For two days and nights before this other horror for my family, I am craving sweet drinks. Believing that I would be simply increasing my fluid intake, we feed the craving. I have mug after mug of ginger beer, iced palm sugar, rose syrup and lemon, easy on the lemon, anything sweet. I keep pumping it in day and night. What I don't know is this — the inability of my pancreas to produce sufficient insulin is slowly leading to a dangerously high blood-sugar level.
Ingesting the amount of sugar I am consuming is bad enough for the average Joe. Without a sufficient level of insulin in the system to process it, I might as well be holding a gun to my head. By the time I walk down the stairs that Saturday morning, I am weaker than I have ever felt, my head is swimming, nothing is really coherent. I just know I am seriously ill. I feel as if the enemy we had temporarily contained has re-grouped, claimed a bit more territory. That deadly, stubborn bit just behind my stomach has been fooling us all along, it’s flaring for the last assault, I will fall and the war will soon be over. I am feeling so ill that I think, This time it will be merciful — I will collapse before I die, feel no pain.
But hope will spring eternal, even if it is built on air. “Nee, I think I need to go to the hospital as soon as possible,” I say to Helen, who is waiting for me at the dining table. Next to Helen is a community nurse who visits once a week ever since my discharge from St George Public Hospital. As a resident in Australia coping with this condition in the public system, St George assigns me these weekly visits, during which the nurse cleans the wound that is left with the removal of my port-a-cath. As I turn from the stairs to face them, the morning light from the backyard is almost blinding. I can hardly see. Everything is blur, but bright, unfiltered, like looking up at a blue, cloudless sky without shades.
The nurse says, “I think we should get you to hospital immediately, and we should call an ambulance.” She tells Helen to sit tight, she will use a special emergency number not known to the public, so I cut any waiting time for the ambulance, and beat the queue at emergency.
 |
| Mum, Errol and I in Kovil Hilir, Sentul. |
Paramedics have arrived. They roll me to one side on the bed, put a sheet under me, roll me to the other side, pull the sheet out. One-two-three-whoosh and they’ve lifted me effortlessly from the bed on to the gurney. One nurse is female and she speaks with such care in her voice she could be my sister.
My first time in an ambulance. The ride is only about 15 minutes but, in my state of mind, it feels far too long. Every time I awake to the shake of the gurney, I think we must be stuck in a traffic jam. The Railway Parade run to St George in Kogarah is full of potholes. The paramedics chat away like they do this sort of thing every day, pick up a man who may be dying, take him to hospital as quickly as possible. It’s a Saturday and there is no siren.
I do not notice it at the time, but I later find out that, back home in Oatley, Ben breaks down when he sees me being wheeled into the ambulance. Apparently the skin on my face is stretched tight, like parchment, and it looks like a skull barely covered. My gums have receded. I am breathing through my mouth, laboured. My second son doesn’t think I am going to make it. As I write this now, I’m wincing because I realise I did not say, Goodbye, touch his hand, his face. I just let them take me away. That poor guy.
*****
I awake a few hours later. It’s almost dark in the room. It must be twilight. Machines are beeping to the left and right of me, and an oxygen mask clasps my face. I have been in and out of St George as a stay-in patient a few times by now, but I have never seen this hospital room before. Through the glass on the wall, I spy doctors and nurses walk down the corridor beyond my door. They all wear masks and hospital gowns. Beyond the hum of electronics, it is silent in my room, eery. I am impressed with the hi-tech. A voice breaks through the stillness. A man is leaning past the door to my room. He looks young, south Indian, and he’s wearing a doctor’s overcoat. Later I find out he is a migrant from Malaysia, Indian by ethnicity. I will get to know him in the coming months as my endocrinologist. He says: “Mr de Cruz. Everything is all right. You’re in the ICU of St George Hospital. When they brought you in, you were in a coma. I’ve been checking on you every once in a while, waiting for you to wake. We’ve got everything under control.
“You’ve just been diagnosed with Diabetes Type 1. I know, I know,” he says, with a gentle smile. “Not to worry, you’ll be on insulin for the rest of your life, and it will be fine. It’s very manageable. I can see from your papers you’re a journalist. So, I thought you’d like to get the facts straight off.”
He says he’ll be back in a few minutes to discuss things in more detail. “It will be better if your wife is also around. I know she’s here. I’ve been talking to her.” Then he goes. I am bereft. I am so frustrated. Angry. But the anger has no energy. I’m afraid — they’ve already briefed Helen, probably to help ease the shock later. A new type of cold darkness descends, more portentous than ever. My mind is clear enough to register that a little cut on your toe can lead to the loss of your foot, or worse, because open wounds, for a diabetic, are difficult to heal. They can turn septic, and the next thing you know, you’re looking at amputation.
 |
| With Leslie, near Oatley (photo: Sheila Surinder Jessy) |
A while later, the oncologist on ICU duty drops in. I break down as I tell him I brought this on myself. I’m crying as I tell him about the sweet drinks spree, the beers I have not been able to give up. Nice chap, full of empathy, and full of emotion himself, listening to me blame myself. I can tell immediately that he feels my pain. “Mr de Cruz,” he says, his eyes brimming with tears, “it’s not anything you did. This is not your fault. The low-alcohol beer was fine, it did not cause this. This was bound to happen. Your pancreas is simply not producing the insulin your body needs to process the sugars you ingest. Did nobody tell you about the diabetes?” I shake my head. He makes a sound like the air has gone out of him, frustrated because he realises his colleagues have not warned me.
I am later to learn that I had been slipping into a diabetic ketoacidosis coma earlier that morning. The high blood-sugar level in my body has led to a dangerous build-up of ketones. Precursor symptoms include extreme thirst, frequent urination, confusion, frantic breathing. Once again, I was looking at potential kidney failure and lights-out for good.
By the time Helen visits me, I am battling a depression that’s worse than anything I have felt so far. I have a fighting chance against pancreatic cancer. Yes, I will undergo life-threatening surgery, but we believe it can work out and I will have the chance of returning to a life as close to normal as might reasonably be expected. Diabetes is different. I know what it’s about. There is no return from diabetes to anything even remotely resembling normal. An entirely new normal takes over, a debilitating abnormality, just as I had started to believe I was adjusting to the earlier version. Diabetes is a life sentence. I break down and sob for the first time since my diagnosis. I look at Helen. I am feeling so sorry for myself. The self-pity is inescapable. The sweet indulgence is a bitter taste. What, what have I done to deserve this? How much more is there? It’s all proving too much for me. What’s the point in surviving cancer if I am severely diabetic? I am due to lose my gallbladder, duodenum, a chunk of my stomach and now what? Stub my toe and lose my foot? Cut my finger, lose a hand, give up the guitar? A walking collection of missing parts?
The next morning, I move from ICU to my old stomping ground, the oncology ward. The diabetes nurse wastes no time in reading the “riot act” to me. Every meal will have to be carefully measured from now on, and for the rest of my life. A small bowl of rice, some vegetables, a bit of meat or fish is a full meal, whether or not that involves a full stomach. Bread is not a good idea for breakfast. Six little lychees are almost too much. Grapes are just balls of sugar. Artificial sweeteners, if you must. Only a little bit of honey. Friends tell me about stevia. It goes on, every bit of new information and advice a fresh stab. I will have to prick a finger, test the blood and give myself an insulin injection — four times a day, every day. The nurses teach me how to prick my finger, test the blood and accordingly adjust the insulin dose I will need, stick a syringe into my belly, just before every meal.
They give me something I immediately hate — my “diabetes bag”, a blue and yellow sling-on big enough to carry the testing kit, a few diabetes syringes, the hospital-issue notebook in which I must record the numbers each time. It will be with me the rest of my life, part of the furniture every time I sit to a meal, whether it’s at home or in a restaurant, part of the luggage when I travel.
I am discharged two days later. But I have to return to the hospital to hear about this new condition, and how it may be controlled. There is no cure.
When my diabetes condition is reported to Samra, he decides to bring forward my surgery to 23 March. Samra says, No more waiting. It’s too dangerous to delay while I catch up on the chemo cycles I have lost due to the fever. I have been getting sick frequently, and more complications may arise if we wait longer. My spirits lift.
This coming home is different. It’s like the last mile, the last extended practice before the marathon. I’m resigned to the surgery, but I am not looking forward to it. There is little joy in the comforts of the home I have longed to come back to. I know that the next time I leave, I may never return. The tiredness I feel from just thinking about it is the heaviest thing. I feel a shrinking of my body, it’s somehow smaller, stripped of any significance. The fight is wearing me down. There is so much uncertainty ahead. I will sacrifice half of my digestive system, undergo life-threatening surgery, put myself through another punishing round of chemotherapy, and still there’s no guarantee. I might yet relapse, if I don’t die on the table. I am supposed to have had six rounds of chemo, but there has only been time for four. I have invested so much energy into protecting others from my pain that I have none left for myself. I cannot share these thoughts with Helen, the kids, my friends, the cousins, certainly not my surviving uncles and aunties. I don’t even want to think if all this makes me less than a good person.
Sri Lanka is totally out of the question now. Neither Helen nor I want to cope with any sort of emergency in another country. It’s just not worth it. What am I supposed to do in Sri Lanka anyway? Stay away from rice and curry, dhosai, all that lovely fruit, a bit of toddy? In the few short weeks ahead, wherever I am, just before my first mouthful, I will have to lift my top, grab enough flesh on my belly to make a ridge, and stick the needle in. No one around me will notice. If I am with friends, they will be distracted by something else. My children, Helen’s nieces, friends, will all discreetly continue the conversation, letting me know, it’s all right, this is how you live. It’s nothing. A lot of people live like this. The empathy leaves me cold, mute, when all I want to do is scream.
Diabetic ketoacidosis is an emergency situation that can lead to organ failure and death. My wife and I did not know I would be vulnerable to the dangerous effects of low insulin levels, that I could get diabetes at the end of that three-day sugar orgy. We did not know I was lapsing into a diabetic ketoacidosis coma that morning the community nurse visited. If the nurse had not been there to see me, I just might have chosen to drink some coffee, with lots more sugar, and gone back to bed. The blood-sugar level was so high that, I now understand, I might have died in my sleep. The nurse saved my life. She was God’s instrument, acting to His will.
It will be about two months before I realise that my life has been turned around, that I have been saved. Again.
No comments:
Post a Comment