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Guest Blog: Self-Diagnosis.

Adam Kaye

I'm traveling to the Canyon Ranch Institute (and spa!!) this morning to give a lecture with Dr. Val of Better Health, so I've asked Adam Kaye to guest post today.  Adam and I have been corresponding by email for a while now, and I had the opportunity to meet him last week.  He's a type 1 diabetic and in medical school - so he understands what "in the trenches" means on plenty of levels.  

Take it away, Adam!

*  *  *

First year of medical school, we learn mostly basic science: anatomy, physiology—we learn how things are supposed to work. Second year is when things start getting interesting.  We learn mostly pathology—why things don’t work. We’re finally faced with the reality that sometimes, those little twinges of pain, that mild nausea, can, in fact, be real disease. During my second year, I was convinced, at different points, that I had a brain tumor, two blood clots in my lung, and six episodes of appendicitis. You pretty much have to force your mind to write it off as what I like to call “Second Year-itis.”   

So, cue up December 1, 2005. It is my second year of medical school. I’ve just come back from Thanksgiving break. My parents had complimented me on losing weight, and made mention of the fact that I almost single-handedly took down one of their Poland Spring tanks. I’m sitting in a lecture entitled “The Presenting Signs of Diabetes.” As I’m sitting there listening to the professor’s description of polydipsia (increased thirst), polyuria (increased urination), weight loss, and fatigue, my mind begins to go into its usual “Second Year-itis” routine … only I can’t shake the feeling that this is real.

If you’re reading this blog, chances are you can fill in the rest of the story. My first diagnosis in medical school was in fact myself.

Now fast-forward to third year of medical school. Third year is easily the toughest year for medical students, both intellectually and physically.  You leave the cozy confines of the lecture hall for the sterile floors of the hospital to practice your newly-learned skills as a diagnostician. The work can be, at times, very rigorous physically, as well as intellectually. I am lucky enough to be at a school where our “overnight call” (read: staying up all night) is kept to a minimum, but the demands of many of my rotations meant very long, odd hours. On my surgery rotation, for example, I would be at the hospital around 5:30 am to round on patients. Surgeries would begin at 7:00 am, sometimes lasting well past lunch. Surgeries could be scheduled in the afternoon, too, meaning we would have to wait until the late evening to round on patients again. With so much to do, and so many hours at the hospital…well, not much time built in for diabetes management. As opposed to the regimented, strictly scheduled second-year routine I had spent 6 months getting accustomed to (my only 6 months as a diabetic, mind you), I was now flung into the chaotic, regiment-less world of a hospital.   

Our fellow Type 1’s can relate to the fact that the world doesn’t wait for us. The rest of the world doesn’t want to wait 15 minutes to eat—they want to eat quickly and get right into the next patient’s room to keep the patient queue in check. The rest of the world doesn’t want us to scrub out from a surgery to check our sugar, they want me to keep holding traction so they can see the whole operating field. The patient will be alarmed, even in a noisy hospital setting, by the BEEEEEEEEEEEEP of my Dexcom, and will be even more confused when I have to excuse myself in the middle of a physical exam to check my sugar.
   
Reading other Type 1’s experiences on sites like Six Until Me, I know I’m not alone. I know we all deal with the frustrations of a world not waiting for us, of a world that just doesn’t get it — a world full of “real people.”  As a medical student, however, I’ve been given a crash course in how to deal with them.

I can only hope my experience has helped me become a better doctor — to understand my patients’ diseases and how frustrating it can be to deal with “real people” on a constant basis.  As doctors, we ARE the “real people”—we don’t know, for the most part, exactly what our patients are going through—but I at least have a head start in my training towards understanding the patients’ side of things.

Editor's note:  Thanks, Adam!  And more guest posts coming in the next few weeks!

Comments

Great guest post Kerri.
Thanks Adam for your candidness and honesty. May you continue to help patients through your own experience.

Great post Adam! You're going to be a GREAT doctor!

Nice Job Adam! Hey, doesn't This looks like an awesome place to begin your academic program! The True Blue Campus at St. Georges University.

As the mom of a 12yo w/ D, I can't tell you how much I appreciate stories like this and this blog in general. While I myself cannot appreciate what you all go through day by day, I hope that what I learn is helping me do a better job preparing my son for the day he is managing himself. Good luck to you Adam, and thank you so much for sharing your story.

awesome post, and adam is going to be a great doctor!

Hi Adam,
I teach in the problem-based learning curriculum at George Washington University Medical Center. My students are doing a case on type 1 so I have talked with them a lot about how I live on my pump, etc. Good luck with your 3 & 4th years and your internship & residency. You have a bright future ahead of you. And, if I might add, a beautiful smile.

Hey Adam! I'm work in the NICU and I'm a nurse practitioner and Type 1 diabetic. And your post rings so true with me. In fact, I was just commenting last night to my coworkers how my lows tend to come at the WORST times! For example, last night we were getting an admission (a premature baby) and I was hoping to squeeze in a test and a snack before the admission because I knew I was low. Well, the kid popped out a bit sooner than expected and before I knew it I was shoving half a candy bar in my mouth and hit the ground running. Not optimal but sometimes necessary.

Anyway, I'm right there with ya' buddy, just so you know there's someone out there who feels your pain! Good luck with residency! Have you picked a specialty yet?

~Layne

Great guest host!! My endocrinologist is Type1 and he is the BEST! He walks the walk and talks the talk! Adam you will be a fantastic MD you have to keep us updated on your education.

Dr. Kaye :)

Great post and so great to see a future MD, get it!!!

One of my endo's was a Type 1 diabetic and he had no compassion for a fellow diabetic. He was a miserable endo/diabetic.

Sorry for your diagnosis and hope there is a cure in your life time.

Karen, Type 1 for 42 years

Funny and poignant! While it stinks that you developed diabetes, it is great that you will have this perspective as you move forward with your career in medicine. You will quickly gain a lot of practical knowledge about medicine that will make you a far better physician.

Thanks for guest posting, Adam! I'm a fellow T1 (also dx'd in 2005) just finishing up my first year of med school.

It seems like diabetes is mentioned almost everyday at my school. It's sort of a running joke among my classmates and I.

People always ask me if I'm going into endocrine. Bet you get that too ;)

I am in the middle of nursing school now, it's tough, but no where near as tough as Medical School I'm sure. I am still trying to find the balance of nursing school and diabetes. I honestly am a bit worried about when I don't have the hand holding of clinicals and I'm out on my own working, having to make sure I'm taking well enough care of myself that I can also care for my patients to the best of my abilities.
Thanks for the post Adam; it helped me see that if you can go through a diabetes diagnosis in the middle of medical school, and still come out relatively unharmed, that I should be able to survive the crazy world of nursing while living with diabetes.
-Tricia, 22, dxd 9/1994

Hey Adam,

Great guest post! I'm just rounding out first year of med school now, and I've been Type 1 since 2000. I can ABSOLUTELY relate to the medstudentitis... it can definitely make you a hypochondriac! It seems like everything I hear about has diabetes as a risk factor. That has been the hardest part of adjusting to this crazy lifestyle; hearing day in and day out about the problems I might experience down the road can really take a toll on my psyche. Its hard sometimes to find the strength to help others when you feel like your own life is out of control, but I work on finding that strength everyday because I know it will make me a better physician. Hopefully I'll see you in practice one day :)

Good Luck,
Roman

Thanks for the comments, guys! Great to hear from fellow diabetics in the health professions.

For those that asked, I matched in radiology last month, so I'll be going to Greenwich Hospital for a year of medicine internship next year, then to University of Pennsylvania for a 4 year radiology residency. And yes, @jill, I get the question about endocrinology ALL the time. The reasons I'm not doing it are a whole different blog post.

Adam,
You have eloquently expressed your journey thus far as a type 1 and its impact on your career training. We know that you will continue to demonstrate caring and empathy for your patients.

nice guest post adam

It's pretty clear that, should being a doctor not work out, (although that would be a real strange turn of events) you could fall back on writing. :)

Thanks for sharing.

T1 diabetic for 20 years (since my 1st year in med school), and practicing radiologist now for almost a decade :)

Around the time of the diagnosis 20 years ago I was not feeling all that well for a few months and had recurrent viral infections.

I had some blood tests and my mother called me on the phone rather distresssed telling me about my high blood sugar, which was possibly an error, to be confirmed.

In an unexpected twist, I suddenly recalled my med school teachings that diabetes meant plenty of urine due to the sugar which draws water into the urine. I promptly confirmed my own diabetes diagnosis 10 minutes later when I saw that my urine tasted like sweetened tea :)

In retrospect I exhibited all the signs of diabetes at that time (polydypsia, polyphagia, polyuria). The onset was slow however and I just adapted to it. I remember how I would bring a bottle of soda on the nightstand just before going to bed...

It's difficult to recall how I managed to pass all these years with multiple injections and 6-8 BG checks per day. The Lantus / Humalog combination has been a blessing lifestyle-wise in the last 4 years. I remember my failed attempt at using the G2 glucowatch as well as a small investment in their failed company stock, (both were money down the drain btw).

Today is my first day on the Dexcom :) This time I was more cautious before jumping in :)

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