The Vindication In The Low

(An updated version of a blog post from December 2011.)

Vindication, when it comes to us, brings with it a sense of self-righteousness, which then manifests itself in a satisfyingly smug “I told you so” smirk. When vindication does not favor you, but results in someone else directing that satisfyingly smug smirk at you, it seems as if said smug is in the worst possible taste.

Case in point:

My mom is a diabetic, has been since the 1980s. It’s only been in the last decade that she’s been on insulin rather than pills. The insulin gave her much better control over her blood sugar levels. She was very serious, very diligent about testing her blood and taking her insulin until she had her aortic-valve replacement surgery two years ago. Since then, she’s been fairly lax: testing her blood only once a day, only taking the insulin once a day that she’s supposed to take with every meal. We’ve gone round and round about it, and things finally came to a head last week.

She called me at 3:46 a.m.

I had not yet gone to bed. I gave up sleep one year for Lent and have yet to return to the regularity of a 7–8 hour-a-night rest. The phone ringing was not as startling as it is when one is asleep. Though, it should be said that anytime an 88-year-old parent calls in the middle of the night, it’s upsetting: there’s usually something wrong. On this particular night, the news is that her blood-sugar level is low, and she needs juice.

If you’re unfamiliar with diabetes, the only thing you need to know at this point is that a low blood-sugar level is not good, and, if not rectified quickly, can result in serious consequences and could even lead to death. I’m happy that my mom is aware of her lows; there are many diabetics who have no idea when their blood-sugar level is low, and this can make things much more complicated.

I made my way into the kitchen, poured her half a cup of juice, added half a packet of Equal sweetener to it (since fruit juice is never sweet enough for her), and brought the doctored-up juice to her room.

She was half-sitting up. Not only did she look like someone who was abruptly awoken from a sound sleep, but she also had The Look. The Look is rather tough to describe in a few words. The Look is what she gets when her blood sugar goes below a certain level; it is a look of Differentness: her skin, while not pale, is not quite as colorful as usual; her eyes seem slightly unable to focus, so she squints ever so slightly; her speech, while not slurred or jumbled, is just different — to someone who wasn’t familiar with her speech, they’d probably not notice, but to me, who is so familiar with her voice, there is this slightly strange difference to its tone and cadence. The Look seems almost as if she’s faded slightly. When I see her with The Look, I know that her blood sugar is going to be really low.

As she was drinking the juice, I got out her blood-testing kit, placed a strip into the machine, gave her a damp washcloth to wipe away any possible sugars on her finger (since these could add sugar to her blood and give a false reading), and handed her the needle to stick her finger. She placed it against her left ring finger and pressed the release. The needle shot out, pricking a small hole in her finger, and a second later, a rich red blood droplet appeared. I put the test strip up to the drop, the meter beeped, and within a few seconds we had the result: 45. A good blood-sugar level is 70–100, while less than 70 is considered low (the lower the number, the more serious the low).

I hate when the number is in the 40s, as that’s when bad things have happened. She gets quite belligerent when her blood glucose is that low, resisting and arguing every step of the way (for many diabetics, this is a common side effect of low sugar). When she gets belligerent, she likes to insult me and call me names — during these episodes, she’s called me queer, homely, stupid, fat, whore, and, more than once, a fag.

One example: she was refusing to drink juice. An argument ensued, with her telling me, “I’m 85 years old, dammit, and I don’t need my fag son telling me what to do. I got to be this age without any help from you!” I, in turn, told her that if she didn’t take the juice, I was going to call the ambulance, and that all the neighbors would see her being carried out on a stretcher. Even though Mom loves to be the center of attention, the thought of being carried out of the house, on a stretcher, in her nightclothes, proved too much. She drank the juice. After, she had no recollection of the argument. (This also seems common: many diabetics don’t remember what happened during lows. According to her doctor, I’m not supposed to take these words seriously, though I can’t help but wonder if she’s giving voice to thoughts she keeps buried, or if they truly are meaningless thoughts brought on by her condition.)

Another time, when her blood sugar dropped to 40, she couldn’t keep the juice down, and she had moved her emergency glucose needle (a syringe full of glucose, to be injected in just such an instance), so it wasn’t in its usual spot. The ambulance had to come. 

Still another time: a low caused by her accidentally taking 20 units of fast-acting insulin instead of 20 units of slow-acting nighttime insulin. We were up most of the night feeding her toast, juice, and several other things, and testing her blood every 15 minutes, until… I’m not sure what the “until” was. I just know that it was daylight by the time she was stable and we could sleep.

While we were waiting for the juice to do its work we started talking. I wish I could tell you that she got belligerent and said something that made me yell, but she wasn’t belligerent.

I wish I could tell you what she said that made me yell. I don’t know.

I wish I could tell you what I yelled at her about. I don’t know.

I remember phrases:

Her: “You don’t understand…”

Me: “Oh, I understand. I understand that you aren’t controlling your diabetes as well as you were before your heart surgery.”

Her: “You don’t understand…”

Me: “I don’t want to hear it. You’re not taking care of yourself like you should.”

Her: “You don’t understand…”

Me: “What I understand is that you’re not taking care of your sugars, and if that’s what you want — if you want to just let this kill you, fine. I just need to stop giving a damn. You do what you want.”

(Again, I’m reminded of how much the roles have changed. Exchange the “Her” and the “Me” above, and it’s a mother yelling at her foolish son for not taking care of himself. It’s my mother yelling at me. She always told me “I just won’t care anymore. You do what you want.)

I ended with, “You just wait! You just wait until we go to the diabetes doctor next week. Just you wait and see how your numbers will have changed!”

Then it was time to test her blood again: 58. Another doctored-up juice, two mini candy bars, and another test, and she was good to go back to sleep.

I was too shaken, too restless to try and sleep. It would be around 6 a.m. before I went to bed, just as Julian was getting up for work.

Later, I was trying to explain to Julian why I was mad. I needed to understand why. My anger came out, and, as most anger does, it was directed at the most obvious infraction, because that’s always the easiest direction for the attack. To admit that the anger is about something more, something deeper, is not always easy to express, nor is it always easy to discover what the anger is about, especially when you’re in the grip of rage. Yes, I was angry that she hadn’t been managing her diabetes as well as she had over the last decade. But I realized it wasn’t anger that gripped me — it was fear.

Whenever she tells me she’s in a low, the memories of past episodes come rushing back. I’m scared the next one could be worse — that it could kill her if I can’t get her glucose up in time. My mind and adrenaline go into overdrive. Once she’s out of immediate danger, the adrenaline drops, but the current is still running through my veins and has to go somewhere. Usually I vent at Julian, or write snarky notes and tear them up once I’m calm. The other day, it got away from me. I yelled. Afterward, I found myself almost eager for the endocrinologist visit — to see how her neglect was showing up in her A1C. I’m embarrassed to admit I wanted it elevated, just so the doctor would lecture her. Vindication would be mine. “Just wait until…!”

Again with the parent/child reversals. Is this any different than the ubiquitous “Just wait until your father gets home”?

One could, I suppose, with not too much thought, come up with some sort of schmaltzy essay about how a caring doctor is like a caring father, how they both have your best interests at heart, blah blah blah.

In reality, they’re much different, at least for this analogy. Whereas when your mother issues the ultimatum about your father’s return, she has a chance to waylay him, relate the story, and agree together that they’ll unite — vindicating Mom in whatever she said. She gets to wear that smug smirk: “See! Your father agrees with me!” In the case of the doctor, while he (hopefully) has your best interest at heart, he has no stake in vindication. He doesn’t care about the balance of power, about who has the highest spot in your home’s hierarchy.

Oh no.

Traitorous doctor has to go and tell Mom, “You’re all fine and dandy. Your A1C is up a bit, but it’s still within the range it needs to be.”

Well, let me tell you, the satisfyingly smug smirk Mom gave me was much more satisfyingly smug than it needed to be, well into the realm of poor taste. And, to add to it all, what does she say when she saw me take a breath in and open my mouth to speak? “You just keep quiet. You don’t need to get me into trouble.”

Damn she’s good — effectively cutting me off like that, making anything I say sound like I’m a mean-spirited snitch.

Instead, I just asked him this: “This is our one area of real contention, the way she manages her diabetes. She does it differently than I think it should be done. So, you say she’s okay. Does this mean I need to stop worrying so much? She’s doing things okay?”

He smiled. “Yes, she’s doing well. With the A1C, if it’s over 8, that’s when things start going wrong, when there’s damage to your body. If it stays under 8, it’s a good thing. We like it under 7, but as long as it’s under 8, she’s going to be fine. (She was at 7.1.) Your mom’s been bouncing between 6.7–7.0 over the past 5–6 years, so can I really say that 7.1 is worse than 6.9? It’s more about patterns, about long-term control, rather than just one three-month period.” This was actually reassuring.

Mom spoke up: “He gets so mad at me when I have a low.”

“It’s because he cares,” said the doctor, sounding less traitorous. “Would you rather have a son who cared too much, or one who didn’t care at all?” And with that sage utterance, he left the office.

And, while it wasn’t as satisfyingly smug as I had been hoping, I was, in my mind, still able to give a small smirk after all.