Posted on by Fred · 2 Comments

Facing Death Daily: Diabetes 102

A good friend, who is also a Front Porch Podcast Producer and an Unofficial Patron Saint, asked me to write about what it’s like to face death daily.  That sounds melodramatic, and I don’t intend it that way.  I’m not a police officer, firefighter, or member of the military.  People don’t make any special effort to kill me.  I’m just not that important.  I have little of value to steal.  The studio setup would probably get you a few dollars at a Pawn Shop.  There’s certainly not enough to risk going to prison for the rest of your life, or, worse, having Speedy Shine jump on you.  If you try to pick him up, he’ll probably bite you.  We’re working on that.  I have some PetSmart virtual training coming up in a couple of weeks.

Nevertheless, I do, in fact, have to recognize that if I lose balance, I can die before I even finish writing this episode.  We covered the details of diabetes last week, and I’m not going to go through them again beyond the context you need to understand this.  Please refer to “The Tightrope of Diabetes,” which is Episode 197 if you’re scrolling through the show looking for it. 

Diabetes is not the only danger I face. I haven’t been able to feel my feet in nearly seven years.  I can fall, and if I’m not careful, I will.  I might be lucky enough not to hurt myself too seriously, and perhaps I’ll be able to get up again, but that is by no means certain.  I no longer have the rubber bones we all seem to have when we’re toddlers.  Mine are old and brittle, ready to snap at the earliest opportunity. 

I live alone, so if I’m unable to get up, unless I have my phone on me, I will just lie there until someone decides to come and check on me.  Stephanie, my best friend, certainly would, but it could be as much as 24 hours before she did.  In that time, it would be simple to slip into either DKA or a coma.  Either way I would be equally dead. 

DKA, for a brief review, is Diabetic Ketoacidosis.  This occurs when your blood sugar gets too high, (at least 250 milligrams per deciliter, which is the measurement used in America, and 11.36 millimoles per liter in The UK) and your body begins to throw off ketones.  I usually need to get above 400 before I’m in trouble.  You may be different.  These can be measured by peeing onto a special strip.  The darker the strip turns, the worse shape you’re in.  DKA will dehydrate you, and if you don’t stop it in time, you will begin to vomit, thereby further dehydrating yourself.  Without hospitalization, you will surely die an ugly death.  When they take you to the hospital you’re unreasonably thirsty, and they won’t give you any water because you’ll just throw it up and make things worse.  They hook you up to IVs to start repairing all the damage.  I can’t begin to tell you how little fun it is to be hooked up to IVs. 

If your blood sugar gets too low, (below 70 mg/dL is dangerous, below 54 mg/dL is severe) you’re no longer able to think coherently.  While I know, right now, that if my numbers drop, I need to eat, when it gets too low, I may not know that anymore.  When it gets low enough, I’ll slip into a coma.  I had a friend who died this way.  My former roommates saved me from that several times.  I live alone with Speedy Shine now. 

I’m not overstating the case when I say I face the possibility of death daily. 

My friend wanted to know how I manage this.  I think it’s worth discussing because, once again, I’m not unique in this struggle.  There are more than half a billion of us on Earth right now.  One of us dies from diabetes every 5 seconds.  There is a wealth of diabetes information in the link below.

Home

First, for me, it’s about acceptance.  I’m the least Christian person you probably know, but there is one prayer I love above all others.  Just as “Shine,” by Sara Niemietz and Snuffy Walden, is my favorite hymn, this is my favorite prayer.

Attributed to Reinhold Niebuhr, Lutheran theologian (1892–1971)

God, grant me the Serenity to accept the things I cannot change,
the Courage to change the things I can,
and the Wisdom to know the difference.

I can’t tell you a thing about God.  You can find billions of others for that.  I can tell you, though, that serenity, courage, and wisdom are essential for me.

Serenity

The first step is accepting that I can’t change my diabetes.  I checked on Amazon, and it turns out they don’t have a new pancreas to replace mine.  They don’t have new legs to replace mine, either, so I need to continue to be as careful as I can. 

Death is one of the few things that truly is inevitable.  The healthiest human on Earth, with all the best medical care, is still going to expire within less than 2 centuries.  There is nothing to be done to change that… at least right now.  I keep hoping for a world in which science finds a way for us to all live indefinitely.  I believe it’s possible.  I don’t believe we’re there yet.  I don’t believe we’ll make it within my lifetime.  I’ve heard of a little baby named Layla.  She’s the granddaughter of my coach.  I hope she gets to live indefinitely.  I hope all her ancestors will, too.

“I do not fear death.  I had been dead for billions and billions of years before I was born, and had not suffered the slightest inconvenience from it.”

― Mark Twain

I can’t find evidence Twain actually said this.  Lots of sites attribute it to him, but I was unable to find the book, or lecture, or letter in which he said it.  Whether he said it or not, the point is worth considering.  Death is a natural state. 

I feared it when I was a child.  I used to have dreams of lying in my coffin, completely unable to move, while worms worked their way inside it and inevitably consumed me, excruciatingly slowly, bit by bit.  As I grew up and began to understand death a little more clearly, it dawned on me that I couldn’t possibly suffer in the way I did in so many nightmares.  There will be no Fred there to experience it.  Whatever it is that makes me Fred will be absent when my heart stops beating and my brain shuts down.  I will be a computer that has been turned off.  I can’t be turned on again, regardless of the Genesis song.  (If you haven’t ever heard “Turn It On Again,” you really should find it on Spotify.)  I’m not Teddy.  All that said, I’m still hoping to be cremated.  I would like my ashes dumped into San Francisco Bay near the place we end up putting my parents’ ashes when the time comes. 

There’s a line from Katherine Hepburn has in On Golden Pond…

Oh… it feels odd.  Cold, I guess.  Not that bad, really.  Not so frightening.  Almost comforting.  Not such a bad place to go.  I don’t know!

— Ernest Thompson from his screenplay, 1981

I feel that way.  I know it will happen, and to a certain extent it will be a relief.  I can’t get in trouble anymore.  I don’t have to worry about whether anyone likes my writing or listens to my show.  I don’t need to seek any longer the sexual satisfaction that diabetes has stolen from me.  And from that, I draw…

High line walker between two rocks concept of risk taking and challenge

Courage

I’m not a fool.  I recognize that I’m in peril every day.  While I was writing this my Continuous Glucose Monitor (CGM) went off to tell me my blood sugar was perilously low.  I should eat dinner, but I’m deep into my writing session, and I don’t want to stop right now.  I went to the bathroom and got some glucose tablets.  They’ll buy me enough time to finish this… I hope.  I hate to stop when the words are ready to come out.  If I stop them, I can’t necessarily just turn on the faucet again.

Courage isn’t being without fear.  It’s being able to recognize that fear and keep it from keeping you from doing what you know you should be doing.  In my case, what I should be doing is writing and recording as much as I can as quickly as I can.  I want to make all the difference I can before I can’t anymore.  I live by the words of Emily Dickinson:

“If I can stop one heart from breaking”

By: Emily Dickinson

If I can stop one heart from breaking,
I shall not live in vain;
If I can ease one life the aching,
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain.

Emily Dickinson

I don’t have any heroism in the traditional sense in me.  I won’t be rescuing a baby from a burning building.  I couldn’t even get inside of a building of any sort without some kind of help.  The only thing I can do to improve the world is what I’m doing every single week on this show.  I’m talking about ways to improve the world in the hope that someone, somewhere, will respond.  I’m hoping someone will make the changes I can’t. 

Supposedly, Albert Camus said, “To believe you can change the world is insanity; failure to try is cowardice.”  I can’t verify that, however, and I have only my late father’s word for it.  Once again, though, it doesn’t matter who said it.  The idea is correct. 

I have no more chance at success than either Atticus Finch or Hemingway’s Santiago.  And I have the same moral responsibility to try. 

I wanted you to see what real courage is, instead of getting the idea that courage is a man with a gun in his hand.  It’s when you know you’re licked before you begin, but you begin anyway and see it through no matter what.

–Atticus Finch in To Kill a Mockingbird by Harper Lee

Here I am seeing it through.  That’s what courage is to me.

Wisdom

This is the most difficult to obtain.  It’s not simply possession of a set of facts.  It involves… oh my… I need to go for a bit.

***

Good morning.  I had to stop last night because, even with the glucose tablets, my blood sugar kept dropping, and I was no longer able to see the screen properly.  My brain began to shut down. 

I grabbed a candy bar.  That should have moved my blood sugar up considerably.  The reading dropped even farther.  I got down to 50, and I felt my heart rate increasing.  That may well have been fear.  I couldn’t think straight at that moment. 

I finally made a bowl of cereal.  That usually forces me to take a lot of insulin to keep from going up too high, and I knew that, but I did it anyway.  I wasn’t going to die if I could help it.

When I began to see colorful spots in front of my eyes, I thought seriously about calling 911.  I don’t want to overreact if I can avoid it.  Even with Medicare and Medicaid, there will be a bill involved that I can’t possibly pay, and I don’t care to take paramedics away from others who may need them more badly.

After about 20 more minutes, I began to be able to think clearly.  My first instinct was to take a shot to counter all the food I just ate.  That would probably have been the best choice, but I was still scared to death.  I couldn’t bring myself to do it.

That, of course, meant that a couple hours later my alarm went off to warn me my glucose was too high.  I took a small shot.  I went back to sleep.  Two hours later when I woke up, it was over 400, which is high as the Libre can count.  I took a bigger shot.  I peed on a keto stick to see if I had ketones.  Since there were no ketones, I was less concerned.  I woke up a few hours later, and I was at 128.  That’s as close to perfect as one is going to get.

***

So… to return to how I handle all this, Wisdom also comes into it.  As I said before I was attacked by my diabetes, it’s more than being in possession of a set of facts.  Last night, I had a set of facts.  I knew how to interpret them, and I knew what I was supposed to do to change the things I can.  Perhaps I lacked the courage to do what my wisdom told me to do.  That’s another sort of balance that is difficult to achieve. 

Life is, I suspect, in one form or another, a balancing act for all of us.  Was it Socrates who called it The Golden Mean?  I could look it up, I suppose, but I don’t care enough to bother.  The idea is valuable.  We need to decide what is most important at any given moment and pay attention to that detail without losing sight of all the other moments that make up a life.  Life is, as John Lennon told us, what happens while we’re busy making other plans.  I was planning to write all night.  Life happened.  Since I managed to recover, I can continue to write this morning.

This is what it is to live daily with the distinct possibility you won’t wake up tomorrow.  It’s a matter of accepting that death isn’t the worst thing that can happen, and that we need to make use of the time in front of us because it can be gone suddenly and permanently.

Depression is a big part of the challenge.  People with diabetes are 2 to 3 times more likely to have depression than people without diabetes.  Only 25% to 50% of people with diabetes who have depression get diagnosed and treated.  But treatment—therapy, medicine, or both—is usually very effective.  And without treatment, depression often gets worse, not better.

That will be in next week’s episode.

For tonight, let’s enjoy the minutes we still have.  Let’s embrace the life in front of us because we have no idea how much more of it we have left.  Let’s Shine while we can.

Posted on by Fred

Violence Is The Tool of The Intellectually Ineffective

The following is my part of a discussion I had on Facebook the other day. 

A friend of mine had posted something Liberal on his page.  A conservative friend of his, referred to here as Name Deleted, talked about how he would “K” Democrats.  He said he meant “Kiss.”  No one believed him.

  • Fred: Violence of any kind is never the answer.
  • Name Deleted: Sure, Fred.  You grow up in church.  You be good.
  • Fred:  I’m an atheist, and ad hominem attacks are not arguments. Violence continues to be no answer.
  • Name Deleted:  Pacifist.  Nope not here.  Grew up military and country.  Saw a lot of stuff in my life.  Called survival. 
  • Fred: Also irrelevant to attack me instead of my argument. You also gave me your personal history, which is also not an argument.  Violence means someone is hurt. It usually means someone is killed. Whatever Good you believe you accomplished with your violence is denied to those who die.  Violence is the answer used by those who cannot be moved by words and logical arguments. It is the answer of the intellectually ineffective.
  • Name Deleted: Fred Eder You Win Freddy. Attack you. Wow. Fragile. You win. Bye.
  • Fred: Thanks for the discussion.

No, of course I didn’t change his mind.  I’ve been on Facebook for nearly 14 years now, and in that time I’m not aware of anyone ever changing their minds based on any sort of debate there.  I recognize the futility of the effort.  Why, then, should I continue to try?

It’s because I believe in the power of words.  Words can inspire.  They can change world views.  They can inform.  They can lift us out of our ordinary experiences and show us a universe we had never imagined before.  They both begin and end wars.  They set humanity apart from most of the rest of life on this planet.  There are hypotheses that other animals communicate, but we are unique, as far as I know, in written language, an alphabet, and our ability to be moved by thoughts from thousands of years ago.  The words I wrote might cause someone, somewhere, some time, to reconsider their own thoughts, even though I have no idea who that person is.  The best any writer can hope to do is to move a stranger.  I recognize that Good people sometimes commit acts of violence.  They are expected of our military, and they are often necessary for members of the law enforcement community.  But they always represent a failure of our intellect.  Soldiers, sailors, and marines don’t kill others for fun.  They do so on the orders of leaders who were unable to use language to convince other leaders to do what they believed needed to be done. 

Shakespeare took this up in Henry V:

BATES

… for we know
enough, if we know we are the king’s subjects: if
his cause be wrong, our obedience to the king wipes
the crime of it out of us.

WILLIAMS

But if the cause be not good, the king himself hath
a heavy reckoning to make, when all those legs and
arms and heads, chopped off in battle, shall join
together at the latter day and cry all ‘We died at
such a place;’ some swearing, some crying for a
surgeon, some upon their wives left poor behind
them, some upon the debts they owe, some upon their
children rawly left. I am afeard there are few die
well that die in a battle; for how can they
charitably dispose of any thing, when blood is their
argument? Now, if these men do not die well, it
will be a black matter for the king that led them to
it; whom to disobey were against all proportion of
subjection.

The most common argument about the need for violence comes in explaining why Neville Chamberlain was wrong not to go to war with Germany earlier than he did.  There can be no debate that Hitler needed to be stopped, and history suggests violence was necessary to accomplish that.  This is a powerful argument, but, for me, it misses the point.

That Hitler was mentally ill can hardly be debated.  He was, in simplest terms, intellectually ineffective.  He couldn’t be persuaded by words he didn’t like.  He loved the fame, the power, and the glory that were heaped upon him by the citizens of Germany at the beginning.  He was empowered by those who believed in the hatred he preached.

Hatred is an extreme form of Anger.  Anger is caused by fear.  (See Episode 123: “The Problem of Anger” for more on this.)  People feared Germany’s collapsing economy would cause them to plummet into poverty and homelessness.  I think many of us are familiar with this fear today in America.  Hitler gave them somewhere to focus that anger.  It grew to the hatred necessary to kill more than 6 million people simply for being different. 

What we see is a massive failure of intellect.  We see the power fear has to overrule our intellects. 

There are those who claim this is built into our psyche by our earliest evolutionary stages.  Fight or Flight kept us alive for quite a long time.  Fight became synonymous with courage, flight with cowardice.  We’re told to admire courage over cowardice.  Running away from an attack is not heroic.  There are few movies made about those who choose flight over fight.  We simply don’t admire such people. 

On the other hand…

“I wish Bob Ewell wouldn’t chew tobacco,” was all Atticus said about it.

According to Miss Stephanie Crawford, however, Atticus was leaving the post office when Mr. Ewell approached him, cursed him, spat on him, and threatened to kill him. Miss Stephanie (who, by the time she had told it twice was there and had seen it all—passing by from the Jitney Jungle, she was)—Miss Stephanie said Atticus didn’t bat an eye, just took out his handkerchief and wiped his face and stood there and let Mr. Ewell call him names wild horses could not bring her to repeat. Mr. Ewell was a veteran of an obscure war; that plus Atticus’s peaceful reaction probably prompted him to inquire, “Too proud to fight, you nigger­lovin‘ bastard?” Miss Stephanie said Atticus said, “No, too old,” put his hands in his pockets and strolled on. Miss Stephanie said you had to hand it to Atticus Finch, he could be right dry sometimes.

Jem and I didn’t think it entertaining. “After all, though,” I said, “he was the deadest shot in the county one time. He could—”

“You know he wouldn’t carry a gun, Scout. He ain’t even got one—” said Jem. “You know he didn’t even have one down at the jail that night. He told me havin‘ a gun around’s an invitation to somebody to shoot you.”

“This is different,” I said. “We can ask him to borrow one.”

We did, and he said, “Nonsense.”

— Harper Lee, To Kill a Mockingbird, Chapter 23

Atticus is a hero.  Anyone can hit someone.  That’s easy.  One could certainly argue, from at least a legal standpoint, that Atticus would have been justified in hitting Bob Ewell.  I suspect a first-year law student could get him acquitted with self-defense.  I could be wrong.  I know many people who would have knocked Ewell on his ass for that.  I know many more who would applaud Atticus for kicking Ewell’s ass.  And, again, hitting someone is easy. 

You know what’s tough? It’s tough to tolerate such an insult without responding.  I maintain Atticus is tougher than Rambo.  I suspect many of you will disagree.  You’re welcome to do so.   

Bravery doesn’t exist without fear.  How we deal with our fears is what defines us.  When we use our language instead of physical force, we save each other pain that solves little.  Though it’s doubtful that Gandhi said, “An eye for an eye leaves the whole world blind,” the sentiment is correct.  I can hurt you, and you can hurt me.  Which of us can hurt the other most is irrelevant.  It would be better for both of us if neither of us was hurt.  I decline to derive pleasure from your pain.  My life is no better because yours is worse.   And I won’t like myself as well if I hurt you.

One of the first things we teach our children is to use their words.  We don’t express displeasure by throwing a tantrum anymore because we’ve grown beyond that.  When I was 3, it would have surprised no one that I threw a tantrum because Mommy didn’t let me have a cookie before dinner.  I wouldn’t do that today.  Neither would you.  We’re adults, and we have learned better ways to deal with our feelings.  We’ve grown.  We need, as a species, to continue to grow.  We need to learn to use our words, just as our parents taught us when we were 3. 

My hope is my words can get you to reconsider your feelings about violence.  I hope we can stop creating a blind world and start creating a world in which we learn compassion, empathy, and love. 

I’m 60, diabetic, disabled, and defenseless.  I have no doubt you can beat the hell out of me for suggesting ideas with which you disagree.  Which of us will be better off?    Will you have proven anything other than that you’re capable of physically hurting me?  Does that make you heroic? You would be, in my mind at least, substantially more heroic by using your intellect to change my mind instead of your power to increase the pain I experience every day.  I invite you to do that in the comments on Patreon, on my Facebook page, or on the show’s Facebook page.  You can even send me something in Facebook Messenger.  Or you can hit me.  (And you wonder why I never leave the house??)  Which do you think is better?