Too busy to get sick..

There are two milestones in the medical career that a doctor must gain. One is mandatory for licensing and practice — internship. The other is Residency — a self inflicted wound. It is the rite of passage one must go through to become a specialist in a clinical discipline. For a resident in Obstetrics and Gynecology, your heart rate is almost always elevated because it’s an area of pure volatility and action. Especially in the labour ward. Things happen at light speed and if you are slow, you won’t know what hit you. You only need to turn away or drop your pen and babies will start to misbehave. Some will want to come out facing the wrong way, others want to walk out and so their feet pop out first; others, because of their curiosity to see the world stretch their necks so far back and get their faces stuck while others just rebel and refuse to come out — necessitating a ceserean section. It is a paradigm of organized chaos with the power to consume you and spit you out whole. By the time your shift is done and you handover to your unsuspecting colleague, your brain has traded places with your feet and you need two days to recover and then you start all over again.

After a while, this becomes your life so much so that if a grenade exploded right next to you, you wouldn’t flinch. In fact, you would jump over the debris as if it was an inconvenience on your path. Residency hardens you. Blunts your senses. So when Grace, a 33 year old resident started to eat a little more than usual or drink gallons of water every so often and have chronic fatigue, she assumed it was because of the insurmountable work she had to do. Unknown to her, she was slowly strolling to the edge of a cliff with symptoms that might have been noticed had she not been so busy dodging bullets and putting others first. Then one day she got to the edge and fell off. She only woke up when she hit the ground but it was too late. Or was it?

It all began with some twisted form of morning sickness — only she was not pregnant. After taking breakfast, she couldn’t keep anything down. One doctor told her it was gastritis but despite treatment it never went away. She instead adapted by carrying around extra food to compensate for the hunger. Then came the hot flushes. She would break into a sweating fit like a switch. At night, it got so bad she would hold audience with the fridge to cool down and because you can’t just stare at food and not eat it, she ate. Two birds with one stone. At restaurants she was very keen to know how long it would take for her meal to be prepped. If it was anything beyond thirty minutes, she asked for a snack. She was just always hungry. And tired. She lived on the first floor of an apartment building but walking that one flight of stairs would render her breathless. She would sleep tired and wake up tired. All her time was spent either working, eating, sleeping or peeing.

In the OR she started to get really bad muscle cramps causing her to freeze and drop instruments while operating. Still, when you are so busy you don’t notice when the devil gets on your back. You feel the weight but shrug it away. At the hospital she knew every nook and cranny where food could be found. She knew where the cleanest bathrooms were and where all the water points were. She was the quintessential girl who walked around with a huge bottle of water stuffed with chia seeds. Grace would eat until her colleagues were convinced she was pregnant or just downright greedy.
On and on it went. Her body tried to tell her it wasn’t ok but she couldn’t hear. It complained and complained until one day it threw a tantrum. The terrible two kind.

At the end of a labor ward shift during the handover, her mind suddenly emptied itself of its contents. Here she was in a room with her colleagues and the shift consultant and she just went — blank. She looked at a patient who she had just seen a few hours prior like she was a stranger. She was holding her case notes in her hand; notes she herself had written but she couldn’t piece her words together. Her vision was blurred and her speech was in staccato. Because this was unlike her, the consultant picked on it and knew something was wrong with her. But what? Even then, Grace didn’t seek help. It was only until a second night shift that week, when she couldn’t ignore her body anymore. That night she carried a full course meal for the 12 hour shift but had inhaled all of it within four hours of the shift and still felt hungry. She left work for a drive through joint to get more food. Amidst all that eating, she felt desert thirsty and drank almost four litres of water in one swoop. By the end of the shift, which was calmer than usual, she felt like she had been ploughing a field. Even after she left for home and slept for more than twelve hours, she was still exhausted.

When she woke up, became still and looked around her house she noticed two things: she had hundreds of empty water bottles lying around and piles of dirty dishes in her sink. Suddenly, her thoughts came together and formed sentences. Sentences that spelled an obvious diagnosis that she didn’t want to articulate. So she walked across the road to a small clinic and asked for a blood sugar test. The reading didn’t take long. If it was possible for the glucometer to screech like a siren or flash neon lights it would have. The reading was not even a number; it was a word — Hi. (Not Hi the greeting, Hi as in High sugars).

“Your machine is broken,” she laughed nervously at the technician, “I will go check elsewhere.” She lied. Instead she ran home and drank two litres of water then went back — to prove the machine wrong. This time it read 28mmol/L. Which was still way too high. ‘This is a joke,’ Grace thought. There is no way I am diabetic!

After consulting with a physician, she drove to a nearby hospital while chugging down bottles of water. She was as hungry as a horse but she was too scared to eat afraid that if she ate, her sugars would sky rocket. But even at the hospital the reading was at 21. And to spice her shock with horror, her blood pressure was high as well. She cracked. No one gives you time to absorb such news when it lands. Immediately you move from being a person to ‘the newly diagnosed type 2 diabetic or the hypertensive girl’. You are referred to as a disease entity and no longer by your name. This was no curtain raiser. It was the real show. As they were managing her sugars; trying to bring them down, a nutritionist was called to see her.

“What is in your fridge? Make a list please.” Grace wrote slowly, trying to hide her list from herself. Soda, juice, rice and all manner of things. “Throw it out.” The nutritionist said matter of factly. “You need to enroll in a gym and start to exercise thrice a week for thirty minutes.” On and on she spoke. She knew all these things. Heck she taught them to her patients but when the fog is heavy you never see beyond your own headlights. Now that it was beginning to clear she could see her life for what it had been. Preaching water and drinking juice. Literally. Despite having a strong family history of diabetes and hypertension and knowing the implications of the same, she had not taken precaution to prevent the same for herself.

When she was started on meds, things started to get better. The muscle cramps, headaches, excess fatigue and blurring of vision went away. Even the early morning nausea and vomiting disappeared. Who knew that had been a symptom of this disease. She has sometimes had episodes where she didn’t follow the instructions of her Physician and ended up in hypoglycemia — a state of severely low sugars.

“I figured diabetes is mostly about carbs so I ditched them altogether. I started to become disoriented and once went blank during a patient consultation. It’s like my thoughts ran away from me. I came to realise these episodes occurred when my blood sugar was low.”

Her journey as a young girl with chronic illness has not been easy. She is only too conversant with the complications of both illnesses and it scares her sometimes. There are days she is afraid to sleep thinking that her sugars might dip in her sleep and she will not wake up. She is a hard worker who loves her patients and her job but it doesn’t help to be too busy to take care of yourself and your health. She is now all about self care and putting her needs and her health first. She has had to learn to listen to the experts on the management of her disease and put aside her doctor hat and follow instructions. And there is nothing as hard to conquer as the desire of the body for food. ‘You are what you eat’ has never been so real to her as it has been in this journey. That the body was not made for food but food was made for the body.

With the coming of the pandemic her fear grew. Especially when the narrative has been focused on people with pre-existing conditions. Let alone that she was on the frontline. “When our colleague who was roughly in the same age bracket suddenly passed on from covid, I froze and felt a whip of panic and knew it was time to take a break. That could have easily been me. So she took leave. I thank God for the amazing support I have received from my lecturers in the department of obsgyn — allowing me to take breaks to have a snack or some tea even during exams, for my colleagues, family and friends.” She has never shied from letting people know about her condition for that is the only way she gets the help she needs.

“If you are like me with a strong family history of chronic illness, don’t wait for it to catch up with you. Do something about it now. Eat healthy, exercise and go for regular check ups. Don’t be too busy to get sick.”

As narrated to me by Dr Grace Nyawira Kanyi — now a consultant Obstetrician Gynecologist. She survived residency.

A special mention to the amazing nurses who have always ensured Grace takes a snack break to keep her sugars up. (Elizabeth, Betty, Monica, Irangi Emmis and Dr Ogeto)

Type 2 diabetes is a disorder that disrupts the way your body uses sugar.

All the cells in your body need sugar to work normally. Sugar gets into the cells with the help of a hormone called insulin. If there is not enough insulin, or if the body stops responding to insulin, sugar builds up in the blood. That is what happens to people with diabetes.

There are 2 different types of diabetes. In type 1, the problem is that the body makes little or no insulin. In type 2, the problem is that:

●The body’s cells do not respond to insulin

●The body does not make enough insulin

●Or both

Symptoms of type 2 diabetes include:

●Needing to urinate often

●Intense thirst and hunger

●Blurry vision

Even though type 2 diabetes might not make you feel sick, it can cause serious problems over time, if it is not treated. The disorder can lead to:

●Heart attacks

●Strokes

●Kidney disease

●Vision problems

●Pain or loss of feeling in the hands and feet

●The need to have fingers, toes, or other body parts removed (amputated)

To find out if you have type 2 diabetes, a blood test is done to measure the amount of sugar in your blood.

Treatment: There are a few medicines that help control blood sugar. Some people need to take pills that help the body make more insulin or that help insulin do its job. Others need insulin shots.

Medicines are not the only tool to manage diabetes. Being active, losing weight, eating right, and not smoking can all help people with diabetes stay as healthy as possible.

Can type 2 diabetes be prevented? — Yes, it can. To reduce your chances of getting type 2 diabetes, the most important thing you can do is control your weight. If you already have the disorder, losing weight can improve your health and blood sugar control. Being active can also help prevent or control the disorder.