The Insulin Express

by Oren Liebermann

  But regardless of the minuscule percentage of people diagnosed later in life with type 1 diabetes, 100 percent of me is diagnosed, and, at this moment, that’s all I care about.

  “Doctor, I will book tickets to go home as soon as possible to get more medical help. Am I okay to fly home?”

  “Yes, you will be fine. Just make sure to drink lots of water. Go to a doctor as soon as you get home.”

  The appointment ends a few minutes later. He asks me to come back the following morning before breakfast to test my blood sugar two more times. He wants to do a fasting blood sugar test, which he explains is a test on an empty stomach that measures my baseline blood sugar after not eating. It is one of the first tests used to determine if someone has diabetes or prediabetes. Then he wants me to eat breakfast and return exactly two hours later for a postprandial blood sugar test that will show how my body handles sugars and how much insulin my pancreas is producing.

  I thank him for his help and promise to return early in the morning.

  I don’t remember anything from the walk to the taxi stand or the cab ride home. I know I have to get in touch with Cassie at the monastery and tell her to come home now. We only have one more day of teaching left, but neither of us will be able to attend those classes. We won’t be able to say goodbye to the kids we have worked with for three weeks, and I know that will upset Cassie. These are more than her students; they are her classroom children, and she cares for each and every one of them.

  On the way home, I run over a mental checklist of things I need to do. I have to talk to my parents. I have to talk to Mark, a missionary doctor in Kathmandu whom Cassie’s family church supports. I have to talk to my host family. And I have to talk to Drew, my friend who has had diabetes since he was ten years old. He is perpetually optimistic, and I need an injection of his positive attitude almost as much as I need an injection of insulin.

  I make my way up to the front door of our home and knock. Bimala answers.

  “Please have Krishna call the monastery to tell Cassie to come home immediately,” I say to Bimala. Or at least that’s what I plan on saying, but the words don’t come out. I had rehearsed the sentence a dozen times in the cab, compartmentalized the thirteen words in my mind so that they’re parked at the proverbial tip of my tongue, but I am suddenly and completely incapable of coherent speech.

  The second I see Bimala, I break down in tears. Heaving sobs wrack my entire body. My arms hang limply by my sides, and my chin falls down to my chest. I have lost forty-five pounds—I am lighter than I’ve been since high school—yet my legs feel like they’re supporting a metric ton. The diagnosis that seemed surreal at the doctor’s office becomes very real in an instant.

  Each time I try to form a sentence—to tell Bimala to call Krishna, to take the first steps toward the Western hemisphere—my tongue fails me. I want desperately to be home, to be away from this moment and this disease; I want Cassie right next to me, but I can’t formulate any of that into words.

  Bimala comes over to me immediately and hugs me. She stops being a mother and becomes my mother. I am nearly ten thousand miles away from my family, and she knows intuitively that I need support. In her arms, I don’t try to hold back the tears. There’s no point. They completely overpower me.

  More than a few minutes pass before I finally vocalize the sentence I’ve been trying to say since I walked in the door. She calls Krishna immediately, and Cassie is on her way home a few minutes later.

  Up in our room, I try to gather my thoughts, but the whole world seems too out of focus. There is no calm. There is no order. Everywhere I look and everything I feel is chaos. I know I have to call my folks, but I want Cassie with me first. I know I should book tickets home, but I need Cassie’s help. My hands are shaking too much to be of any use.

  Everything makes sense and nothing makes sense. I begin to understand why I’ve been tired for two months, why I almost collapsed near Annapurna Base Camp, why I’ve been so thirsty, why I lost my appetite. All sorts of “what happened” questions suddenly have an answer. Yet I can’t understand much simpler questions, the ones without qualifiers or specifics. Why? And how?

  Stripped of all the other details and circumstances, these are the questions I need answered. And yet I feel that these answers are farther away than my home. The latter is a few plane rides away. The former has no such roadmap, no easy-to-follow directions to comprehension.

  Sitting on Cassie’s bed, staring at my computer screen and wondering what to do next, I am able to control my breathing, but only for a moment. As soon as Cassie walks in the door, I break down again and hug her. For the last few weeks, I have been physically weak. Now I am emotionally drained too. Nothing in my thirty-one years has prepared me for this, and it shatters my suddenly tenuous grip on this world.

  When I am calm enough to speak in full sentences, I call home, where it is 2:30 in the morning. Last week, Krishna installed a small solar panel for his Wi-Fi router so he could have Internet all day. That small investment allows me to call home immediately instead of waiting for power to kick on at night. My mom answers the third time I call, unaccustomed to her phone ringing at this hour.

  “Hallo?” She is groggy, wondering who is calling at this hour, not realizing yet that it’s me.

  “I’m so sorry, Ima. I went to the doctor again today because I was feeling worse. I found out I am diabetic.” I pause so she can process what I just said. “You were right. I was wrong. I’m coming home.”

  I describe the morning’s visit to the doctor in as much detail as I can remember while sitting in the stairwell near the router to make sure the connection doesn’t drop. Cassie is already preparing our bags in our room.

  “Oren, I’m glad you listened to your body and went back to the doctor.”

  “Is Aba there?”

  “Aba is in Houston. You can call him now.”

  “Ima. I love you. I’ll see you soon.”

  I call my dad a moment later. He answers on the first ring, still awake after a late business flight.

  “Hi Aba. You can yell at me as much as you want now. You were right. I have a disease. I went back to the doctor today and found out I have diabetes.” The words still seem strange coming from my mouth. I have diabetes.

  But my dad doesn’t yell. His words are calm and measured. “I’m happy that you went to the doctor. When will you be home?”

  “We’re gonna look at flights in a minute. We’ll email you when we have flights booked.”

  Cassie and I sit down to look at flights. First, we need an early afternoon flight to Kathmandu, which Krishna books for us. Then, we need a flight home. Apparently, a Kathmandu–New York flight isn’t exactly in high demand, so we’ll have to connect somewhere. After a few minutes of searching, we book Qatar Airways Flight 651 from Kathmandu to Doha. The flight leaves tomorrow night and arrives in Qatar at midnight. After an eight-hour layover, we will fly from Doha to New York. If the flight schedule can be trusted, I will be on American soil at 2:05 p.m. and home from the airport ninety minutes later.

  Normally, as someone with an Israeli name and Israeli visa stamps in my passport, connecting in the middle of an Arab country wouldn’t be high on my to-do list, but geopolitical rivalries are of no consequence to me at the moment. I want to go home.

  I need to go home.

  We email the flight info to my family, and then I sit down to compose another email to my siblings.

  Thu, Feb 13, 2014 at 2:48 a.m.

  Oren Liebermann

  To: Erez Liebermann, Tamar Brooks, Hadas Liebermann

  Subject: I have never been more wrong

  On Monday and Tuesday, the doctor said the only problem was lack of nutrients. I wasn’t feeling any better, so I went back to the doctor today and he double-checked my blood sugar (which had been fine on Tuesday).

  Today, my blood sugar came back 406 mg. A normal person’s blood sugar is 150 mg. (Normal blood glucose ranges from 70 to 140 mg, but I didn’t know it at the
time.) In short, it looks like I am diabetic. The doctor will test my blood sugar twice tomorrow, which will likely confirm the diagnosis.

  Then we’re on our way home for as long as it takes for me to put on weight and get the meds I need.

  I apologize to all of you for the massive attitude I gave you. I will apologize in person when I see you again. But we’re Liebermanns—arguments are what we do.

  We will see you all soon. It looks like we will get back Saturday afternoon. Erez—we’ll probably stop by your house on the way home, and then you can drink Blue Label for me.

  All the love in the world,

  Oren and Cassie

  I compose one more quick email to Drew. I already need his help and his optimism, even if he is halfway around the world. Though I am still unable to comprehend the last few hours, let alone the rest of my life, I know how helpful he would be, both in terms of his advice and his attitude.

  Thu, Feb 13, 2014 at 2:50 a.m.

  Oren Liebermann

  To: Drew Greenspan

  Subject: I’m gonna need your help these next few weeks

  I was feeling awful for a few weeks here in Nepal. I finally went to the doctor and he checked my blood sugar. The test came back 406 mg. Looks like I’m diabetic, which we will confirm tomorrow. I’ll let you know.

  I’ll be home in a couple of days—the right move seems to be coming home to recover, put on some weight, and learn how to use an insulin pump and do the shots and all that. We’ll do dinner one night.

  We start making preparations for the journey home. We pack up our clothing and get our bags ready to travel. We clean out our room, strip our beds, and throw out any leftover food we haven’t eaten. I am able to put aside my perpetual exhaustion, knowing that I have precious few hours to get ready for an incredibly long and challenging journey back home and back to good health.

  Throughout the afternoon and the evening, the tears keep coming. In powerful tides, the waves of heaving and sobbing ebb and flow. One moment I am fine, rolling up my spare pants to pack in the bottom of my backpack. Then I am gasping for air, searching for Cassie, for home, for help, for something stable upon which to right my violently yawing world.

  Tamar is the first to respond. She’s in Kenya, so while it’s the middle of the night for most of my family, it’s the middle of the day for her.

  Thu, Feb 13, 2014 at 3:46 a.m.

  Tamar Brooks

  To: Oren Liebermann

  Subject: RE: I have never been more wrong

  Oren—

  Mom just called me. I am heading home immediately to try to reach you. I wish you were right!!! I wish it was just food. But as I said, that is a massive weight loss in too short a period.

  I am not a doctor nor ever claim to be, but I am not sure you can wait. Your body is probably producing ketones, and that is the problem. You need a hospital now and they need to flush you with IVs and meds. It is poison to your system. This is why you are so thirsty. Ketones smell and Cassie should be able to smell that you have a different odor. You cannot survive a flight like this. I am not kidding. I spent days in the hospital with Pam when she had this. She was diabetic.

  Delhi and Singapore have good hospitals. We have money. Get to one of those now and get care.

  Sincerely,

  Tamar Brooks

  I have no idea what she’s referring to—ketones? poison? smell?—and I decide to ignore her advice, since I have the medical backing and sound advice of Dr. Griffiths, who cleared me to fly home. I kindly inform her that I’m not going to Delhi or Singapore for the simple reason that I’m coming home.

  Drew responds a short time later. He is up early with his newborn, and I knew he would get back to me as soon as he checked his email.

  Thu, Feb 13, 2014 at 5:03 a.m.

  Drew Greenspan

  To: Oren

  Subject: RE: I’m gonna need your help these next few weeks

  Oh man… that sucks but out of all the things to happen and go wrong this is by far the most manageable. we can handle this no problem.

  First thing were gonna do is get together and figure out our plan. I would say nutritionist first to get a good baseline for diet. There where I’m falling apart lately ;) and honestly diet and exercise (and a little insulin of course) are by far most important.

  How do you feel right now BTW? Are you on insulin now? Is there a chance that its a shrot term abbe ration? Its pretty late in the fame foe type 1 diabetes. Though if it is you need to talk to Sean B. He ended up with type 1 diabetes a few years bakc and he can prob offer SME gpod insights as to how he changed things life wise at this point.

  you don’t think tpy caught it from me during one of our long man hugs do you??

  Where are you flying back to? And when?

  Grammatical and typographical errors aside, Drew’s email makes me smile for the first time all day. I never really expected that I would have to go through this alone, but Drew’s help and positive outlook are already reassuring. I’m not even back in the States yet, and he is already my mentor.

  We plan to be at the doctor’s office early so we can confirm my diagnosis, run by the monastery to drop off some school supplies, take a quick shower, and catch our first of three flights home.

  Logistically, it’s a pain in the ass to get home from Pokhara. There are only three flights a day from Pokhara to Kathmandu. They’re short flights—twenty-five minutes—but they all leave between one and five in the afternoon. If we can’t find a late flight out of Kathmandu, we have to plan on spending the night in the Nepali capital, meaning we have to add twenty-four hours of travel to our itinerary. There are a few options home once we get to Kathmandu. We can go east through Hong Kong or west through the Middle East—Abu Dhabi, Dubai, or Doha. Each of these flight schedules has an eight- to ten-hour layover, so getting home will require a bare minimum of thirty hours of travel, starting with our first flight to Kathmandu.

  It will be a busy day, but in the back of my mind, I know it’s one step closer to getting treatment and going home. That bit of good news isn’t bright enough to qualify as the light at the end of the tunnel, but it’s all I’ve got at the moment.

  When I had climbed out of bed this morning, everything seemed to make sense. Life fell into a neat, orderly routine of waking up, exploring, traveling, and going to sleep—or at least as neat and orderly as the travel lifestyle ever gets. I knew and understood the past, enjoyed the present, and had a good idea of what would happen in the future. Now I can claim no such confidence in any of those three verb tenses. I don’t understand what happened in the past to put me at this point in the present, and I have no idea what the future has in store. All I know is that I am very far away from home, and I am absolutely terrified.

  Chapter 12

  Valentine’s Day 2014

  28°14’10.9”N 83°59’50.6”E

  Pokhara, Nepal

  Cassie and I show up at Quality Healthcare at 7:30 a.m. sharp. This time, I am not alone, and there should be no surprises. Today’s blood sugar tests will confirm yesterday’s, and I will be officially diagnosed with type 1 diabetes. Then, as soon as I can get on a flight, I am on my way home. And that is the only silver lining I can see in all this. This nightmare diagnosis in a foreign country, this change to everything I know and everything I knew, will be over soon, and I will begin to adjust my life to a new set of rules.

  On our way over to the doctor’s office, I keep thinking about one story that seems oddly appropriate. This is the one part in the story where my experience as a pilot is relevant.

  On our first anniversary—the dating anniversary that only teens and newlyweds count, not the wedding anniversary—I rented a small four-seater plane and took Cassie to the Outer Banks of North Carolina. At the time, I was living in Norfolk, Virginia, so the flight to Ocracoke should’ve taken no more than ninety minutes. But an hour into the flight, as we passed Kitty Hawk, North Carolina, visibility suddenly dropped in what seemed like an opaque haze. I told Cassie we
would spend the day in Kitty Hawk, not Ocracoke, and I turned the plane around.

  I thought I was making a level turn, but as I looked down at my airspeed indicator, I realized I was at about 155 miles per hour—not an easy speed to obtain in an old-model Cessna 172. I must’ve been descending, but when I checked outside the plane and glanced at the horizon, it didn’t look like I was descending. Something was wrong, but I couldn’t quite figure out what it was. Regardless, we landed at Kitty Hawk and spent the day hanging out at the beach.

  In the early afternoon, the air filled with a thick, gray smoke. I’d covered enough fires as a journalist to know it wasn’t house-fire smoke—it was wildfire smoke, and it stank of the burning leaves and charred woods of a forest fire. As quickly as it came, it was gone, and the sky cleared. We enjoyed the rest of the afternoon on the beach, caught a movie when the sun got to be too much, then headed for the airport for the short flight home.

  I checked the weather, and everything looked great. The possibility of thunderstorms—always a constant threat in the summer months—had passed with the afternoon heat, and we fired up the engine, looking forward to a beautiful flight home.

  Only it turned out not to be so beautiful. Ten minutes into the flight, visibility again dropped to zero in thick haze. I was following Route 158, a road that goes straight from my origin to my destination, yet I found that I had to fly lower and lower to keep sight of the road. Before I knew it, I was down to 800 feet and still descending—dangerously low in a small airplane.

  I kept flying north, hoping to break out of the clouds into clear weather. But it wasn’t clouds. The more time we spent in the haze, the more I realized I was flying in smoke. The same smoke that had covered the beach a few hours earlier. And then it dawned on me. It was the same smoke that I’d flown into in the morning, only I hadn’t been in it long enough to realize it was smoke. The worst wildfires in the country burned seventy miles away in North Carolina, and the winds pushed the smoke over the Outer Banks. As the wind shifted, the smoke drifted north, from Ocracoke, to Kitty Hawk, and now to Chesapeake, Virginia, where we were at that moment. Because smoke isn’t a phenomenon of weather, it didn’t show up in any meteorological charts that I checked.