Attainable goals

As briefly mentioned in the previous post, I recently (in the last two years) starting experimenting with what it would be like to set goals in line with my desires. This seems basic as I type it, but I think what I was doing before was setting goals in line with my hopes or maybe more realistically, my shoulds. Even if it was a goal I wanted (desired) to accomplish, I would set it on a hope/should timeline. For example, I wanted to publish a book – by the time I was thirty – and I didn’t. Although really, I just meant that I wanted to write in a format that other people would read. But I thought I needed to manipulate this desire into a framework where I could measure it and check it off and somehow through that process feel good about it. I wanted to accomplish!

I’m 35 and I haven’t published a book. At the start of the pandemic I put together a manuscript of poems from my twenties and submitted it to a poetry publishing contest. I didn’t win and then I didn’t really pursue it further, in large part because the poems I had compiled didn’t speak to me the way they had years before. Almost all of my poems are about things that fly – birds, bugs, bats, that kind of thing. And searching for something. I guess maybe once I had gone off to find something else, these poems didn’t make as much sense to me as they once had.

The interesting thing about pursuing a sense of good feelings, aka accomplishment, through goals is that if you’re not careful, you’ll take the joy out of the process. I’ll never write a book by the time I’m 30. I’ve missed my goal. Should I even write? What’s it all even for?

So that is why last year I set my New Year’s Resolution to eat more cheese. I knew I wanted cheese and I also knew I would eat cheese, and aren’t goals just about fulfilling our desires anyway? I have to tell you it went really well. I’m not saying I did this to make a big statement to myself, it was more of a joke, but I did notice that if flipped the script a little bit. When I was first diagnosed with diabetes I got a food scale. I was a freshman in college and had struggled with times of obsessing over calories in high school. Suddenly I was sanctioned to restrict my food (albeit based on carbohydrates, not calories) in the name of blood glucose management. While I actually did learn a lot about carbohydrate counting that has been beneficial for me throughout my time with diabetes, it also contributed to the culture of restriction I was building for myself around diabetes management. And chronic conditions rarely visit alone – so I amassed other restrictions and before long I was running into many invisible walls hoping that if I could just stay within them, I would feel great.

These last few years, maybe starting in the height of the pandemic, have been some of my least restricted when it comes to diabetes. And I’m happy with my current blood glucose ‘control,’ aka levels. I want to be clear that this doesn’t mean that I abandoned blood glucose targets or stopped counting carbs or bolusing when I eat or any of the other self-management tasks, it just means that I loosened my grip on achieving blood glucose perfection. Sometimes this meant that I rested instead of taking a walk. That I ate foods I would not have eaten at other points in my diabetes journey, just because others were having it and I wanted to share. That I didn’t feel bad about having to correct for it later. Sometimes I did still feel bad for it, but I didn’t let that stop me from making that brave choice. I loosened my grip on the idea that somehow, if you took everything else away, perfection was even something I had control over.

Because you can’t remove all the other variables from life. There are other goals in my life besides my hemoglobin A1c or time in range that are really important to me and that I want to prioritize. In fact, my motivation for glucose control is to live the life I desire, so constant restriction will never get me there. By the way, food is just an example, not the point here. The point is that there are ways I was trying to control the situation through any means I had available. And for certain aims, that control worked, especially at various points in my diabetes learning journey. But, now when I step back and ask, ‘why the control?’ I’m confronted with the desire to be more fully present with my life. My goals are flexible and interconnected. Maybe I’ll write a book, maybe not. In the moment, other things might feel more important, like making plans with friends or taking a last minute trip with my mom, or doing nothing with a cup of tea.

*This blog contains my personal reflections on my journey only. I am not a medical provider and nothing in this blog is intended to serve as medical advice.

Blood glucose and the stress response

My travels to Ohio last weekend were more exciting, but very related to, this post’s title. I have been less interested in travel over the past year, as the COVID overlay has made everything just a little bit more tiring, both in the lead up and the recovery. Wearing a mask all day in the airport, making sure I understand the ever-changing travel requirements, and just being worried in general about the virus has discouraged me. But this past weekend I was happy to be getting out of NC and headed to Columbus for a dear friend’s wedding.

I arrived at the airport a little less than 2 hrs early and made it through security in less than 15 minutes. I settled into the gate to wait for my departure, when it became clear that the flight would be slightly delayed. My connection would be tight, but I’ve made tighter, so it didn’t seem problematic. But then the flight was delayed further. Now we would be arriving at my connecting departure time. Obviously, this would not do.

Before learning that there was no way I would make my connection, I had been entertaining myself by scrolling through my mind to see if I could find something to worry about. I get this way on travel days. I think it comes from the necessary process of asking myself, “do I have everything I need to survive over the next X days?” I usually stick a post-it note inside my front door: “insulin; a way to get insulin into my body; test strips, poker (lancet device), and backup meter; charging cord; contacts; glasses.” If I’ve got this stuff, I’m gonna survive, so I’m good to go. Still, the packing and double-checking leaves me with this feeling of, I’ve surely forgotten something important and, subsequently, a vague sense of unease. But, what I love about travel is that it’s unpredictability almost always jolts me into the present.

This was true when I learned that I would not be making my connecting flight, and even truer when the agent on the phone said, “We’re going to do everything we can to help you,” followed by, “I’m sorry, but there’s really nothing we can do,” in the same conversation. There were no seats on later flights that day from Charlotte to Columbus. “Could I fly into Dayton, OH and rent a car?” the airline agent asked. “Only if the airline will pay for it,” I countered. “Oh, I’m not in charge of that, you can write to customer service.”

We all know that when a company that has its own app and operates giant flying machines wishes for you to write somewhere, this means they intend on doing everything they can to not give you any money.

So I declined Dayton and also declined the option of leaving Charlotte at 10:30 pm Friday and arriving in Columbus at 10:30 AM Saturday (“What? how could this even be possible?..” you ask. The layover would have been in Phoenix, AZ. Don’t fly to Phoenix from NC to get to Ohio. Just don’t do it.)

The point of this story isn’t the weird details of how I got to Ohio, although I did make it. Ultimately, I decided to take the risk of getting on the flight (inspired by my previous success) and making it standby for a later afternoon same-day flight. The point of the story though, is what happened to my blood sugar during this whole ordeal.

Graph Alert!

Graph 1 shows my blood sugar during the hours before and after finding out about the flight delay. Notice how I spike around 11:45 and stay above 200 for much of the afternoon.

Graph 2 shows that I had to take 41 units of insulin that day to keep my blood sugar in range. The other bars show a useful comparison of ‘typical’ days.

Now, don’t let me fool you, there are no truly ‘typical’ days with diabetes, but to give you a reference, my average short-acting insulin use per day has been about 25 units a day over the past few weeks. So, even allowing for the necessary amt. of typical variability, 41 units is an extreme anomaly. Graph 3 shows how many units I used on my return day, which went off without a hitch. Graph 4 shows my blood sugar on a more stable Friday, one week later.

What is it about stress that tends to make blood glucose spike and also makes us more resistant to insulin? Well, it comes down to a few things interacting together.

First, let’s disentangle the state of being stressed from various potential stressors. It’s the process of becoming and being stressed that raises blood sugar – aka the response. I like the definition of stress provided in here, “Essentially, stress can be considered as anything that tends to change the control that you have over our body and our emotions.”¹ While I don’t much like this article’s terminology or conclusion, I do like this definition because there is a synthesis that has to happen between a stimulus and the stress response in our body. Some people are stressed by holidays – it’s not that holidays are inherently stressful – it’s our associations with them. When I heard that I would not make my connector, the associations I made were:

I’m going to miss the wedding
I’m going to let all my friends down
I’m going to lose the money I paid for this ticket

All of these thoughts were very paralyzing. I was also low at the time that I was trying to rebook my ticket and literally couldn’t figure out the order I needed to do things in. Interestingly, it was diabetes that got me back on track. Once I recognized that I was low, I stopped frantically flipping between my American Airlines app and my web browser, and hung up the call line I was waiting in. I ate some Annie’s gummy bunnies (sponsor me, Annie’s?) and took some deep breaths. I then realized that I would survive and everything would be fine.

But my blood glucose had already received the signal that it was go time. And in truth, it was. I had to make calls, decisions, perhaps hustle from one gate to the other, so it was great that my body was ready for that. When we get stressed, either physiologically or mentally/emotionally, the body releases certain chemical signals and hormones, namely epinephrine and norepinephrine, to prepare itself to take action.^1,2

Brief aside – I hate the term ‘fight or flight.’ It’s overly binary and it leaves out freeze. Personally, I first exercised freeze, as previously described, and then I chose to fight respectfully on the phone with the first American Airlines rep who I talked to, before moving to schmooze, which is really another key omission in the term. After schmooze, I finally landed on plead, which was really the ticket.

Anyway back to stress hormones. So when the body releases these ‘stress’ hormones, they stimulate the liver to actually produce glucose (what, the liver can make glucose? Read about that here and see some cool diagrams).³The liver releases that glucose into our blood stream, thus raising blood glucose levels.

So at this point, maybe you’re making some conclusions. Perhaps you’ve decided that stress is bad for blood sugar. This used to be my perspective too. Now, however, I would say that it depends. In truth, my body is doing what it’s supposed to do – preparing me to handle a situation. Wow, thank you, body. An important conclusion though, is that your response to stress really matters on a physiological level (I’m looking at you too, people without diabetes). There are a couple of ways I’ve learned to manage the effects of stress that I typically deploy with varying success. During my travel day, I tried to keep some perspective on the issue at hand. I had a support network to help me out if I was stranded, I had a cellphone to call customer service, and above all, I’ve been through things like this before and been just fine. So I reminded myself of that, did some deep breathing, and remembered quicker than I could have that I could handle the situation. The second thing, and this is the most important in my mind related to blood sugar, is that I no longer get as stressed about being stressed as I used to. Earlier on in my diabetes days, I would be watching my blood sugar climb over the course of the day and get so distressed about higher than normal levels. This would then perpetuate the stress cycle and I’d be left with higher than usual blood glucose levels for days. I think that over the course of my time with diabetes, I’ve lessened my expectations for consistency in how I feel day to day, moment to moment. I’ve also tried to let go of that idea of perfect, normal blood sugar, and employ more gratitude for my body’s efforts to get back to stability. I don’t always succeed, but it’s been a relief to try.

The sources linked here will provide you with more information, but remember that no source is perfect or absolutely complete and that no one person’s experience of diabetes is representative of the whole.

People with and people without diabetes, please let me know in the comments how your blood sugar/body reacts to stress and some of the ways you deal with it!

Sources:

“And the pitch, it’s a delayed flight! She knocks that stressor out of the park!”

Walking through Innsbruck

To awaken quite alone in a strange town is one of the pleasantest sensations in the world. – Freya Stark

I stayed in a small Air BnB across an azure blue river that ran straight through the middle of Innsbruck. I walked there for the first time from the train station – my gracious host offered to pick me up, but I screwed up military time in a text message and told him I was coming 2 hours after my actual arrival. He gave me directions and I looked them up using the train station’s wifi (which was the only way I could use my phone) and headed on my way.

Google Maps estimated a 25 minute walk. I arrived an hour and a half later. Although I was toting my backpack stuffed to the brim, a rolling suitcase, and finally my purse, flung around my shoulders, I wasn’t slowed down too much by my baggage. I just simply couldn’t stop spinning around in circles to take in the shining spirit of the city. Here’s my walk in pictures:

I strolled across the street to a pedestrian only plaza where shoppers and diners milled and mingled.

…before finding this strange alley of murals. That closest one is a kiwi on a chicken bone. Perhaps a show of peace among vegans and carnivores (although I’m doubtful).

I didn’t stay at this hotel; I just took this picture to prove I was really in Innsbruck.

I walked across the bridge towards my new abode in the wake of mountains all around.

Et voila, practically home. The huge wooden door was tucked behind a swath of climbing red ivy between two classically Austrian buildings.

Everyone was walking or biking up and down the steep hills. In many places there were wide pedestrian sidewalks next to double-lane bike paths, bordered by a line of trees and flowers, before finally meeting the edge of a quietly buzzing road on which the motorists dutifully slowed on yellow and stopped on red.

It took me awhile (I mean like two weeks after I returned) to realize why I felt (at least in part) such a sense of peace in Innsbruck. It could have been the mountains all around or the fact that I was at a conference where everyone was thinking and talking obsessively about diabetes (just like me!), but another huge part of it was the pervasive walkability of the city. Pervasive because it was unavoidable – you couldn’t get where you needed to go without walking. It didn’t just feel safe to walk alongside the cars, but in many places there were no cars at all. The restaurant I ate at twice – Osterreich – which I actually thought had something to do with an Ostrich, before I realized how painfully complacent my brain was acting – was only accessible via foot. And, what’s more, the whole time you sat, enjoying grilled chicken or roasted sausages, fluffy piles of freshly grated horseradish, or mounds of sauerkraut, you could watch, not cars whizzing by, but a live feed of humans doing human things.

For example, this brass band bedecked in green, who lined up to play in the heart of the city.

Walking is one of my favorite things. But also, walking is one of my favorite things about traveling. I’m grateful to have a car, but I don’t like cars. I like moving more slowly through life and having the chance, if I so choose, to reach out and touch it. And diabetes loves a walk. People talk about the benefits of exercise for diabetes management, as if exercise was some strange set of unnatural activities that the body must be guided through. I’ll admit, I go for a run every now and then, and it does bring my blood sugar down, but for me, there’s nothing like walking to bring my body into balance. Adam Brown, a writer often featured on diaTribe, explains the blood sugar benefits of walking beautifully here. When my bg is high, instead of dropping rapidly like I do while running, I glide towards a more reasonably blood sugar. Instead of tiring me out, a long walk makes me ready for another walk, or a night of dancing (lucky for me too, because of all the specialists, pediatric endocrinologists are the best dancers).

My last day in Innsbruck, after cramming my head full of presentations and standing up to do a couple myself, I took myself on a mind-clearing walk. My host had told me there was a tram to the top of the mountain, so I headed up the hill towards the peak. Shockingly, I did eventually find the tram, but then decided that my budget preferred continuing to walk. Oh also, that’s another thing, walking is cheap!

Not to mention beautiful.

Gazing out over Innsbruck, I felt overwhelmingly grateful for my experience and for all the people who helped me get there. Although I enjoy the feeling of solo exploration, traveling, more than anything else I think, makes our interconnectedness blazingly obvious. I was guided by countless mentors and passed from hand to hand of old and new friends on this journey. Thanks to each and every one.

Leaving Vienna in the morning

**Monday of this week was World Diabetes Day 2017, so in honor of all my diabetes sisters, brothers, and supporters, this post will offer a little more intimate look at the diadetails of my life than others.

After yoga Monday evening in Vienna, I followed a group of yogi/inis to a delicious dinner of Vietnamese food. Yes, definitely Vietnamese and not Viennese – although I would end up eating a lot of traditionally Austrian fare. I was just a little bit low by the time we arrived at the restaurant [70 mg/dl or so], which was really a pleasant surprise after battling some higher numbers on the sedentary plane ride. I ordered an ‘Elderberry Water,’ description in German, so I was taking a total leap. It was, in fact, an elderberry-infused glass of water – and totally delicious.

I also ordered several other things – Vietnamese crepes and spring rolls with interesting mayo-based sauces. As a lover of sauce I was delighted. I was also almost delirious from exhaustion, approaching the evening of the day that should have been a night, but it was wonderful to be sitting at a table with people living their lives in this new city I’d just stumbled in to.

That night, teeth brushed, ready to climb the ladder to my lofted bed, I found the walk back to the apartment could not compete with the long plane flight, screwed up schedule, and reduced control over food choices. Nevertheless, despite a blood sugar of 201 mg/dl, I took an extra shot and crawled happily into bed.

Every morning I wake up and check my blood sugar. Then, as my coffee is percolating, I take my shot – the same amount each morning unless something exceptional is happening that day. I have my first cup of coffee and plan the day while my insulin activates, so to speak. It’s a wonderful routine – a forced stillness and reflection courtesy of diabetes. When I awoke in Vienna to a dreamy light pouring into the vaulted living room, my blood sugar had evened out to some degree (mid-hundreds). I drank my coffee staring out onto the criss-cross of streets below and apartment windows across.

Unless you have it, at this point you may need a diabetes glossary to understand a few concepts:

Walk competing with a plane ride…What?

Insulin activating…Hmm?

The day-to-day details of life with diabetes are heightened when traveling, precisely because of the exciting release of control that a good adventure requires. So at the same time that you’re sinking into the moment, diabetes can loom even bigger in the back of your mind. But I’ve learned, slowly, painfully over the years, to not let it steal the joy of the unknown from me.

A few ways I’ve successfully experienced this reclaiming of joy:

Allow myself a wider target range while traveling – if I’m not dropping dangerously low at night, I’ve succeeded! Likewise, as long as I can bring a high blood sugar down, things are fine. Interestingly, often this more ‘relaxed’ attitude brings with it surprisingly ‘good’ numbers.
Tin foil and plastic Ziplock bags at all time. How could a Ziplock bag improve my bg numbers while traveling? – you ask. Well, this may not be true for everyone, but I am the sort of person who doesn’t need to eat a whole treat to be satisfied, but who feels utterly denied if I can’t try a bite of something I’m offered. I don’t typically buy or order things that don’t support my blood sugar, but if they are there and free – I just gotta know. There are only a few exceptions I turn my nose up at completely (likelihood increases if said ‘food’ is enveloped in sealed plastic). So if I get a treat while traveling, say a flakey pastry pinwheel like they displayed on small square, porcelain plates at the conference during coffee breaks, I have a delicious bite (sometimes two) and pop it in the bag. Although often I throw away the remains before completely consuming it, it’s still less waste overall because one treat extends over a whole day, or sometimes even two or three (remember to refrigerate when necessary)!
And let’s talk about refrigeration. I always arm myself with a doctor’s note before traveling that states that I will be traveling with my medications and that they will need to stay cool. Perhaps because of this, or maybe my medical id bracelet (also essential when traveling alone), or because I am open about proclaiming my diabetes in airports, I have always been able to carry a little cooler with me without being stopped for having what is technically an ‘extra’ carry-on bag. I never let this cooler out of my reach – not to put it in overhead bins and definitely not to check it. I’m curious if others with T1D have successfully traveled with small coolers. Mine is soft and I use a little tiny icepack – which does flag the security scanners sometimes. Both times this has happened I have been cleared to continue on my merry way.

My diabetes travel guidelines in summary:

Be kind to myself, aka loosen up
Carry Ziplock bags or tinfoil
Be open/up front about diabetes

I packed a yogurt in my icepack for my four-hour train journey to Innsbruck, during which I would retrace on the ground the route I had flown the previous day. I jostled back in forth from one side of the train to the other trying to catch views of mountain peaks and aquamarine waterways, before finally being lulled into a nap by the hum of the rails.

The Story Begins

Epilogue

If you missed Chapters 1 – 3, which precede this post, you can find them here:

You’re Never Gonna Make It

With a Minute to Spare

The Plane is Coming Back?

And in case you’re wondering, “How long can she drag this story out?” I guarantee you that this is the last in the series about getting on the plane, but I had left the moral of the story untouched, or at least inexplicit, if there is one at all.

None of this was clear to me while I was writing the story, but I realized that during the whole journey from NC to Bolivia, I was balancing two contradictory emotions: panic and trust. Is trust an emotion? For me, at the time, it was. It was a force I could call on, not from outside of myself, but not just from inside of myself either. I would like to say I knew all along that it would work out, somehow, miraculously, meaning some fluke would allow me to defy the odds and make it on my flight, but really, I think I just knew that it would all work out even if I missed my flight and ended up stuck.

How nice that I have that security, even if sometimes it might be misguided. How lucky I am, truly lucky, to be able to have faith in humanity and in individuals, to help me if I am in a bind.

Here’s the thing about the panic: I could have skipped it. I could have proceeded with my plan, read SkyMag on the short flight to Miami, leisurely strolled down the deserted aisles, and arrived at my gate, right as the woman on the intercom was calling us over to let us know that the plane was re-docking.

I’m not advocating for panic. And since this experience, I’ve learned how to calm it down, and reassure myself in the moment that if I am feeling that trust, I can lean on it, and know that even if it doesn’t go according to plan, I’ll be able to make it work. But yet at the same time, emotions overtake us and sometimes hold on with a fierce grip. I didn’t breathe until I got on the cart with Jose and as we were racing, so to speak, towards the gate, I felt that people really wanted to help me, that I wasn’t alone.

With each kindness my panic subsided a little bit more and the glowing warmth of trust that I felt grew bigger. My path was validated by each point at which it seemed unfeasible.

On the plane, making my way to my seat, all emotions stepped aside so that I could experience pure elation (and exhaustion), which I have to say is one of my favorite states to be in. When I found my row, a man sitting by the aisle got up, looked at me quizzically, like, “Where did you come from?” and then let me pass. I flopped down in my window seat. He turned to me and said, “Are you just now getting on the plane.” “Yeah!” I said and smiled. “Yeah, it came back for me. No I mean, there’s technical difficulties I guess, but I missed it, and it came back.” “Wow, you’re the only person who’s happy about this” (talking about the tech issues, which at this point we had been informed were being addressed). I just laughed. Usually I would have explained but I didn’t even really understand what had happened. So we just talked about the plans we had for our trips and our work and lives back in the US. This person would become a friend who I would run into, by chance, two more times during the course of my trip.

The story didn’t end when I got on the plane; really that’s just where it began. Looking back, it seems like the interdependent lucky breaks that I caught were tailored to fit together in one precise pattern, like a code to crack. In truth, I suspect other versions of the story that would exist had one thing been different, would also have been rich and meaningful. But the blessed nature of my departure and take-off carried me through the challenges of travel, and reminded me that I was on the right path.

We all, each day, comprise the narrative of each other’s lives and write our stories together. Today I’m thinking about how we are a community even as we are strangers. Today I’m thinking about how the difference between apathy and compassion sometimes lies in simply looking people in their eyes. Today I’m remembering the power of helping someone get where they need to go.

The Plane is Coming Back?

First, I want to recognize MLK Day and my gratitude for a day of remembrance, action, and unity.

Chapter 3

“I’m here! I’m here!” I shouted as I leapt off the airport go-cart.

“Hi, hi, I’ve got to get on the plane, I’m the last passenger” (I’m not sure when I decided this fact), I said as I stumbled over to the airport boarding and security person, my backpack flopping to and fro.

“Goodbye Jorge! Thank you!” I turned and yelled to my friend who shook his head at me and motored the cart a few feet away.

“You’re too late. The plane is gone. Nothing we can do.”

The airport guard said all these statements in a rapid montage that I like to call, ‘The most painful one-liners a hopeful traveler can hear.’ It was as if he’d practiced the exact combination of phrases that would shut down all hopes the quickest.

I was crushed, like a peanut shell on the sidewalk. Yet, shockingly, I remained undeterred by this obstacle. Somehow, the run had made me confident in my choice to get on the plane to Miami and embark on the first leg of my journey. The adrenaline coursing through my veins made me feel like I was in the sort of adventure where the protagonist overcomes incredible odds and ultimately completes her goal.

I said, “Nooo!”

He said, “Yes.”

I said, “I have to get on that plane. I have to go to BOLIVIA!”

“I said there is nothing we can do. The gate is closed. The plane has left. You were too late.”

At the repetition of those words I was filled with shame. I had let the plane go by. I was too late.

The moment passed and I decided to try arguing again.

“But I can see it! I know it’s there. I can see the plane!” I exclaimed, pointing out a foggy wall-length window.

“This is an airport. That’s not your plane.”

I realized then, the flaw in my argument. I realized too, how fixated I had become on this goal, as if it were the only way that my plans, my life, could work out.

I began to sob. Heaving sobs. I think it was that I hadn’t been able to really breathe for some time now. That and, up until this man, everyone else had been SO supportive, as if they were sent to help me along on my journey. Now suddenly it felt as if he’d slapped me in the face with a wet fish of reality (just trying that metaphor out).

“Stop crying. You don’t need to cry. People miss their flights every day. It’s not like somebody died, you just have to go over there and rebook your flight.”

Now this struck me as simultaneously cruel and also useful. He had reframed what was a complete disaster, to me, as a normal, everyday ‘oops’ from which there was a recovery protocol. And it was, right over there, at a counter where I noticed a little more than a dozen other passengers talking anxiously among themselves.

I looked back at him. “I do need to cry. I appreciate what you’re saying, and I’ll go to do that, but first, I just need to cry for a second.”

At this I saw his eyes soften, almost imperceptibly, but it was there. He walked away as I exhausted the rest of my adrenaline, still strapped to my backpack in one of those little hard blue chairs. I looked over to see Jorge, staring at me with sympathy in his eyes from the other side of the hall.

I thought about going in search of food, or to make some calls, or something before jumping right back into the mess that I’d created. But instead, after a few minutes, I got up, blew my nose (and then washed my hands because I was in an airport and that’s the right thing to do), and walked over to the ticket counter. I was in line behind a beautiful couple who were holding what appeared to be a wrapped painting as their only carry-on. I sniffled as I listened to the conversations around me in Spanish and tried to contact my friend in Bolivia (who I actually hadn’t met in person yet) through Whats App.

‘Lo perdí (el avion)…voy a ver que pueda hacer ahora. Hay muchos aqui que perdieron.’

She replied: ‘Que pena.’ I agreed.

‘Estoy en Miami. No se adonde esta mi otra maleta…’

‘Que complicada – no creo que puedas viajar hoy en Bolivia.’

The other problem was that my friend was flying from her hometown to the capitol, La Paz, to meet me. She would have been on the verge of going to sleep to wake up just a few short hours later for an early morning flight. And by early, I mean 3 am.

‘Estoy en la linea para hacer otro vuelo, pero no pienso que puedo volar hasta manana.’ – 10:33 pm

I heard another Whats App message come in from her, but I was too distracted by the sound of an airline employee speaking into her walkie-talkie: “What? What about the plane? Pasajeros a La Paz! Passengers going to La Paz! Passengers going to La Paz, come over here.”

That was me! I ducked under the stretchy cord that was creating our queue, got stuck because of my backpack, fell to my knees and crawled, heaved myself up, and made it to her, right behind the elegant couple with the painting. It was just us three. She wasn’t looking at or acknowledging us at all, but rather, still communicating over her walkie-talkie: “The plane is coming back?” she queried into it. “Well, should I send them over?” “Send us over!” I said, quietly, but audibly, eyes wide. “Yeah, send us over,” said the man with the painting. She finally looked at us. “Ok, I’m gonna take you over to the gate. It looks like the plane may be coming back. But nobody get excited.” I was NOT excited. Promise.

We got back to the gate, and she walked us up to the yellow tape line. She said, “Nobody step in front of this line. If you step in front of this line, you’re not getting on the plane.” We stood several feet back.

I heard her talking to a male airline employee who looked to be dressed for a technical occupation, building, repairing, etc. He was very nice and started to talk to us, in Spanish, and by us, I mean the couple in front of me. He looked at me and asked if I understood. I said yes. I had called my friend in Bolivia on Whats App as we hurried over to the gate moments before, to tell her that I thought I was maybe getting on the plane, and so, to not cancel her flight and to continue on with the plan as we’d laid it out. I told her I would let her know. I also told her that the plane had come back just for us. That was, after all, the only explanation I could think of. I wondered if my tears had anything to do with it.

“Problemas tecnicos,” the airline worker said. “El avión tenía problemas tecnicós.” Technical difficulties. Hmm. In one way, this was extremely lucky, in another, a little disconcerting.

The woman reappeared. She said that the plane was now back at the gate while they fixed the issue, but they had to check to see if there were still seats available (plausibly they had given away our seats to standby passengers because we were late).

The man of the couple put me in between him and his wife, which I thought was one of the kindest in the string of kindnesses I’d experienced that day. Obviously, they were not going to split up a couple.

The female airline employee found a seat for woman of the couple and she walked through the door, which had reopened, to board our plane. The employee looked back to her computer. A minute passed, I was sweating. She looked at me, and she said…

“Are you ok with a window seat?”

I would have been ok sitting on one of those fold out platforms that the flight attendants use during shuttling and take-off. I would have been ok pushing the carts of beverages up and down the aisle. I probably would have sat for 8 hours on the lid of the toilet in one of the bathrooms. So I said, “Yes, that should be fine.”

I stepped onto the jet bridge and was shortly followed by the man of the couple who’d also been found a seat. Moments later, at 10:55 pm, I sent the following Whats App message: ‘Estoy en la avion!’ Which means, sort of, ‘I’m on the plane!’

I was on my way.

Stay tuned for the epilogue (as it currently stands), coming soon.

With a Minute to Spare

Chapter 2

So at 8:05 pm I’m sitting on the plane to Miami muttering, “Come on, come on,” under my breath, and hoping they start the engines soon. By 9:00 I felt like I had aged several years and my cortisol was jumping up and down like a jack russell terrier. I had one of those little in-flight tracker screens right in front of me, and although I enjoy many traditional flight hobbies like writing in my journal, doing crossword puzzles, and reading SkyMag, this time all I could bring myself to do, literally, for two hours, was watch that little plane icon move slowly through my home state (Georgia), and onwards towards the tip of Florida.

At 9:05 the estimated arrival time had jumped back from the original 10:15 (which remember would leave me with a total of 5 minutes to make my connecting flight) to 9:44 pm. I would have, calculating time for deboarding, at least 20 minutes of straight running time before the gate to my second flight closed. At this time, I did decide to update my journal. In it I wrote:

24 minutes to destino. Quick update, I’m on the plane. BG (blood glucose) is 320 mg/dl. Was so low in Raleigh that I couldn’t think. Didn’t take insulin for a long time. We are set to arrive @ 9:44 and then depart at 10:20. As long as no gate change I’ll be at F25 (only 20 gates away from where we arriving). I’m going to write an update at 10:40 pm saying I made it, and my BG will be perfect. Then I will fall into a nice sleep until 4 am, then write for an hour. Someday I’ll learn Portuguese.

This was my last journal entry for four days.

Back on the plane, as we declined in elevation towards our destination, I looked at the screen, then back at the overhead compartment, then at my purse, then at all the people around me, in a nervous loop. There were so many people in front of me, and I knew I had to get off of that plane. A flight attendant walked by. I asked her if she could help me. I said, “Hello there…I know this might be a weird request, but my connecting flight leaves at 10:20, and that lady up there, hers leaves pretty soon too, and if there’s any way we can get off this plane, like, first, or sooner, that’d be great.”

She agreed to make an announcement over the loudspeaker. She was very kind.

5 minutes later, as people rustled around and the captain updated us of our status repeatedly, a quiet announcement urging passengers to allow those with close connecting flights to depart first, was made. The attendant warned me that most likely, people would take little heed, especially those in first class.

And yet a door opened. Behind me, a couple on their way to an island off the coast of Florida, anticipating their vacation, had heard my anxious request. “You’ve got a close connector too?” One of the women asked. I sighed. “Yeah, it’s pretty close…” “Yeah ours got crunched with the delay. What’s yours?” she asked. I told her. “OH, that is close. That makes me feel pretty good about ours.” Despite this, she was very sympathetic. ”Here’s what you need to do,” she said. Follow us off of here and we’ll get you pointed towards the Sky Train. You’ve got to get on the Sky Train because where we are, you’re never gonna make it on foot all the way to your next gate. This airport is a giant.”

Now remember, our flight was arriving considerably early. It was 9:40, and we were descending towards a gentle landing. At 9:44 we touched down.

At 9:55 we were still waiting behind several other planes on a slow, slow pathway towards deboarding. Our huge machine idled in the queue. I began to feel flushed and frantic (noticing a theme?).

My friends from a few seats back knew that everything wasn’t going to go as smoothly as they’d originally presented. They amended the plan. “Ok, here’s what you’ve gotta do. As soon as we get up there, and they turn off the seatbelt sign, we’re gonna stand up and make an opening for you so you can get your backpack and get off of here. And then, don’t look back. Don’t wait for us, we’ll just slow you down. You gotta get off this plane and run like hell. You gotta get to gate 11 (9 gates away) and get on the Sky Train. I think you’ll have to go up some stairs…”

At that moment we docked.

The seatbelt sign went off.

My friends stood up, and I began to act.

I heaved my Osprey backpack from the overhead compartment and hiccupped down the aisle, meeting the line as it slowly moved off of the plane. I stepped onto the connecting bridge and could see the light of the airport at the other end, but I was still blocked by a throng of passengers. I tried to wait patiently because I don’t like pushing through crowds or running around other people who I could potentially crash into. So I slowly trudged along, until suddenly, in the Miami airport, at what was now 10:08 pm, I saw an opening, and I made a break for it.

My backpack was flapping on my back because I hadn’t buckled the waist strap and my purse was bouncing repeatedly into my stomach. If I had ever pushed myself this hard in high school track, I might have placed in a race. I had never run like this before. I also had never run before wearing a 35 lb. backpack. There was no one in the airport, no one out in front of me. Which is sort of a figure of speech because there were a few others, walking on the moving sidewalks which had been disabled because of how late it was. After about two minutes of running, my hair flying into my face, cheeks red, eyes wide, heaving breaths from the exertion, I see a business man and I think, he must know how this airport works. As I pass him on my right, I turn my head like a frenzied bull and with panic in my eyes I scream, “Where’s the Sky Train?!” “What?” he queries back. “THE SKY TRAIN?!!!”

I still don’t know where the Sky Train was. He failed my question a second time and I waved my hand at him in dismissal before continuing to sprint through the deserted airport.

Up ahead, one of those little cars was sitting horizontal in my path. As I approached it, I yelled to the conductor, “Please, sir, I’ve got to get to gate F25,” and instead of dodging it, I jumped on (not recommended behavior).

I learned my friend’s name, and where he was from, and that he had no faith that I would make my flight because moments before he had taken the last passenger who they were calling for over the loudspeaker to the very same gate.

I disagreed with him, but I was grateful for his kind presence and effort, nevertheless. We sped (at 5 mph) through the airport. My hair flew behind me, finally out of my mouth and eyes. I began to try to breathe again, although my lungs burned and my chest was tight. I was invigorated, I was going to make it. I had 1 minute before they would close the gate at 10:10 pm as we neared F25.

…To be continued.

You’re Never Gonna Make It

Well I’m snowed into my apartment in North Carolina, so I think it’s finally time to tell the story of the time I missed my flight to Bolivia and got stuck in Miami, and then, miraculously, how the plane came back for me.

Chapter 1

It was 4 pm on a Tuesday in June, and I sat in the Raleigh-Durham airport next to several women dressed for the beach. A woman on my left read the paper, the news showed the latest escapades involving Donald Trump, who at this point hadn’t become President. Reality still felt somewhat trustworthy, and I expected soon enough to hear over the loudspeaker that my plane to Miami would board.

I was albeit, quite early, having left my house around 2 pm for a 6 pm flight, driven to the airport by my friend Sadie, who escorted me all the way to security at which point she waved goodbye dramatically. We wouldn’t see each other for at least three weeks, which was far longer than any other separation we’d had since becoming friends in grad school.

Sadie sent me several WhatsApp messages while I waited at my gate. I was going to Bolivia, where text messaging wouldn’t be possible, so we’d already assumed the new mode of communication. She told me to be careful, to have a safe flight, implying that I was somehow in control, which seemed doubtful.

Things still felt very normal, but I was on edge, as I am before all big things that involve a dramatic leap into the unknown. In this case, this trip, involved several layers of unknowns, from the people I would be working with to the culture and landscape I’d be entering.

And then the first text message arrived from American Airlines. My flight was now set to depart on time at 8 pm. This was not on time at all. My connecting flight from Miama to La Paz, Bolivia, was set to depart on time at 10:25, which meant that if my flight was leaving RDU at 8:00 and arriving in MIA at 10:05, I would have a layover of 20 minutes. Miami is a large airport, but I did not know this at the time, and even were it small, the gates close 10 minutes (at least, I would learn) before flight time.

I saw people around me lining up at the counter. I, flustered, quickly followed suit.

When it was my turn, I explained my situation, and the airline professional explained theirs right back. There had been heavy rains in Raleigh, making landing impossible for a while, and all the flights coming in, mine included, had been delayed. However, now flights were arriving on time. There was nothing they could do to get me there sooner. However, she looked at my itinerary and said, with a slightly detectable accent, “Oh, you’ll make it, you’ll be fine.”

I went and sat down. “I’ll be fine,” she said. I tried to remain calm, or rather, become calm again, which I hadn’t been for several days. I thought about eating, but I had stress-eaten an apple while trying to interpret the text message, and now my blood sugar would be soaring because I hadn’t thought to give myself more insulin until after I spoke with her, so I decided to wait.

A beautiful woman with lush black hair sitting near me, was talking about her crumpled plans. I guessed she was returning to Brazil, but I found out her destination was actually Argentina, and they had told her a similar explanation of why, but that in fact she would not be fine, and would have to reschedule the second leg of her trip because she would never make her connecting flight with such a short layover. I asked her how long her layover had become, and she said her original connecting flight was set to leave at 10:45 PM. My brain registered a problem.

I went back up to the counter where the woman with red lipstick and perfect scarlet gel nails had told me that I would be just fine. I recounted my situation again, almost verbatim, with the caveat that although she told me it’d be ok, I just didn’t see how that could be true. She clicked her nails on the desk and asked for my boarding passes. “Oh no! You’re never gonna make this. Sorry.”

“What?” I asked, or said, because I had heard her, and really didn’t want to hear it again.

“Yah, no, you’ll never get from that gate to the departing gate in, what, 20 minutes. Nope.”

“Ok, well, can you offer me some other options?”

And then she starts looking at tomorrow’s flights, and she’s talking about how I can leave in 24 hours, from here, this gate, and just do this whole thing that I’ve been waiting for, for months, tomorrow, instead of today. And tomorrow feels so far away, in fact, so far, that it doesn’t even exist in my mind. Tomorrow is supposed to exist in Bolivia, which is a place I can’t even imagine, and that I would learn was totally different than even the small imagining I had been able to do. And I couldn’t imagine, going back home. Going back home to my apartment where I had eaten all of the food except for half of a carrot because I wanted to make sure I could leave everything closed up like a book I had finished and come back fresh from this journey. The house that I had checked four or five times to make sure that the dryer, and coffee pot, and oven, and lights, and sinks, and all of it, were turned off, that the door was locked, the blinds were drawn. I couldn’t go back.

“I can’t go back” I told her.

“Well if you go to Miami, I mean, you might be able to get on a flight tomorrow at 11 AM instead of 6 PM but….”

“No” I said, “I have to get to Bolivia by tomorrow morning.” (I was scheduled to arrive and meet my friend in the airport in La Paz at 5:30 AM).

I began to look more and more frantic. My eyes were wet, I was crying a little. I heard her speak Spanish to a co-worker as she turned and took a break from me. She looked back.

“What are you doing in Bolivia?”

I responded in Spanish, which was a good move, it turns out. I explained to her about the children with Type 1 Diabetes I would be meeting and talking to. Her eyes looked wet too. Suddenly a flurry of google searches, she was really trying to help me. I had become ‘Mamita,’ which I felt really good about. But…there were still no good options.

“What if,” I started, “the weather gets bad in Miami,” and then the planes can’t leave or are delayed from there?”

“Nah, it’s not as hard for them to leave, and your second plane is already there, sitting at the airport. Not gonna happen Chica.”

“Ok, ok, well what if my first flight gets in earlier than expected, I mean that happens right? And then I run like crazy to the next gate and at that one, maybe they know, at the airport, because y’all could give them a call, and tell them, that it’s not my fault but I’m going to be just a few minutes late..and…”

“Mmm, look, if you get on the plane to Miami, you better make sure you have some backup once you get there. Because since this is weather, and we can’t do anythin’ about that, they’re not gonna pay for any accommodations for you either.”

I go sit down. I get on Facebook. Miami in the search bar. I know no one. I start to send text messages fervently. I realize I know two people who know two people in Miami. Neither can promise me outright that those people want a house guest who may, or may not, be arriving at 11:00 PM and leaving early the next morning, but it’s the best backup I’ve got.

I go back up to my friend at the counter. She says hello, with sympathy in her eyes. I explain the situation and I say, “What would you do.” She meets my gaze and says, “You’re never gonna make it. But you could go for it.”

This was the whole truth. I was never gonna make it, but I could postpone that realization by several hours and accept it once I was alone in Miami. So that’s what I decided to do.

To be continued.

Bienvenidos a la familia

The first thing I noticed after we pulled into town was the smell of smog. In Bolivia, on the weather report it is common to see ‘smoke’ listed as if it were a naturally occurring phenomenon like wind or rain. But smoke has been introduced into the nation, a byproduct of mining and concrete factories and the wood people burn in their homes to combat the dusty, dry, creeping cold of the Altiplano winter, which runs June through August.

Looking up at the denuded mountains from a Bolivian tin mining village.

After we’d checked into our hotel in the city center, we rode to the clinic in an ambulance that I’m still not sure the status of. It may currently be in operation, or it may just be the finest van in town. Upon entering the building we were greeted by immediate embraces and kisses from all who had come for the focus group. The first to hug me was a woman wearing a traditional pollera skirt and whose thick, jet-black braid ran far down her strong back. She kissed me solidly on either cheek and rubbed my shoulders vigorously, her eyes glistening with emotion.

That woman was the mother of Angela (name changed), a 19 year old girl who has had Type 1 Diabetes (T1D) since she was around 14. The next day we visited the whole family in their pueblito at the base of a giant tin mine where many of the residents, including Angela’s mother, work to collect minerals from inside the mountain or from the river bed that catches the heavy-metal runoff.

Earlier in the day we had boarded a dusty microbus on the side of the road next to women selling fried breads of all varieties and hot drinks in plastic bags with red straws sticking out of the tied ends. Maria bought one of each for the road. I poured hot water into my orange backpacking mug balanced on one knee and made a cup of instant coffee to sustain me through the morning van ride. We had three home visits ahead of us, separated by miles of pockmarked and potholed roads, and coffee was non-negotiable.

Each day from my time in Bolivia could stand alone as a life-changing experience based on the stories I heard and people I connected with, but this day in particular shines bright in my memory. Maybe it was the sun rising over the arid quinoa fields at the base of the Bolivian Andes, or talking with the teenage sisters who live with Type 1 Diabetes in temporary housing with no electricity or running water. But I suspect above all it was the immense kindness and generosity we encountered from the families we visited. Not only did they share their experiences living with Type 1 Diabetes and managing it in a country where finding supplies is hard and affording them is nearly impossible, but they also filled our stomachs with homemade breads, hot drinks, and even fresh sheep milk ice cream, frozen overnight in the rafters (that was breakfast).

All this social eating was a little tricky for a gal living with Type 1 Diabetes herself, but I came to realize just how immensely blessed I am to be able to manage my blood sugar with an insulin pump and to check my blood sugar anytime I want to. I already had some idea of this, which is part of why I wanted to go on the trip in the first place. I connected with the organization ‘Life For A Child’ (LFAC) because they provide test strips and insulin to children living with Type 1 Diabetes in low-resource nations who lack access to adequate medical supplies. I was hoping my practicum could translate to a learning experience for me and an immediate benefit for others living with Type 1 Diabetes who don’t enjoy the luxuries of management that we have here. OruroOvejas My purpose on the ground in Bolivia became to interview, chat with, observe and learn from as many people living with Type 1 Diabetes or supporting those who do. Over the course of three weeks and five cities I got to do over 40 interviews and focus groups with nearly 100 participants made up of youth with T1D, their families, and the clinical staff and volunteers who support them. Everywhere I turned, a new element of life with diabetes in Bolivia jumped out at me. It became apparent that Bolivian cultural values were critical to consider when thinking about successful health outcomes for youth with T1D, especially the role of the family. One participant who volunteers as a leader for the group in Potosí and who has had T1D for 23 years himself, said that in all the situations he has observed, “La familia ha sido fundamental para poderlo apoyar..cree una necesidad, de, en todo diabético, de que la educación no sea sólo en el paciente diabético, pero sea también en su entorno. Ese apoyo a la familia, o esa educación a la familia, creo que también es muy importante, porque es un daño que afecta la familia” (“The family has been instrumental in that it can support…it creates a need, that, for all diabetics, the education not reach just the diabetic patient, but also their environment. This support for the family, or education for the family, I think it’s also really important, because it [diabetes} is an injury that affects the whole family”).

Worth the insulin

Here are a few Bolivian specialties that I declare are worth the extra insulin. Salteñas, various baked and fried goods at street markets such as this one that appeared to be purely cookies, and small batch Greek yogurt w blackberry beet sauce at ‘Frozz’ icecream and yogurt shop in Sucre.