“Endo Anxiety” and the Visit that Changed my Mind
It is Tuesday and I am at work. I am anxious and unfocused, because in the afternoon I know that I have an appointment with my endocrinologist.
I know, rationally, that this shouldn’t shake me as much as it does, but I can’t help it. This is my first steady endocrinologist relationship since the end of college, when my pediatric endo broke up with me (he said I was too old). Since graduating two years ago, I have moved to one big city and then to another, soon after I became comfortable in the first. Finding an adult endocrinologist, let alone one that “clicks” with me, fell low on my list of priorities, beneath more pressing concerns such as: finding housing, making friends, doing laundry, self-actualizing. Now, finally in a full-time position with health insurance, I have found a great endocrinology clinic close to my work, and although it makes my mother happy, it doesn’t make me hate going to the doctor any less.
I am nervous because I am afraid of what my endo could say to me when she notices that I have been controlling my diabetes horribly. I have been lazy all winter, my eating habits have trended increasingly towards a strict take-out only diet, I have not worn my CGM in months because after 12 years of diabetes, I am still afraid of needles, and I have mostly stopped caring about what the CGM would be telling me anyway. By all measures of my self-assessment, I am doing horribly, and I am convinced my A1C has gone up. What is the point of going to see the doctor if I already am I aware of everything I am doing wrong?
Later that afternoon, at the receptionist’s desk, I mentally rehearse my Endocrinologist Visit Success Plan: The only way to avoid defeat is to beat the endocrinologist at her own game. I have to openly admit how horrible I am and then I will be immune to any criticism and insults to my ego. I must present my flaws plainly, with full admission of guilt, and then I will receive mercy instead of shame. This is the only way I am safe.
As the receptionist takes my insurance, my endocrinologist peers from around the corner. “Dan!” she exclaims, like she is happy to see me, and I freeze in a small panic. I’m not ready for this. Her voice is warm and welcoming and wise-sounding, the way that I know she is, but it is so different from the berating tone that I am expecting. “I can’t wait for you to meet my new intern,” she says. Her eyes twinkle, and she turns back to her office. I look puzzedly at the receptionist.
“You’ll like her new intern,” the receptionist affirms with a smile.
I follow my endo into her office. I see that next to her desk is a bed for a small dog, who immediately emerges from underneath the desk and makes a daft attempt at escape through the open door. I shut the door quickly behind us as my endo scoops the animal up in her arms and presents him to me. “His name is Pushkin! He is our new therapy dog,” she says with glee. Suddenly I am holding this dog with two hands from underneath his front legs, and we are staring at each other. “He’s a bichon frise,” she explains, and then proceeds into a brief history of the breed while I take a seat in her chair, my thoughts completely sidelined by this creature who quickly falls asleep in my lap.
“So,” she starts, finished with her side rant, “Diabetes. How are you doing?”
I suddenly remembered my plan. I stammer out a response, “Uh, well not good.” She turns her head as if to say, go on, and I continue with my rehearsed litany of sins.
When I am finished she adds another: “And you also beat yourself up too much!”
“Yes! That too!” I agree excitedly, because I had meant to include this on the initial list but I had forgotten.
She shakes her head. “You are doing great,” she assures me. “Your A1C is exactly the same as it was last time.”
“Seven point eight?”
“Seven point five.”
I am mildly shocked, as this was better than I was expecting. My A1C has come down a few points since I was in college, when it reached an all time high, but it’s still not where I’d like it to be. The last time I visited the clinic, the ophthalmologist told me I showed signs of background retinopathy – get that A1C down, he said, and don’t smoke. I’ve regarded cigarettes with fearful disgust since then, but the A1C has remained stubborn. My endocrinologist takes her notepad and writes a name in her best hurried doctor’s handwriting.
“Here,” she says shoving the paper at me, “I want you to see this guy. He’s great. He’ll help you work through this stuff.” I realize quickly that she is trying to suggest therapy without scaring me. The prospect of therapy has been in my peripheral vision for a while now. I know that it would be a good thing to do. The central messaging of many diabetes outreach and advocacy groups, the ones that I have surrounded myself with for the past few years, seems to be that “diabetes doesn’t hold you back from anything.” This, undoubtedly, a great and necessary message, but it comes with pitfalls – the determination to push beyond can turn into a false feeling of individualistic invincibility. Diabetes always takes a toll on the mind, and that isn’t to be ignored.
Suddenly I feel a sharp pain in my hand. The dog is gnawing on my thumb. I yelp a little, and grab his little muzzle between my two fingers. He glares at me.
“That will be enough, Pushkin,” my endo says, addressing her dog in roughly the manner which I expected her to address me when I walked in. “I apologize for him. He is teething. He is only 12 weeks old.” She takes the dog from my lap and places him back in his bed. She writes me a few prescriptions, I thank her, and we say goodbye.
“Having diabetes is hard, but going it alone is harder.” This was my mantra in college, when I was starting my College Diabetes Network chapter, trying to convince the other students with T1D at my small school to join this fledgling club in pursuit of peer support. Two years out, nothing has really changed. Diabetes will always be tough, but there will always be people waiting to help. It stinks of irony to have to be reminded of it now, but I hope I don’t forget it again.
The College Diabetes Network (CDN) is a non-profit organization, whose mission is to provide innovative peer based programs which connect and empower students and young professionals to thrive with diabetes. To connect with other young adults, or to find out more, sign-up for more information HERE.