Chapter Six

"Inside our bodies we have lots of different organs that do different things," Dr. Benton is saying. He settles back down on Ashley's right side and is talking directly to her. "Take the heart. What does it do?"

"Pump blood," Ashley says.

"Right. And the lungs, what do they do?"

"Take in oxygen and get rid of carbon dioxide."

"And the brain?"

"It regulates the other organs and processes information."

Dr. Benton seems impressed. "You must be an "A" student." Ashley smiles back. It's a weak smile, but it's more than I've seen in a long time, and I hope maybe he's diagnosed her wrong.

"Do you know what the pancreas does?"

She shook her head.

"It produces a hormone called insulin. Insulin takes the glucose in your bloodstream and helps your body use it as energy. With diabetes, your body has stopped making insulin. Without insulin, your body can't use the food you eat as fuel. Even though you might eat, you feel tired all the time." I see Ashley nod, and I think of the last two weeks and how she slept all the time and how I thought it was all because of the flu.

"Then the glucose--the sugar--doesn't have anywhere to go, because your cells can't turn it into energy or store it for use later, so it builds up in your blood stream. Essentially, it's poisoning you. Everything you eat and drink, except for water, is poison to your body right now. Your body wants to flush the sugar out, so it craves water. The more water you drink, the more sugar gets flushed out of your body."

"But she's not eating sugar," I interrupt. "She's hardly had anything sweet in two weeks."

"The word sugar is a misnomer," he says, turning from Ashley to me and Travis. "Almost everything you eat has at least a little bit of it that gets turned into glucose by the body. Anything carbohydrate, like the bagel this morning, is primarily seen by the body as sugar. It doesn't matter if it actually has sugar in it or not."

He turns back to Ashley. "But even if you don't eat, your body is producing glucose on its own. You need insulin whether or not you eat, and you aren't making any insulin right now."

"Do I have to have surgery? My pappy had a heart attack last year, and they stuck a balloon in his veins."

"No," he says slowly, glancing at us. "There's no surgery for this. There is no cure."

I think these may be the worst four words I've ever heard in my life. "But the nurse said she could live a normal life. Like all the other girls her age."

"She can." He takes a small black pouch off the top of the pile of papers he has on his lap. He unzips it and pulls out the contents one by one: a small blue machine that looks a little like a calculator without all the buttons, a fat blue pen, and a container that looks like what my camera film used to come in.

"You now get to be your own pancreas. Since yours isn't checking the sugar levels in the blood and making insulin to cover it, you will do it yourself." He opens the top of the vial and pulls out a strip of black, shiny paper. "This is called a test strip. It will show you how much sugar is in your blood." He puts it into a slit in the top of the meter and the screen lights up. A few numbers flash across it, and then it settles into a picture of a blinking drop of blood. "That means the meter is ready," he explains. He draws an almost microscopic needle out of a pocket in the pouch and unscrews the cap of the pen. He places the needle into the pen and then lets Ashley look at it before screwing the top back on.

"See? Tiny. You won't hardly even feel it." He takes her hand and presses the end of the pen against it. "This is the lancet. You should put a new needle in it each time you test. Then, you place it on the side of one of your fingers and--" He presses the button on the side, and I hear a slight wiz of air. Ashley grimaces and then relaxes.

"Is that it?" She grins at us. "It didn't hurt at all!"

He squeezes her finger slightly and a dot of blood surfaces. He holds the test strip up against it and it sucks the blood right into it. The screen changes suddenly to a countdown. 5 – 4 – 3 – 2 – 1.

565. I feel the color drain from my face. "That's bad, isn't it?" Dr. Benton takes the test strip out and throws it into a red biohazard container. "Normally, yes. That's very bad. But it hasn't been that long since the medics started the insulin. She's come down almost three hundred points, and that's exceptionally good. Eventually, we'll get it stabilized around 100. Then, the trick is to keep it there."

"How do I do that?" Ashley is examining her finger.

"With insulin shots." She stops examining and looks up at the same time that Travis and I lean forward.

"Shots?"

"Yes. Testing is only part of the job of the pancreas. The other job is giving your body the insulin it needs to cover the glucose in the blood, or, in the case of a diabetic, the glucose they are about to eat."

"What about pills?" I ask.

"You can't take insulin in a pill," he says. "Insulin can't be absorbed by the stomach."

"I see them on the commercials all the time," I say.

"They aren't for type 1. That medication is for type 2. It helps the body use the insulin it is already making. But Ashley isn't making any."

"Do I have to get a shot every day?" Ashley is like a rabbit looking down a shotgun barrel.

"Several times a day. And let's be clear here, Ashley. This isn't your parents' job. They should watch you carefully, and help you out, but it's your body, and your life, and you need to be the one in control of it. That means testing your own blood, and giving yourself shots."

She couldn't have reacted with more horror if he'd just cut open his own chest and handed her his bloody heart. "I can't give myself a shot!"

Travis backs her up. "She really can't. Don't none of us like needles none, but it took two of us to hold her down for vaccinations when she was a young'un."

I hit him on the arm, but the doctor ignores him.

"You can and you will. And before you leave this hospital, it will already seem like no big deal." Neither Travis nor Ashley looks like they believed him.

He puts aside the meter and begins laying out papers on the bed, motioning for Travis and me to scoot closer. "Before we hand you a syringe, though, all of you have to understand how insulin works. It's a tightrope you have to walk carefully. Too little, you'll be back here." He looks gravely at us. "Too much, and she'll be dead."

~~~~

The nutritionist comes later with her stack of Xeroxed pyramid charts and fake plastic food. She explains that we need to measure everything out now, and know exactly how many carbohydrates are in each serving. Lean meat doesn't require insulin, but we should only eat four ounces, the size of a pack of cards, or the palm of my hand. We need to cut back on beef and other fatty meats. We have to worry about fat, because heart attacks occur at much higher rates among diabetics. Only a half a cup of mashed potatoes or a half-cup of rice, fifteen carbs. One cup of strawberries, fifteen carbs. One ounce of chips, fifteen carbs. Suddenly the entire pantry is reduced to cups and ounces and measurements of fifteen carbs.

"Do I really have to count how many Doritos I eat?" Ashley asks.

"It's important that you measure everything you eat before you eat it. That way you'll know how much insulin you need to cover it. If you're still hungry later, you can eat more, and take more insulin for it. The days of sitting on the couch eating chips out of the bag are over, I'm afraid."

She doesn't look afraid at all. Ashley, on the other hand, is getting paler, and her eyes keep closing.

"Are you tired?" I'm hoping she is so the doctors will leave us alone to digest all this information, which I don't think has any carbs.

She manages a "hmm," and a sigh, but don't open her eyes.

"I'll come back tomorrow, " the nutritionist is saying as she picks up her toy food. "I'll leave these pamphlets for you to look over. Here is a book that lists the nutrition facts about food sold at popular restaurants. You should keep that one in the car with you. And these other pamphlets--" She puts them on the pile of pamphlets Dr. Benton left us and stands to shake our hands. "I know this all seems overwhelming right now, but it will become second nature to you really quickly. You won't always have to measure everything you put on your plates. You'll be able to eyeball it soon, but for now it's important that it's done right. For Ashley."

As if it would be for anyone else.

~~~~

The sky behind the shaded window is dark. We survived our first day. Travis and Logan are with Ashley, who is asleep, and I send the hospitality brigade home. I barely touched their pulled pork and potato salad. All I can think of as I look at it is Dr. Benton telling Ashley, "Everything you eat is poison to your body." I try to remember what he said about fats and proteins and carbohydrates, but it all blurs together and all I remember is poison.

When I was a teenager, a girl I babysat got leukemia. Blood cancer. They gave her chemo and all her hair fell out, and she threw up all the time and couldn't hardly walk she was so weak. I asked my mom why she was so much sicker when they were treating her than before, and she said it was because they were treating her with poison. "It takes poison to kill the poison that's killin' her," she said.

I wonder if insulin is poison. I wonder if Ashley will get worse before she gets better. I remember how casual the doctor sounded, and the nurse, and how all normal it seemed to them. But something in my stomach tells me different. A mother listens to these instincts. We trust them more than science. Sometimes more than God. Something tells me it's going to get way worse before it gets better.

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