blood sugar moments.

This morning, I crashed again. From 32 to less than 3 and falling. That low number is usually bad; coming from 32, it's devastating. I felt like a small child again; I basically had to be rescued and taken into work. I didn't think I could make it to the bus. Again, even when things work well, they can work so well they betray you. Little things making you feel so small. How could I be a professor if, this morning, I could barely get my legs to move? How can I teach people when there are so many mistakes to be made?

The one saving grace of all of this is that, even at past 2am, social media and some very good people made it possible to get companionship and support through that harrowing night. Thank both night owls and time zones, but most of all, thank friends. Plastic fails. Metal fails. Batteries are spent. But friendship? Now that's strong.

-Ilana

New Year's Comedy and Tragedy

January has been a month of ups and downs so far, and it's not even half over.  I began the month with a lovely New Year's party; it's been a tradition amongst my friends to have New Year's at the same house (ever since high school), and then more recently, to have a day of marathon TV or movies on a particular theme at a nearby house the next afternoon, after the night's party is over.  I was reluctant to go this year, because my beloved 21-year-old cat Pumpkin was not doing well, but I was happy to have been able to see and spend some time with her that day (I'd just gotten home from Florida) and was going to come home and spend with her whatever time she had left.

This year's marathon was of The Simpsons, and of course, we had all sorts of great episodes to choose from. The one that suddenly resonated with me this time, however, was the one where Marge becomes a cop, "The Springfield Connection." Yes, this is another moment where I connect pop culture with diabetes. Bear with me. I realized that the Springfield Police Department is my immune system, with Chief Wiggum in charge.

Marge, in her police training, is tested at a shooting range. Angry criminal cutouts pop up in windows, doors, on the street. It's her job to shoot the criminals, but in the meantime, innocent people are also popping up. There's a woman with a baby, a blind man with a cane and dog. Marge wisely avoids shooting these people. After she has done her job perfectly, Chief Wiggum strolls out to deliver her score. Clucking his tongue with shame, he says, "You missed the baby...you missed the blind man..."

Yes, that's my immune system in a nutshell. Not content to kill the criminals floating around in my body, it goes after the baby and the blind man, innocent (organs) civilians. The corrupt police force (sucked in by the lure of counterfeit jeans, again happy doing the wrong thing) was a perfect encapsulation of my life, forcing my pancreas, a young go-getting official, to quit in disgust. Also appropriate is the moment when Marge walks into the station to declare her intentions of joining the force, only to be greeted by Wiggum's "What, what, what? This had better be about pizza." How sad my immune Wiggum would be to learn that, because of his ineptitude, it is substantially harder for me to eat pizza and not feel awful afterward as the pizza goes on the attack.

Amused by this comparison, I came home to some terrible news. While I was out, in the wee hours of the morning, Pumpkin had taken a severe turn for the worse. My parents rushed her to the vet, and had been told to let her go. My cat was gone. She had lived just long enough for me to come home, pet her for hours and tell her I loved her, and fifteen hours later, she died. I was glad that I'd had a chance to say goodbye, but I'm still unhappy with myself for not being there at the very end.

This is a diabetes blog, so I don't want to dwell too much on unrelated topics, and I don't think I could ever properly eulogize her, but Pumpkin was one of the few things in my life that had been constant since way BD (before diabetes). She came in to my life when I was six, six whole years before diabetes became my reality. I am angry that my diabetes is still here, while she is not. Not only was she the most beautiful cat who ever lived (and I'll prove that with a recent picture, still gorgeous at twenty-one), but she was loyal, loving, whip-smart (she was always trying to figure out how things worked, and I once taught her to turn off the light switch by putting a knitted hairband over the switch; she would jump up and turn the light off), and true. In many ways, her passing symbolizes the final iron door slamming shut on my childhood, which should have probably happened many years ago, but that probably makes it more painful rather than less. One of my friends described her as having "an unfearful symmetry," which I loved. Her face was exactly half-orange, half-black, right down the middle; the most striking cat I have ever seen in my life.  All of my friends who have lived in Toronto remember her; we grew up together. There are really only a couple of friends who I can say I've known as long as I knew her, and really only one who wasn't a relative.

I remember going on a "mystery trip," as my parents called it, the day we got her and her sister (who predeceased her a few years before). I walked into the barn, up into the hayloft, to see three kittens; a grey boy and two calico girls. My parents explained that the kittens' mother had been kicked by a horse and had to be put down, and would I like to take two of the three kittens? (Someone else would take the third.) It was my dream, as a small child, to own a kitten, and with the sudden prospect of two I was giddy with glee. I took the two calicos because they were snuggled up together, they were practically twins, and they seemed like they needed each other. As an only child, it was intriguing to me to see this matched pair.  Through the years they were my constant companions, and I loved them both, but Pumpkin was special and "my" cat from the start. She always knew when to come comfort me when I was upset. Maybe that's why, almost two weeks past, the wound is still fresh, because she's not there.

I still think I hear her or that I should let her in, because she's clearly just outside. In her later years, she developed the trick of getting more food by going outside for thirty seconds, and then returning and letting us know she had been outside, so that meant time had passed. My parents' bedroom door was never closed at night for twenty-one years because she always slept inside, snoring in the cutest way possible, and would beat on the door like a battering ram if it was closed. I went to bed late the evening of the first (had trouble sleeping for a week and a half), saw the closed door for the first time, and cried my eyes out.

Sleepy kitty.

Pumpkin loved to eat flowers. When I was a child, I thought I would circumvent this desire of hers by making my mother paper flowers, which were put in a vase on the dining room table. When I came back into the room, she was up on the table eating the paper flowers; I still treasure the incriminating photo of this I snapped. Later in life, she would continue being strange about paper, carrying around wadded up Kleenex and howling while depositing them in a neat line down the hallway. I often wondered if this was due to her missing her sister, an odd grieving ritual.

I have all sorts of stories about Pumpkin, but I can't go on forever here, though I would like to. She was my best kitty friend, almost a twin but one of a kind. All I am left with are my own grieving rituals.

Dan and I walked home late on the night of the 2nd in the middle of a snowstorm. It was very quiet and snow was rapidly accumulating under our feet as the flakes lightly touched our faces and melted. The atmosphere was reverent, full of hushed beauty. As we walked up the driveway, I noticed a set of tiny animal footprints that had been left before we arrived. Cat footprints. The footprints walked up to our door and then disappeared.

I am a rational and scientific person. I do not believe in spirits, God, the afterlife, ghosts, or anything like this. I know that whatever animal was walking across the driveway probably disappeared into the bushes at the side of the house.

But in that moment, every fiber of my being wanted to believe that Pumpkin's spirit had found its way home, to the house she had spent every night but five (Pumpkin's Great Adventure, being spayed, foot surgery, infection recovery) of her more than twenty-one years.

This blog turned out very differently than I expected, and I'm going to have to write about the start to the semester and a particularly scary low in another post. But I guess I still wanted to say goodbye, and thank you.

Thanks, friend.