Jacob Brogan

The world is always ending


            Though cancer comes as a shock, illness is no surprise now.

            The summer after my first year in graduate school we drank caipirinhas. Cut limes into quarters, into eighths. Place them in the bottom of a cup, blanket them with sugar, muddle the mixture to form a thick paste. This was the ritual. The cachaça – a foul-tasting Brazilian spirit – that we would pour in next came almost as an afterthought. Sometimes when my glass was empty, I would eat the sweetened limes, peeling smashed flesh from the rind with my teeth.

            When the acid reflux started, I at first imagined all the citrus was somehow to blame. There were plenty of things wrong with my body that summer: I had lost twenty pounds in two months, my muscles locked up whenever I went swimming, I felt sick all the time. My mother asked me to take down a picture I had posted to Facebook, horrified by how gaunt I was. In retrospect, I should have guessed that something was amiss. Nevertheless, it was the unpleasant sensation that crept up my throat and filled my chest that I worried over most. Everything else, I assumed, was surely the product of overwork, the exhaustion of two semesters collapsing on me all at once.

            The most obvious symptom appeared to be nothing of the kind: I craved sugar all the time, craved it with a loopy enthusiasm. Sometime in late June, I marched into the living room where Celeste was working, stamped my feet, and proclaimed, “Baby Martians need cupcakes!” On the first day of July, Jess stopped by while I was languishing in bed, queasy with an unfevered flu. When he asked if I needed anything, I sent him out for milkshakes. He has never forgiven himself for complying.  

            All this, and yet when I made my way to the student health center it was the reflux and the reflux alone that I mentioned. My other issues came up as a matter of course, idle facts elicited by the standard medical inquiry. I watched my doctor adding them up in his head. When I asked him what might be wrong, he frowned, bit his lower lip, and hesitantly proposed leukemia. Talk about all roads!

            Here’s what was wrong with me: A minor infection that had torn through me in January, one easily treated with antibiotics, had flipped a long dormant genetic switch. Instead of fighting the infection, my immune system had begun to release leukocytes coded to attack the insulin-producing eyelet cells of the pancreas. As this autoimmune siege proceeded, my body grew increasingly incapable of processing carbohydrates. Stagnant, they degraded into acid, perilously lowering the pH of my blood and sending me spiraling into a potentially fatal condition called ketoacidosis. Perversely, my inability to process glucose led me to long for sweet things, exponentially intensifying the state of emergency. As the normally self-regulating feedback loops of the endocrine system broke down, my body literally consumed itself from the inside.

            This, at any rate, was the story that my blood work would tell the day after my clinic visit. It would be months, however, before I could tell it from beginning to end, and, even now, parts of it remain largely conjectural. When my doctor called, I knew none of this. I heard only four strange syllables, each of them a needle pricking the skin: Die-a-beet-ees. Diabetes? Celeste was baffled when I told her what I had. She shook her head, looked at me sideways. “No you don’t.”

            I did, though I found it equally implausible. At my doctor’s insistence, I would take a cab to the hospital that night, this night, seven years ago. The next day, friends called to check in. When Celeste handed me the phone, I would apologize to them for ruining the holiday. I felt as if I had let the burger patties spoil in the sun, left the fireworks out in the rain.

            In the hospital, I learned to pull synthetic insulin from a vial. I steeled myself to press needles into the adipose tissue of my stomach. I studied carb counting and the signs of low blood sugar episodes. I was no expert by the time I was released three days later, washed clean of acid, still weak. I was no expert, but I would become one. I would become one and I would survive, survive largely without consequences through seven years of endless self-care.

            Seven years. Seven years today. Diabetesversary. Insulin Dependence Day. This is my holiday, so I will allow myself one punning cliché: There is no sugarcoating diabetes. Like all chronic illnesses, it is a daily burden, one that never fades into the background. And yet we carry on. We do not live with our diseases but in spite of them.

            Seven years today. Have a cupcake with me. The baby Martians are hungry.