I really like my nephrologist

October 25th, 2012

I really like my nephrologist.

He wears crazy ties, and he’s got a plastic model of a kidney on his desk that somebody glued googley eyes onto.

I was seeing a young fellow today, a nice woman with an Eastern European accent who made the mistake of mentioning how I probably know a lot more about diabetes than she does and how I probably know a lot more of the people at Joslin than she does.

She’s right, but she never should have said that. There was a tone in her voice, a lack of confidence. It’s like running away from a peacock who wants to peck dents into your shins. Your show of weakness invites attack by the strutting bastards.

There’s a lot at stake. They have much to prove in the dance of winning a mate.

When I saw Dr. Robert Stanton, my nephrologist, whom I call Bob, but not to his face, since that just feels wrong, out at the reception desk, I said, loudly,

“Hey! There’s Dr. Robert Stanton!”

But maybe he didn’t hear me. He walked off down the hall to his office.

“HEY!” I said, a little louder. “I guess Dr. Robert Stanton doesn’t want to say hello to Lisa Vaas!”

What a rude thing to do. The poor fellow with whom I was visiting, Dr. Taschi, was staring into her computer screen the whole time, busy checking off things in the insanely complicated software tracking program they use at Joslin.

It’s not like she was asking me something.

But still. You know?

I’m such a peacock.

There was somebody singing gospel in the waiting room at Joslin Clinic today. Her voice filled the room, and the room is big. Patients and nurse practitioners and lab assistants and patient account specialists looked back over their shoulders, paused and looked up over their computer screens, and stopped walking, patient charts in their hands, all of them turning toward the singer, like compass dials gravitating toward true north.

Usually, the waiting room is full of glum people, or frail gray-haired people hanging on to walkers or the arms of their middle-aged children, or obese people with defeated, sagging shoulders, or me, clutching my bike helmet and hoping that people wonder what such a young person is in there for.

“Must be picking up one of her parents,” I imagine they say to each other.

Particularly given that my hairdresser touched up my roots on Tuesday.

I bounce. I affect a bantering, robust tone. I heft my backpack down on a chair. I spring up and say “Hell-O!” when they call my name.

But the truth is, I’ve been going to Joslin for 47 years. I guess I fit in with that crowd in the waiting room better and better with every year that goes by.

Besides. Really. As if they think of me at all. As if anybody thinks of anybody at all, most of the time.

That’s not something you typically hear in this place,” I said to the receptionist as the singer sang about the lord’s love from the bottom depths of her belly. She smiled and nodded.

“Usually you just hear people screaming as they get jabbed,” I said.

“Usually, it’s me screaming the loudest,” I thought.

The receptionist said the singer comes in now and then, and she sings. The singer is a patient.

“You should hire her,” I said.

I like it when medical people talk to me. I like it when Dr. Bob Stanton skips over my records and gets to the heart of the visit, which is typically doing something like pulling up video from the latest Daily Show or running Google searches on gila monster saliva, which, it turns out, increases the body’s sensitivity to insulin.

“Who got it into their head to use gila monster spit for that?” I asked him. “And how do you get saliva from a gila monster? Aren’t they poisonous? Do they kill them? Or do they milk them for spit? How do you milk a gila monster?”

He doesn’t know. I asked Quora, and somebody got snotty and literal and said the medicine was based on an analog: something cooked up in the lab to resemble gila monster spit, as opposed to being real gila monster spit.

“Well, duh,” I said. “I want to know how the first person who did it, did it. As I said in my original query.”

I eventually found the title to a book about it. I haven’t followed up on that one yet.

The point being, I like it that my doctor knows that I’m in good shape. I like it that he doesn’t bother to educate me. I like it that he just runs through the basic stats, does a rote check of my lab results, dismisses the proteins in my urine as being just a lingering effect of scarring from kidney infections I got in my 20s before I was smart, tells me I’m going to live forever, then talks to me, like I’m not a critical case.

I like to put as much distance between myself and the critical cases as possible. It’s like putting distance between myself and death. I’m a peacock with a lot at stake.

I can forgive myself for that. But I don’t forgive myself for being judgmental.

Because here’s the thing: I got diabetes when I was 3 years old.

Until I got into my 20s and at-home blood-sugar testing was invented, and until Joslin doctors nagged me into giving in and puncturing my fingers multiple times a day to test my blood sugar, I didn’t do a good job at being diabetic. I did a terrible job. I ate whatever I wanted, and my blood sugars bounced, and I wound up in emergency rooms.

But still, in spite of the fact that it took me years—decades—to learn enough about diabetes to control it, at least I never had to adjust. I was blessed by getting it at the age of 3. I was blessed by having no habits to break. I was blessed at being free of a sense of entitlement.

Because that’s what tortures the newly diagnosed: the idea that they’re entitled to a life of health. The newly diagnosed feel, it seems, as if there’s something profoundly unjust about having to watch what they eat, or take insulin injections, or prick their fingers. This sense of being unfairly singled out breeds resentment, resistance to effective treatment, and depression, and that depression in turn leads to the state of brittle diabetes: a situation in which the impaired psychological profile prevents the diabetic from mastering his or her disease.

As if any of us are entitled to such a thing as health.

The self-pitying grow depressed, may God and the Buddha bless them.

But the singers sing, through the pain of their blood being drawn into tubes.

They sing, and I’d rather sing with them.