The Insulin Express

by Oren Liebermann

  “I just don’t know how much longer I can do this. I can’t be here with you and responding to all of their emails.”

  “I’ll write an email to my folks. Send it to them when you get Wi-Fi.”

  My words have no effect, and the frantic messages continue at the same unabated pace as before, leaving Cassie in a miserable situation.

  The doubts about the quality of medical care I’m receiving creep their way into my mind on the third day in the hospital. I should be leaving today. All of the doctors predicted I would be on my way home by now, but we keep hearing the same answer every time we ask about leaving.

  “We need to stabilize your blood sugar levels and flush the ketones. That will take another twenty-four to forty-eight hours. Then we will be ready to discharge you.” The doctors say it as if they’re reading off a cue card. It’s the same thing we’ve been hearing for three straight days. Meanwhile, every doctor back in the States has said I shouldn’t be in the hospital more than two or three days. It doesn’t take that long to regulate blood sugar and clear the system of ketones. On top of that, I still haven’t gotten the diabetic menu I’m supposed to be eating, so Cassie and I guess at what I should be eating and how much of it to eat. We are very much the blind leading the blind.

  My blood sugars are still in the mid to high 200s, and I feel helpless. Even Cassie, who has done her best to radiate eternal optimism, is wearing down. I want to go home, and yet that seems no more plausible now than it did when I arrived at the hospital. For the first and only time during our stay in Pokhara, the sky is covered in a thick layer of solid overcast. Normally this sort of weather clears very quickly here, but now it is here for days. The darkness seeps through the window and into the hospital and into my room, draining me of any positive energy. The frigid temperatures have worked their way into my very core. I shiver at night in my sleeping bag, waiting and hoping and praying for all of this to end.

  The third night in the hospital is the hardest and longest night of my life.

  When Cassie leaves for the evening to update friends and family, I am left alone with my thoughts and a TV that has a bewildering array of random channels, all of which are categorically unable to distract me from my present condition. There is no clock in the room, so I have no way of judging time. Seconds and minutes tick away in a relentless grind that I cannot measure.

  In a week of hardship, these are my worst moments.

  These are my darkest hours.

  I try to stay awake as long as I can, watching whatever sport I can find—I watch more cricket during my time in the hospital than I’ve ever watched before—hoping that when I open my eyes again, Cassie will be there. If I fall asleep too early, I’ll have to wake up and wait for her arrival in the morning, and I don’t know if I can handle that. I want to face the morning and a new day knowing she is by my side.

  The movie Contraband comes on a random channel around midnight, and I stay up watching the entire flick, happy to have something in English to watch that doesn’t require me to learn the rules of an entirely new and apparently nonsensical sport. It’s certainly not Mark Wahlberg’s greatest film, but it gives me something on which to focus my thoughts for its full 109 minutes, and for that, I am eternally grateful.

  “How’s it going, babe?” Cassie asks when she arrives on my fourth day at the hospital. “How was last night?”

  “It’s tough. I just want to go home. I feel like I’m going to be here forever.” I take a deep breath. “And I can’t get any goddamn answers around here,” I whisper. After carefully discussing and considering all of our options, the pros and cons, risks and rewards, and costs and benefits, we make a very serious decision.

  In short, fuck this place. We’re leaving tomorrow. Mark, the missionary doctor in Kathmandu we happen to know through Cassie’s church, recommends a Western clinic there, and he promises good care and warm beds, two things that seem to be in very short supply at this hospital that has become my prison these last few days.

  We expect a fight in the morning when we tell the doctors about our plans to leave. Instead, they tell me that I’m well enough to go and that I’m barely producing any ketones anymore. They tell me I’m healthy. My bullshit alarm goes off, but I keep quiet as we discuss my time in the hospital.

  “Have you been eating the food we recommend for diabetics?”

  “No. I never got the diabetic menu.”

  “Okay, we will make sure that you get that immediately.”

  “Doctor, don’t I need some way of testing my blood sugar on the way home?”

  “No, you do not need to test your blood sugar. You will be fine,” he says in a way that somehow introduces more doubt than comfort.

  An hour later, I still haven’t received any inkling of a hint about a diabetic menu. I go ballistic. I’m no longer hooked up to the IV—I get two bottles of fluids a day, but I’m not constantly connected like I was during my first two days here—so I storm down the hallway and toward the nurses’ desk wearing my black CBS fleece atop my gray T-shirt. That part of me looks somewhat normal. But I’m wearing athletic shorts and wool socks pulled up over my calves. That part of me looks insane. I verbally assault the first nurse that looks my way.

  “I was told I’d have a diabetic menu three days ago. Then I was told I’d have one an hour ago, and I’m still waiting. I want to know what’s taking so long.” This is not a country accustomed to raised voices and pointing fingers. My words have the effect of a torrent of curses, even without interlacing my language with the liberal application of colorful profanity.

  “I’m sorry, we will have someone bring it to you as soon as possible.”

  Out of the corner of my eye, I spot the menu. It’s been sitting here on the nurses’ desk—for how long I have no idea—and I realize immediately why it wasn’t brought to me. No one finished translating it. The breakfast menu and part of the lunch menu are in English, but the rest is missing. A piece of paper that’s clearly the Nepali menu sits right below it.

  “Is that my menu? Why haven’t you finished translating it? I want someone to translate it right now, while I’m waiting here!”

  A nurse grabs the pieces of paper, takes one look at them, and then puts them aside. For the first time in my life, I am tempted to deliver a flying uppercut to a medical professional, perhaps with an emphatic hadoken or shoryuken.

  “You know what? Just give me that.”

  “You speak Nepali?” This is the nurse’s attempt at humor at my expense.

  “No, but I can learn faster than you can translate.” In all honesty, I didn’t say that—I should have—but one of the residents comes over at that moment and finishes translating the menu. My effort is nonetheless pointless. The doctors have already agreed to let me leave early the next morning. I don’t care about anything else at the moment. I just don’t want to be here anymore.

  I barely sleep my fourth and final night at Dhital Educational Hospital. I’m too excited. In my four days at the hospital, I have left my room only twice. Now I am leaving for good. When Cassie shows up in the morning, we quickly grab our belongings, sign out of the hospital—we have to wait for them to hand copy my medical notes since apparently they have no copier—and head for the hotel room that has been Cassie’s home while I have been infirm. She throws her stuff together while I hop in the shower. I didn’t bother showering at the hospital because they didn’t have hot water. That wouldn’t have been a problem if the room had any semblance of heat, but there was no fucking way I was taking a freezing cold shower in a freezing cold room. Diabetes is enough to deal with. I’d rather not have to fend off pneumonia as well.

  We race over to Krishna and Bimala’s house to say goodbye to our host family one final time. I haven’t seen Bimala or the kids since I went to the hospital—Krishna stopped by to check up on me—and I embrace them all like the family they have become. It may be years before I see them again, but I have no doubt this is not our last time together.

  Then it�
��s off to the airport for the short flight to Kathmandu. We haven’t had our bags fully packed since we arrived in Nepal six weeks ago. I couldn’t have imagined then what I’d be going through now, but this is my reality.

  On the twenty-five-minute flight, I keep hoping the doctors at the Western clinic will clear me to fly home immediately. Then we don’t have to unpack. We can head straight back to the airport and buy tickets for the next flight out. No more nights of waiting. No more horrible uncertainty about the immediate future. I can just go home.

  We called ahead from Pokhara, so the staff at the clinic, called CIWEC, is expecting us. A nurse leads me into an examination room and immediately puts an IV in my left hand, just below the wrist. She draws blood to test my blood sugar.

  When the doctor sees me a short time later, I tell him my diagnosis and my experience at the last hospital. He looks over my medical notes for a moment.

  “I think you should stay here for at least two days. We need to regulate your blood sugars and teach you to use insulin before we can let you fly home.” My dreams of catching a flight home tonight have vanished. Worse than that, the doctor’s treatment plan sounds exactly like the plan from the last hospital.

  The nurse returns with the results of my blood test. My blood sugar is 320, and my ketones are 3+, the highest reading on the scale. Ketones are a byproduct of dangerously high blood sugars and happen when there is not enough insulin in the system. The condition that arises is called diabetic ketoacidosis, where the body poisons itself. Untreated, it can be fatal, and before the invention of artificial insulin, it nearly always was. Theoretically, it should be easy to treat with modern medicine, but I had spent five days at a hospital that’s considered the best in Pokhara, and for all of the doctors I saw and all of the tests they ran, they managed to do absolutely nothing except hydrate me. My blood sugar is still through the roof, and my body is still poisoning itself.

  Once again, I feel like I’m going nowhere. We took one huge step toward home by moving from Pokhara to Kathmandu—we are now a short cab ride away from the only place we can catch a flight home—but that still feels like an eternity away. Cassie and I bring our bags up to our room on the second floor. I wonder how long we’ll be here, and if this room will turn into the same prison cell that the last room became.

  Dr. Kishore Pandey comes into the room after we settle in. He is the doctor that advised us to stay at least two days, so he’s already fairly high on my shit list at the moment. But he’s smiling, and that automatically scores him a few redemption points. As he describes to me what will happen over the next few days, he is straightforward and honest, looking me right in the eye, yet he speaks with a warmth and empathy that melt away any frustration I had at being stuck in Nepal even longer. For the first time in two weeks, I am in front of a doctor who makes me believe he knows what he’s talking about—a not inconsiderable feat considering how many doctors I’ve seen—and I realize I am in a far better place with infinitely better medical care. And—thank Moses—my room has heat. The staff at CIWEC is even happy to move the Wi-Fi router so we have a good signal in our room.

  Dr. Pandey throws away the plan from the old hospital. He takes me off the insulin they gave me and switches me to two different types of insulin. He sits with us for maybe forty-five minutes, explaining diabetes and its short- and long-term complications, as he teaches me not only how to regulate blood sugar but what it means to have blood sugar readings that are too high or too low. We learn more in five minutes with him than we did in five days at Dhital Educational Hospital.

  “Our endocrinologist will be in tomorrow morning to see you. If you need me, I will be right across the hall,” he says after we finish with my first lesson in diabetes management. Cassie and I busy ourselves emailing my family to fill them in on the flight to Kathmandu and the new hospital. We give my parents my phone number, and they check in twice a day.

  Sleep comes much easier on this night. Cassie has her own bed in the room, and we both know I’m in a better place. I allow myself to be a bit hopeful that we will be home soon. It is a dangerous hope, one that I have had too often this past week, and that dream has turned out to be untrue so many times. Now, maybe it will finally happen.

  The moment I wake up, I go through the regular routine of blood tests and vital signs that has become nearly metronomic at this point. Dr. Jyoti Bhattarai sees me in the morning, and just like Dr. Pandey before her, she knows how to put a patient at ease and convey the impression that, with her care, you will get better, not worse. She reviews a lot of what Dr. Pandey talked about, then looks over my notes. She creates an entirely new insulin regimen for me, and she says she’ll be back tomorrow to check my numbers and make any necessary adjustments to my new plan.

  “Do you have any questions?”

  “Just one, Doctor. We want to go home as soon as possible. When do you think we’ll be able to leave?”

  I hold my breath. I’ve asked this question of every doctor we’ve seen and haven’t gotten a real answer yet.

  “I think you will be healthy enough to fly home tomorrow afternoon.”

  I could jump up and hug her for that answer. There is no hesitation or doubt in her voice. Unless something goes wrong, she says she’ll be more than happy to discharge me tomorrow.

  Cassie and I order lunch from the restaurant next door—standard practice at this hospital—elated at the good news. I don’t even mind when the nurses come in to teach Cassie how to administer insulin. They take turns pinching small bundles of fat on my stomach and sticking me with the short needles. Now I know what it’s like to be a human test subject, and if I had any tears to spare, I would have shed one for all the rats that unwittingly devote themselves to medical experimentation.

  We check flight schedules and find a flight on Etihad Airways that leaves late tomorrow night. Cassie calls the airline’s Kathmandu office and asks them to hold two tickets. Dr. Bhattarai will check in with us this afternoon by phone and give us the go ahead to make the purchase.

  Two hours after lunch, I’m sending an email to my parents, giving them the medical update and mentally preparing myself for a long journey home. It is time to test my blood sugar with my small hoard of newly acquired diabetes supplies. Instead of waiting eight hours for the results, I have only to wait a few seconds. It is, I notice, the same type of blood sugar monitor from a week ago when I was first diagnosed. The numbers tick down.

  5 … 4 … 3 … 2 … 1 … 152.

  It is 1:50 p.m. local time on my sixth day at the hospital—February 19, 2014—and though this time and date have absolutely no significance to the vast majority of people out there, they are so important to me that I write them down, never to forget this exact moment. Ever since I started showing symptoms of diabetes eight weeks ago, my blood sugar had been sky high. Even after getting medical help a week ago, my blood sugar was still too high. Finally, after five days spent in two different hospitals, my blood sugar is normal. Well, almost normal, but I couldn’t care less about almost in this situation.

  For the first time all week, the tears I shed are tears of joy. I am going home. I will hug my family and laugh with my friends and learn about my disease, and I will do that all from the comfort of my parents’ house. When we speak with Dr. Bhattarai on the phone, she is thrilled for me, and she says it’s fine for us to buy tickets.

  Cassie races over to the Etihad Airways office and purchases two business class seats on Flight 293 from Kathmandu to Abu Dhabi and on Flight 101 from Abu Dhabi to JFK. It is the only time on our trip we are not sitting in economy, a welcome respite from our shoestring budget. My parents told us they would pay for the seats to make sure that, if I needed any help or medical attention, I would get it immediately. My sister’s husband, Cam, who is on a business trip in Dubai, will meet us at the airport and hang out with us during our ten-hour layover. Then my parents will meet us at JFK when we step foot on American soil once again.

  I email my family, expecting their respons
es of “Safe travels!” and “See you soon!” to clog up all available bandwidth in Nepal. Instead, we get crickets. Not a single response for hours. My entire family was all too happy to send a thousand emails for every small bit of bad news, but now that I’m finally coming home, everyone has apparently lost interest.

  The rest of the time in the hospital flies by. One more night and one more day. Dr. Bhattarai stops in to see me one more time before our flight. She makes a small adjustment to my insulin regimen, and wishes us a safe trip home. Cassie snaps a picture of me standing with Dr. Bhattarai and Dr. Pandey. I have known these two doctors for only two days, yet I will be eternally grateful for the help they have given me. I give them each a big hug. I don’t particularly care if I violate any of Nepal’s social norms by hugging people I barely know, but it’s the only way I know to express my gratitude.

  We stay at the hospital until it’s time to head for the airport. I’m getting antsy, ready for us to be on our way, and I can sense Cassie feels the same way.

  “Do you think you’ll want to finish our trip?” she asks.

  “Yes, absolutely.”

  “How long do you want to be home for?”

  “I don’t know. Maybe four to six weeks? Does that sound okay?”

  “Yeah, I was thinking the same thing.”

  An email pops up in my inbox. I see it’s from my mom, so I open it up.

  Wed, Feb 19, 2014 at 10:11 p.m.

  Yaffa Liebermann

  To: Liebermann Family

  Subject: Cotton Candy

  Hi my children

  Cotton candy is my favorite from childhood.

  Just for the fun of it I am sharing this picture. We went to the famous restaurant: “farmajrry” in Random (my mom’s typing trails off here).

  It it still a nice evening.