Chapter Thirteen

Dr. Benton shows up a few minutes later, his hair still wet, wearing running pants and a black t-shirt. He could be some model in a Calvin Klein ad.

"Sorry it took a while to get here. You caught me at the gym. So you gave Nellie a hard time?" The twinkle in his eyes told me I wasn't the first to get her goat. "What have your blood sugars been the last 24 hours?"

I hand him the logbook where Ashley's writing down everything she eats and the time and amounts of her shots. He glances through it. "Is there any reason you know why your readings have gone up in the past day? Anything you ate that is hard to calculate? Any snacks you didn't write down?"

Ashley shakes her head.

"I know your mom is here, but you need to tell me the truth. It's really important. We need to find why your blood sugar has gone up 250 points when you haven't eaten anything. Did you miss a shot?"

I think Ashley's going to cry when she shakes her head. "Honest. I didn't eat anything."

He looks at me and I nod.

"Okay, then, I'm going to look at where the allergist gave you the shots. It won't hurt. I just want to see which ones gave you the most trouble back here."

He examines her without any other words. When he finishes, he just says, "I'm going to find the allergist who did the shots. Can you wait a few more minutes?"

He don't wait for an answer because we aren't going anywhere.

"I don't think he liked what he saw," Ashley says.

"Nonsense. He sees stuff like this all the time. It's just an allergy. We'll find out what it is that you're allergic to, and then we stop using it."

It takes a long time before he comes back, the doctor from yesterday in tow. They both look again, without talking, and they leave again.

"Something's wrong," Ashley says. "He's always really nice. He always jokes with me. What do you think is wrong?"

"Nothing's wrong," I say, but I don't believe it. I see the same thing Ashley does, and it ain't good.

When he comes back, he's alone. He pulls up a swively chair, and the twinkle is completely gone.

"What is it?"

"Well, it looks like I was right. Ashley has an allergy to insulin."

"So we just switch, right? That's not too bad, right?"

"It's not that easy. She doesn't have an allergy to just aspart or lantus or any of the others. She has a systemic allergy to all of them."

I search his face for some sign that he's kidding us, but there's nothing. I feel Ashley stiffen beside me. "But I need insulin. Don't I? Don't I need it to stay alive?"

"Yes."

"But I'm allergic to it?"

"Yes."

"Then there's something else, right? Something else I can take?"

"No. There's nothing else."

Ashley looks at me wide-eyed and scared. I'm out of my body, watching this like a scene out of a movie, because this cannot be happening. People who need to take insulin to stay alive don't become allergic to it. God wouldn't do that to people. God wouldn't do that to Ashley.

"This happens. It's really rare, but it happens. You have a systemic allergy. That means it's not just one part of your body, like the place where you give yourself a shot, which reacts. Your whole body is reacting to the insulin."

"Does she have to take medicine on top of the insulin then? Something that keeps her from rejecting it?"

"That's a start, but it isn't that simple. If we keep giving her this amount of insulin, her body is going to continue to reject it, and more forcefully. Already, in just a small timeframe, she has hives all over, and the insulin itself isn't even working. That's why her blood sugar is so high."

"Am I going to die?" Ashley's voice is freakishly high.

"Of course not," I say. Dr. Benton doesn't say this. What he does say are the words I don't want to hear.

"We need to admit her into Children's Hospital again." He stands and lays his hand on Ashley's good shoulder. "We need to get on top of this quickly. There are a couple avenues we can take. The first is to get you on some stronger antihistamines, to see if we can't get your reactions under control. Also, we're going to take you off the shots and put you on a subcutaneous insulin pump."

"A what?"

"An insulin pump. It's a little machine the size of a cell phone that will deliver insulin through a tube directly into her abdomen."

"I'm going to have to be hooked up to a machine?"

"A very little machine."

"For how long?"

"If it works, forever. The good news is you'll be done with shots. The pump will act in place of the shots, kind of like your own pancreas. It will give you a lot more freedom eventually to live a more normal life, too."

"How can it be normal if I'm hooked up to a machine all the time."

"A very small machine. I guarantee almost no one will even notice." When Ashley raises her eyebrows at him, he lifts his shirt and pulls a black gadget off his belt clip and holds it out to her. A tiny tube runs from the bottom of the pump and disappears into his sweats.

She holds the pump, small enough to clamp in her fist, and stares at Dr. Benton. "You have diabetes?"

He nods and takes the pump back. "Since I was three."

"Why didn't you tell us?" I ask.

"Is that the first thing you want people to know about you?" A look of understanding passes between them "I need to shuffle my appointments around today and take care of a few things at the office before I get to Children's Hospital. I'll phone them and let them know you're coming and have them get a room ready. You need to prepare for at least a few days. Can you do that?" I nod. "Okay, then. Have you eaten this morning?"

"No," Ashley answers.

"Don't eat. Can you do that?"

"Yes. I'm not really hungry anyway."

"The high blood sugar will do that to you. You do need to drink as much water as possible, though. And throw out your aspart, but keep the lispro, okay? Lispro is less likely to cause allergic reactions, so that's the one we'll try in the pump."

"What about the Lantus?"

"Throw it out too. The pump uses only one kind of insulin. That will help, too, with the possible allergic reactions. Any other questions before you leave for the hospital?"

"Will this work?" This is me asking, but I see the question in Ashley's eyes, too.

"Maybe." Dr. Benton sits down again. "It might work, but it might not. I told you this is pretty rare. The combination of antihistamines, some good immunosuppressants, and the pump take care of the problem in about half the cases."

"Half? What about the other half?"

"Then we move on to something else."

"What else is there?"

"Maybe we should take it one step at a time. Let's see if this works. If it does, there's no need to worry about what else."

"I want to know," Ashley whispers. "What are the other options?"

He seems to study us before answering, as if he is trying to see if we can take the news. "If it doesn't work, we'll try something called desensitization. It's the same kind of thing we do with people with hay fever and grass allergies. We give shots a little at a time of the substance, increasing the amount until you build a tolerance to it."

"You're going to keep giving her the stuff that's making her look like this?"

"Yes. But not in these quantities. In much smaller quantities, so she doesn't have quite the reactions."

"But won't her blood sugar be really high if she's not getting enough to begin with?"

"Yes. Which is why we'll need to keep her in the hospital. We'll have her on a special diet, probably mostly through an IV, and watch her very carefully."

"Does that usually work?" It seems to me if that would take care of the problem we should start there.

"Sometimes. Sometimes not. I'm not trying to be a wet blanket here. I just want to be honest."

"Has anyone ever died because nothing worked?" This is Ashley again, and I'm surprised she can ask the hard questions I can't make myself ask.

Dr. Benton doesn't answer for a minute. He looks like this is as hard for him to answer as it is for her to ask, and I know before he opens his mouth what the answer is going to be.

"Yes." He takes a deep breath. "But very few. Rarely. Very rarely. And I'm not going to let that happen to you, okay?"

I know he can't promise this, but Ashley has complete trust in him, and I let the sentence rest in air.

"Go pack your things. I'll see you this afternoon in Austin. We're going to get you better, okay? This is just a blip on the radar screen. Next year you'll look back on this as just another page in your diary. Or in your scrapbook. Or wherever you ladies keep that information these days."

When he leaves, I expect Ashley to cry, but she don't. She's quiet until we get to the car, when she suddenly blurts out, "The youth group is having a movie night on Saturday. Do you think I'll be back in time to go?"

This is twelve. I know, because I remember it, and it's so normal it makes me laugh out loud. Ashley frowns at me like I'm making fun of her, but I'm mostly just amused at the equal level of importance she gives her health and a social gathering.

"Well?"

"Probably not, sweetie. But there will be others."

She pouts a bit on the way, and for the first time since puberty struck, I'm enjoying it.

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