Wednesday, June 23, 2010

"Can I Physically Do This?"

I am spending my summer doing research on adolescents with lifelong, and function limiting, chronic illness. Spending hours pouring over qualitative data on how teens identify with their illness has reminded me of my relationship with diabetes as I transitioned through adolescents. It also reminded me of the summers I worked at diabetes camp, and my tween and teenage campers who I desperately wanted to grab by the shoulders, look in the eye, and promise that it would get better in a way that they could hear.

Today, in hopes of nurturing my professional development, my PI (principle investigator) spoke wise words about my academic future: "You are in a tunnel. There is an end. But at this point you need to be careful that the light you see isn't another train coming at you." These same words so adequately describe the double edged sword of being a teenager and having a chronic illness.

Even now, a few years removed from the turmoil of teenage insecurity, I still struggle with acceptance of future: as a physician, as an adult giving back to society, as a sister, daughter, wife (maybe?), mother (hopefully), AND as a type 1 diabetic. Below is a "fear essay" on the subject that I had to write for our humanism in medicine class this past fall:

Can I Physically Do This?
My biggest fear about becoming a physician is actually less about the process of becoming one and more about my future career in medicine. I am afraid of not being able to physically handle the life-style associated with the practice of medicine. I am also afraid that the stress associated with a life in medicine will have a negative influence on my health. I am afraid of there being truth in all of the nay saying I have heard over the past 19 (plus) years of living with type 1 diabetes.
At six years old I was diagnosed with diabetes after an abnormal result was found on a routine blood glucose test during my annual physical. My blood sugar was 157 and I was completely asymptomatic. Three days later my pediatrician performed a very unscientific glucose tolerance test (checked my blood sugar, sent me out to eat a sugary breakfast, had me come back to check my blood sugar again). This led to me being ushered off to the pediatric endocrinology unit at the local teaching hospital. The events of that day are my first tangible and complete memory.
Growing up with a chronic illness, especially one that is surrounded by a huge amount of misinformation, has been hugely influential in the development of my personality. I believe that my experience as a “diseased” person in society is what led me to major in Medical Anthropology, a background that will be hugely beneficial to my career in medicine. With no one in my family in the medical field, I strongly believe it is also what inspired me to seek a career practicing medicine. This desire was strengthened when I was diagnosed with Celiac disease after many years of seemingly unrelated symptoms. Diabetes has given me a (sometimes overzealous) drive to achieve everything I possibly can and not take a single day for granted.
However, there have been tremendous physical and emotional obstacles to surmount. One of the greatest challenges for me has been overcoming the emotional burden of the “scare tactics” used on me as a child. I grew up in the age of “if you eat that your arm will be amputated”, “if you don’t check your sugars more often, you’ll loose your eye sight”, and “high blood sugars will kill you”. I was taught to weigh my food, to micromanage my sugars, to be meticulous about taking insulin, and to use food exchanges as a way of cheating death. My parents, doing the best they knew how, had the attitude of “everyone has their problems and so at least you know what yours is” which left little room for me to ever be upset or frustrated at the disease that shared my childhood.
I made the decision to pursue a career in medicine a little later then most of my peers, as I had to first determine that diabetes was not going to get in my way. While I rationally know that it wont, and know that it never has before, I am still fearful that it will. There are many events that have happened recently to reaffirm my fear of a future as a diabetic in medicine. Such as my endocrinologist advising me to keep my disease hidden in the application process and in medical school rotations, as according to him, “old world surgeon types will judge you and think you are incapable”. Or having to fight to be able to take my insulin pump and blood glucose meter into the testing room with me during the MCATs. Or that countless numbers of people have given me unsolicited advice about how as a diabetic I should avoid high stress lifestyles in order to avoid complications.
I find myself wondering how I will manage to keep my blood sugars stable during the unpredictable pace of 3rd and 4th year rotations. How will I carry my pump, multiple pagers, and a smart phone on scrub bottoms without them falling down? (I have mastered the pump and 1 pager or radio already, but not multiple.) I worry that I wont be able to fit exercising, sleep, and cooking healthy meals into the packed life style ahead of me. I am concerned that high levels of stress combined with little sleep will lead to uncontrolled blood sugars. And I worry about what will happen if I have a sudden low blood sugar, or accidentally pull out my pump site, while working a code or during surgery? Will diabetes hold me back from a specialty I really want to pursue?
I also find myself worried about diabetic complications, and irreversible past damage I may have already done to my body. If I loose a limb as a result of this disease, will that be the end of my career? And if so, why am I putting all of this time into trying to be a doctor in the first place? Should I be taking advantage of the time I have with all my appendages somewhere else? Or what happens if I go blind?
I also worry about how my experiences with a chronic disease will influence my ability to doctor, and how I view my patients. I already know that I have an unfair frustration towards type II diabetes and diabetics due to the assumptions made about me from the mention of “diabetes”. I need to quickly get over this bias, as I will probably have many type II diabetic patients regardless of my specialty choice. Will I be unsympathetic or judging of non-compliant patients? I really hope not.
I know that I am not the first diabetic to pursue a career in medicine and I am sure I will not be the last. I also know that I have had the blessing to grow up surrounded by new technology and that things like constant glucose monitoring systems will significantly ease the burden of managing diabetes in a fast paced life style. I also realize that it is okay for me to have these fears but I need to ensure that the fear does not become debilitating. Hopefully my diabetes will aid me in my career as the best physician I can possibly be instead of holding me back.

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