It’s on the kitchen counter, having arrived in the mail a day or two ago: a letter from the Joslin Diabetes Center with a full, quantitative report on what’s going on in my blood cells and, by extension, me. I’m not ready to open it.
Last week I saw my diabetes specialist. At one time, when I was new to diabetes and full of zeal, my performance — at monitoring, eating, record-keeping, sweets-avoiding, exercising, and controlling — was excellent. Sometimes, when Dr. A. introduced me to a med student on rotation, he would say, “This is my best patient.” Or even, “Here’s my A student.” In my late 20s at the time, that always struck me as paternalistic, if not affectionate, but still flattering. In the last couple of years, however, my body’s quarterly report card shows a more erratic performance. Occasionally, those numbers look great. More often than not, they look… merely adequate. Last week, as we looked over the records that I keep daily on my blood sugar, Dr. A. raised his eyes over the top of the paper and asked me, in so many words, why I couldn’t do better. When I shrugged and smiled weakly, he caught my glance and then tapped the side of his head (home of the brain) as if to say, “You can do it. And because you’re not doing it, it must be your attitude.”
He’s right. Diabetes is the disease that’s all about control, self control. The more you have, the healthier you are, the longer you live.
He’s right, too, as he has said many times before, I can do it. I am able, I am smart enough, and I have many resources.
It is so grindingly tiring, however, to have so much responsibility for one’s self, and to fall short so often. I mean, I can’t help but fall short; the body is not a perfect machine.
And my numbers always falling short means that I fall short. Although I’d like to separate myself from my illness — “Hey, it’s her fault, not mine!” — that’s impossible. We are shackled together.
What would make me feel better? Not numbers. I want some qualitative feedback. And I want a compliment. Shake my hand; hug me.
It’s funny, a few weeks ago my family and I were at a party, and I was talking to my neighbor who graduated from MIT years ago. With him, I was sharing my experience with my students there who want to know their grades on everything. I have been perplexed that even the highest-performing students have been frustrated by my specific remarks on their scientific writing, and my use of evaluative words such as “excellent.”
My neighbor visibly balked: “Excellent?! That’s vague. That’s not quantitative. That doesn’t mean anything.”
I laughed, a great burst of it. Instantly, I had insight into a miscommunication, between nonquantitative me and my quantitatively-fluent students, who are math, biology, and engineering majors.
Now I’m wondering if my doctor, whom, really, I trust and even love (in an appropriate, professional way — it’s just that I’ve known him so damn long), is speaking to me in a language that, to him, conveys all meaning, “The A1C is 7.8,” and I’d like something a little more… wordy.
I want both: precision (numbers) and encouragement (words). Sure, diabetes is a disease of numbers — maybe all diseases are — but we (diabetes and I) are a person, too.
Back to that report card… When will I open it? First thing tomorrow morning, when the day’s slate is clean.
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have you read mark greif’s ‘against exercise’? it was in the first issue of n+1 and reprinted in best american essays in (i think) 2005. it’s worth hunting down, if you haven’t. it’s about our (contemporary well-off cosmopolitan folks’) relationship to health-measuring numbers and our own humanity/mortality/ideas about will.
and speaking of the will– fuck that. i get that talking in terms of will power can be an effective way of motivating people (by way of shame or hope or whatevz), but it’s a misleading way of talking about about human capability as far as i can see. i’m thinking of another essay now– from the new yorker several years ago– about gastric bypass surgery. in it a woman who had gone through the surgery talks about how now she has the will power to stop eating, whereas before she didn’t. those are the terms in which she makes sense of her experience. only she didn’t have surgery on her will, she had surgery on her stomach. a stronger will in the face of appetite is, at it turns out, just what a smaller stomach (among other things) feels like.
it’s certainly complicated making sense of our experience of our daily struggle to do right, and it’s easy to think of many of those struggles as a conflict between what we want to do and what we believe we ought to do, but it seems clear to me that it’s really a conflict among desires, mediated by belief (maybe), and that we don’t have anything like full access to the reasons why one desire wins over another in the case of a specific person at a specific time. it means something about a person, of course, that she does or doesn’t succeed at realizing some particular desire at some particular time, but i think that what it means must be something much richer and more complex than what the strength of her will is. will, i think, must be the shorthand for whatever that more complicated set of data, which doesn’t obviously mean anything good or bad. it’s just information.
I always want to know how well I am doing compared to others – not so much because I am competitive, but just to put it in perspective – of what is real and what is realistic. I’ll bet you still are one of his best patients – not that that is what you are striving for…
Hi there!
I’m so late to tuning into your blog! I’m sorry that I’ve missed some great stuff so far, but you can count on me checking into updates as you post them.
I really enjoyed this post, particularly this paragraph:
“It is so grindingly tiring, however, to have so much responsibility for one’s self, and to fall short so often. I mean, I can’t help but fall short; the body is not a perfect machine.”
So true.
Emily, if it’s true that I am one of his better patients — and I’m willing to believe that — I would like some props for that. Instead of just being visibly disappointed, he could say what I’m doing well, and then maybe we could talk about something to do differently. I do like to be aware of health studies on specific populations, if that’s what you mean, to know if I’m in range.
Scott, thanks for reading! I enjoy reading your blog, too.
Laura… it’s peculiar that we view will as a kind of on/off switch and desire as more murky and multi-stranded. Why isn’t will more multi-stranded; why can’t we see desire as on/off? I absolutely agree with you that we don’t have full access to our many wants or motivations. Furthermore, others don’t have access to our wants or motivations either. I find it funny that people sometimes congratulate me for being such a moderate drinker, as though I am exercising self restraint. In fact, alcohol doesn’t taste as good to me as it might to someone else. (Sometimes I even *force* myself to have a beer, just to be social in an adult way.) I like it a little, but not that much. And there’s no moral quality to that.
Yes, I have read that essay by Greif. It’s excellent, and I think he’s right, if not a little severe (in a Vivian Gornick kind of way). Have you read his essay “Afternoon of the Sex Children”? His concerns about our obsession with youth are original, not the same-old obvious observations. He’s so smart. I remember that NYer essay on gastric bypass surgery, although not that particular passage. Interesting that the patient would ascribe her new self control to her “will” and not to the discomfort her stapled gut experiences when she eats.