When you have lived in one place long enough, your sense of the roads you drive becomes burned into your mind. All the curves, all the hills, and all of the stop signs take up permanent residence in your memory. Driving those roads becomes an almost automatic undertaking. Restricted to staring only skyward at the ceiling lamps inside the ambulance, however, one experiences the road from a very different perspective. I felt the inertia of every stop, every start, every acceleration, every move that my unseen driver made. With astonishing accuracy, I found that I was able to correctly anticipate each turn on the fifteen minute ride to the hospital. I knew the shortest route, and, apparently, so did the guy behind the wheel. It took my mind off of having to pee.

At the ER, an entirely new roster of players came into my life. I envy them in their work not one bit. Emergency Medicine is appreciated by people who watch it as entertainment on television. People who seek Emergency Medicine, on the other hand, are generally not in the mood to appreciate anything, especially when they have to wait a while to get it. It is entirely lost on me why they are called a word that is a homonym of “patience.”

As was the case back in 1982 during my four-day sojourn there, the professionals at St. Anne’s were caring, smart, and helpful. They were also busy. That’ll teach me to wait until Friday night to wreck the truck. (FYI: Sunday mornings are bad, too. Lots of palm stitching on bagel-slicers who forget to quit when they reach hand.)

Various nurses, techs, and MDs looked me over, poking and squeezing, checking ranges of motion, and getting me in and out of X-ray. Mercifully, I was allowed to venture under my own steam to a WC. Sure, I could have used a bottle at any time, but I enjoy a good challenge. Builds character.

One of the doctors handed me a prescription for a pain killer, and said that I’d be thanking him for it tomorrow. When you smash yourself up on Friday, it can take until Saturday for you to learn all about “delayed reaction.” That’s when hurt moves in and makes itself uncomfortable, in a big way. This is why you stay away from boxing.

You might be wondering how I know what went on inside the cab during the actual impact when I was so “out of it” at the time. After a few days, I took a ride to the body shop where the truck was being stored and played CSI for a few minutes. I inspected the vehicle inside and out to be sure that nothing else had been taken from the wreck. I always kept a nice set of Craftsman sockets, wrenches, and other tools in a small tool box, and I also kept spare ignition wires, spark plugs, hand cleaner, and a breakdown kit for emergencies on the road. There was a nice set of Hadley air horns inside the engine compartment, too. Everything had been strewn about the truck, but it was all there. The bungees were on the dash. The small storage compartment door that left a mark on the leather shifter was on the floor.

In the days following the accident, some sympathetic people offered me an out by alluding to my “unexpected” low blood sugar. But I disagree. There was nothing unexpected about it. There never is, because it’s a simple, mathematical formula: insulin minus food equals hypoglycemia. Though I had not bolused, my basals had yet to be properly established. You fellow insulin users know how it works. We live with that tidy little equation floating around in our heads every day. Sure, I’ve simplified it a bit by omitting factors like stress, exercise, and correction boluses. But go ahead, load up on insulin without eating, and then let he who doesn’t go hypo cast forth the first glucose tablet.

The answer is in knowing that your sugar is about to fall off the table. These days, I don’t start the vacuum cleaner without first burning a strip, and then, usually, suspending my Paradigm 512 before cleaning the house.

But for a single blood test, this huge nutshell of a story would have never happened. And while there might be a chuckle here and there in reconstructing those events, I will never find humor in the fact that someone other than yours truly could have been injured, or even killed, as a result of my actions. It emphasizes the absolutely paramount importance of testing before driving.

When I first began pump therapy, I did not have sufficient experience to establish safe, effective basal rates for myself. My educators had told me to watch for sudden highs and lows by testing more frequently. But I let one get by me, just one time, and that’s all it took. I learned the hard way about how careful diabetics need to be. Tempting fate by getting behind the wheel without testing is an act of industrial strength stupidity. In the weeks that followed my accident, I got better, bought another truck, and things got back to normal, happily ever after. My bag of luck was very full on that day, and I am not about to forget it.

“Glucagon, buddy. How are you doing?” A paramedic answered a question that I did not remember asking. He was pulling a needle out of me when my eyes began to open. Again, I reached to feel for my teeth, but now found that my arms, legs, chest, and head wouldn’t move. “Don’t try to do anything. Just relax for now.” Mr. Glucagon and his merry medics had strapped me down to what was beginning to feel like the world’s biggest cheese grater, and had wheeled me into their ambulance. I double-checked for missing chicklets, this time using my toungue.

Through the vehicle’s open rear doors, flashes of blue and red light pulsed in a rhythmic cadence identical to the beat of Huey Lewis’ “Heart of Rock n Roll,” illuminating cabinets full of emergency medical supplies within my limited field of vision.

There was no question that the young fellow in the blue uniform knew his job, and did it well. His foremost concern at the present time was getting my incapacitated carcass safely to a place where people even more well-qualified than he was could examine and evaluate any possibly hidden damage I might have done to my stupid self. Still, staring at the ceiling of his antiseptic ambulance, I could not help but see myself as the subject of some evil, though oddly humorous, interrogation. I also had to pee.

“Vaught iszh yaw name?”

“Jeff. What’s yours?” I muttered.

“Kon you viggle zee toez.”

I viggled.

“Iszh dayer zomevon you vish vee zhould call?”

In a moment of brilliant, extraordinary hypoclarity I realized that Nancy, my wife, would have left work already for her half-hour drive home, and she often stopped at the gym to exercise or to pick up some things at the grocery store. This was before we began carrying cell phones. It made no sense to have an EMT call my house; no one would be there. And I did not want Nancy coming home to an answering machine message that, for all I knew, could possibly leave unmentioned the fact that I had not assumed room temperature. So I gave them my parents’ phone number. I knew they were home because that was where I had just come from. They would be able to contact Nancy, or at least leave a proper message on our machine. It made sense. Utterly logical, hypoclarified, sense.

NOTE: For all you guys who are happily married, and want to stay happily married, listen up. Next time you’re strapped into a paramedic’s gurney in a hypoglycemic stupor, rationalizing like an imbecile that, just because you know your lovely bride is not at home to take a call from an EMT , maybe the EMT should call someone else, make him call your bride, even if she’s not home. Bride comes first. Bride first. Always. Bride. Then, and only then, anyone else.

My paramedic friend now asked me if there was anything in my truck that I wanted to take with us. Still ensnared within the mangled cab were my briefcase, test kit, and Igloo cooler. As I lie there tied to that God forsaken board of torture, I considered, for a flittering moment, a little self-depricating remark about leaving the test kit behind. What the hell, if I had used it when I should have, I wouldn’t be feeling like a piece of shredded Il Villagio Grana Padano on a house salad. But this was no time for jokes.

“My Rolex.” I still had to pee.

The EMT retrieved my test kit and briefcase from the wreckage, and said that we would be on our way shortly. “Are you still doing ok, Jeff?” he asked. “Do you have a preference where you’d like to go?”

“Heaven, if you can set it up.” He was making it too easy.

“What hospital would you like us to bring you to?” He withdrew and rephrased.

Something about bouncing around inside a truck like a human Rustoleum agitator ball makes you get religion. “St. Anne’s,” I requested. It was where I had gone through diabetic boot camp in ’82, and it was closer than any alternative. I also knew they had a bathroom.

Check back tomorrow for Part IV

Here's a good one from last week.  Anyone ever try to take your supplies away?  What's that old saying?  ". . . from my cold, dead, hands."  Check it out here.

In my stupor, I tried automatically to reach for the ignition key to turn off the engine – the same thing I always do when a trip is over.

I needn’t have bothered. The impact had its own effective way of stopping the engine. Besides, my keys had been jarred loose and taken flight from the steering column, which itself was no longer in the same place Toyota had put it.

One breath, and another. Adrenaline brought me around to a vague awareness of something amiss, and an old instinct from my hockey days had me tapping lightly on my front teeth. “Chicklets,” Derek Sanderson of the Bruins once called them. Thankfully, all present and accounted for.

The dashboard was now closer by at least a foot to the ceiling, and the hood, once flat, was buckled into a pyramid shape, quite visible through the shattered glass of the windshield. The telephone pole had split the grill dead center before cutting the radiator in half and forcing its way into the engine compartment. Only when the aluminum engine block refused to give up any more ground was the swath of twisted metal destruction halted.

My door was bent and open, with no chance of ever closing again. Searching blindly for what seemed an eternity for the seat belt buckle -- it was down there, somewhere -- I heard it snap open, and realized that the shoulder belt was responsible for the mighty force that had nearly torn off my shoulder. I worked feverishly in a preposterous, uncoordinated daze to untangling myself, and the insulin pump on my belt, from the snarled straps.

Slowly, I hoisted myself out of what only moments before had been a good looking truck, down into the grassy, trench-like gutter, where I sat upright and stunned at first, then lowered my upper body backward and downward onto the ground. My head came to rest beneath the truck, just forward of the rear tire.

Traumatic events can play games with perceptions and thought processes, and, coupled with an excess of insulin, had me convinced there was a surefire way to go back in time and undo the last few minutes. So, lying there like Phil Leotardo, I began working on that little issue, and then closed my eyes.

Check back tomorrow for Part III

According to the Courier-Journal in Louisville, Kentucky, if your diabetic kid goes to an Oldham County middle school, he is not allowed to test his blood sugar in class.  Read all about it here. 

As Type 1 diabetics, we all pay a heavy price for wandering outside the boundaries of caution when it comes to using our insulin, and the ramifications can reach both physical as well as psychological extremes. But everyone makes mistakes. That’s why pencils have erasers. Look at what happened this summer to Roosevelt Sims of St. Louis when he was kicked off an Amtrak train in the middle of Nowhere, Arizona. And surely you’ve read about Mr. Universe, Doug Burns, whose hypoglycemia was mistakenly interpreted as drunkenness by police in a movie theater.

When a nice Toyota pick-up went by the other day, I was reminded of a mistake of my own several years ago – one that cost me a similar truck, but could well have ended much worse than it did.

At the time, my insulin pump was something new, and I began to take for granted the good luck I’d had with it so far. I climbed into my truck, started it up, and began the drive home. Foolishly, even after having been warned to check my sugars at least as frequently as I did in the past, I felt confident that my new gadget would keep me from going too low. Six miles later, I learned otherwise.

Comparable to a sudden patch of turbulence on a flight, the rumble of transitioning abruptly from pavement to off-road terrain ignited the last spark of awareness in me. Barely conscious, my eyes cracked open at the last instant to see a narrow, vertical post careening toward the center of the grill. The trip home was coming to a sudden, violent, absolute, end.

Pieces of my truck’s interior flew around me in a cyclone of shrapnel. Two bungee cords from the cargo area behind the passenger seat shot past my ear and smacked against the windshield. The small door of a storage compartment hurdled the center console and deflected off the 4WD shifter. Something massive grabbed hold of my left shoulder and gave it an enormously powerful yank backward. The airbag deployed, saved me, and deflated in a tenth of an instant. Having sacrificed its own life for mine, its flaccid remains drooped over the steering wheel like a deflating parachute. Everything – the engine, the radio, the off-road rumble, the violence of it all – stopped. Everything, that is, but me.

Check back tomorrow for Part II

Yesterday, I reached into my pants for my car keys and got a not-so-pleasant surprise when I discovered that the pocket had been transformed into a vat of sticky goo. First I thought my small travel bottle of Purel had busted open, until I remembered that the santizer was in my other pocket. So I reached back in and pulled out my keys. They were a sticky, drippy mess.

Then I excavated a tube of glucose gel that I bought at a convenience store – the one that sounds like “skeevy yes,” not that there’s anything wrong with sounding like “skeevy yes.” I had never opened it, but it somehow had not been sealed properly at its flat, non-cap end. At least half of the sugary gel had oozed out and made a total, thorough mess of my clothes, keys, and hand.

At $11.49 a pack, I’d think we were beyond this already. After all, clipped to my belt is a little, blue, medical miracle that does its own math and administers insulin accurately in increments as small as half a tenth of a unit. Six inches lower, technology can’t keep from turning my clean, dry pants into a baker’s piping bag. Soon, the gel was seeping through the fabric, forming a noticeable sweet spot, if you will, on the outside of my pants. I envisioned another diabetic walking by. “You’re a pumper!?!” Then, seeing the ugly spot, “and you carry gel, too.”

NancyTW (The Wife, not to be confused with The Sister, NancyTS,) has taught me that to avoid being disappointed, I should keep my expectations low. Thus, while such an event would once have gotten the better of me, I am now totally down with my pocket goop experience, and also with using my one remaining goop-free hand to steer all the way to Wal-Mart, where, incidentally, glucose gels are less than ten bucks a pack.