Heartstrings and Violins
By Kimberly Ford Chisholm
My friend, we’ll call her Lisa, recently told me about an afternoon that I imagine to have gone something like this:
At a late spring barbecue, Lisa—who is forty-four and has T1D—found herself sitting on a pretty garden wall with a paper plate on her lap beside a woman she didn’t know well but who seemed smart and warm and interesting.
When Lisa lifted her blood glucose meter from her purse, the friendly woman said:
“Oh my god! Do you have diabetes?”
“Yep. Since I was twenty-six.”
“Oooh, that’s rough. I had it too! Mine was gestational. It was so hard.” The woman took a big forkful of couscous salad.
“I hear ya.”
“I mean. I had to test my blood sugar every day.”
Now. Lisa had had a long day. She woke up with her blood glucose at 240 for no reason she could identify. She changed her pump site, took Tylenol for the headache, had only eggs for breakfast, checked again two hours later to find she was 214. Deciding the insulin was bad even though it should have been fine, she threw away the almost-full vial. She took the last one from the refrigerator, making both a mental and a physical note that she needed to get to the pharmacy, given that Lisa hardly ever letting it get so she only had the one vial, open, in the liquor cabinet, where her five year old wouldn’t find it and . . . Lisa wasn’t quite sure what she thought her fiver year old would do with a sealed vial of insulin. The five year old, by the way, who’d been having a whine-fest all day because her parents were going to Marin to barbecue with old friends and children were not invited. What Lisa really wanted, at this point in the long afternoon, was to enjoy her glass of wine and the warm weather, without the pressures of educating yet another person as to the differences between gestational and type 1 and type 2 diabetes, let alone latent autoimmune diabetes in adults, or LADA, a term Lisa herself had just learned.
“Yeah,” said the woman, “and later I think they made me check twice a day.”
“Oooh.”
“For like six months!”
“Whoa. Awful,” said Lisa, who understood that if this conversation kept moving in this direction, she just might have to give her crash course in type 1 even though it wasn’t her favorite party topic. It had the potential to make conversation awkward. Sometimes the other person felt insensitive. Worse, talk of T1D might lead to hours of this woman talking about an uncle (with uncontrolled type 2, Lisa would have to imagine) who had both feet amputated or an aunt who had just died of melanoma, which wasn’t related, but was the kind of story that tended to come up when Lisa tried to explain about her disease.
“The doctor told me,” the new friend said, “that if my numbers were high, like over 120, I think. I don’t know. I can’t remember. Then I had to take a walk around the block.”
Lisa lifted her brows.
“You know how when you’re pregnant—do you have kids?”
“A daughter! She’s five.”
“Well then you know. Pregnant? The idea of walking around the block can sound like the worst idea in the world.”
Lisa, opening her mouth in the hopes of moving the conversation to children, was pleased to see—even as the woman was now trying to remember the highest her blood sugar ever got and was guessing 190 or maybe it was 180—that Lisa’s husband was coming up the grassy slope behind the woman.
“I mean, the nutritionist—I had to go to two separate appointments with her that took forever—she told me that I needed to avoid carbs, but oh my god I just totally could not stick to the diet and I splurged some nights and on those nights, it was bad, but I didn’t even check my numbers.”
Maybe now a yard behind the animated woman, Lisa’s husband—who is genuine and caring and supportive—stopped. He cocked his head and listened to what the woman describe how much it hurt to prick her fingers and how she sometimes skipped that too. He smiled a faint knowing smile. He nodded slowly.
Lisa said, “That sounds just awful.”
“It was. Although, nothing bad ever happened on those nights.”
“I’m sure not a lot did.”
“And jesus, that flat orange soda? The one you have to drink at the OB? The one that’s so gross? I seriously thought I was going to puke.”
Behind the woman, Lisa’s husband raised a hand and tucked an imaginary violin under his chin. He held out an imaginary bow with which he began to perform the score to this poor woman’s suffering.
“Of course,” she said, Lisa’s husband drawing a long note across the invisible strings. “I was so incredibly worried the whole time that I was going to have a ten pound baby. I mean. They almost had to do,” her voice dropping an octave, “a c-section.”
“But everything was okay?”
“Fine. Eight pounds one ounce. But the artificial sweeteners?”
Lisa’s husband ran the bow furiously over the strings.
“You would think, with all the diabetes in this country, that they could make a sweetener that don’t taste bad.”
“They are gross.”
“Yeah. But they were nothing compared to what a pain it was remembering.”
“Remembering the sweeteners?”
“No, to bring the testing kit thingy.” The woman pointed to Lisa’s meter. As if she were deeply regretful, the woman said, “I forgot all the time. Like when we’d eat out. Or take a weekend trip or something.”
“Shoot,” said Lisa, who worried for the first time that maybe the woman would turn and see her husband, who now had his eyes closed, his knees bending with the intensity of a measure. He somehow, though, received Lisa’s message and dropped his instrument. Coming around the stone wall, he said, “I’m Keith. Lisa’s husband.”
“So nice to meet you! We were just having the most interesting conversation.”
Keith smiled at his wife. With that one look, Keith let her know that he appreciated how hard it might have been to not tell this woman that Lisa checked her blood sugar at least six times a day. That Lisa had tried to use a CGM and had wanted, badly, for the continuous monitoring to work well but that she felt overwhelmed by so much information and had decided not to continue, which was surprisingly disappointing.
Keith could have told this woman that Lisa’s own pregnancy was fraught with far more than concerns about walking around the block.
And if this lady thought artificial sweeteners were bad, try warm juice boxes that had been in the car door literally for years, but that Lisa had needed to power down last summer on the edge of the Grand Canyon when her levels had gone to 46.
“I was just telling your wife about my diabetes,” the woman frowned. “It was gestational.” The woman looked at Lisa in a way that just might have been an appraisal of Lisa’s slim physique, one that didn’t square with the “other” diabetes the woman knew about. “Wait. Sorry. You aren’t pregnant are you? Is yours gestational?”
“Nope. Type 1. It’s pretty different.”
And because Lisa took an especially deep breath just then, her husband put a hand on her shoulder and said to the woman in an engaging and thoughtful voice, “So tell me. Where are you from?”
