The Miracle of Route 24

by james s. hirsch

When do you tell a child with type 1 diabetes about the “facts of life”? These “facts” are indeed about life: about the importance of taking care of yourself to avert serious long-term complications, about being vigilant every day to avoid a calamity that can land you in the hospital, or worse.

Thankfully, a child with diabetes, with proper care, will live a long, rich, and productive life - no less, no more, than if that child does not have diabetes. But at what age do you convey the consequences of neglect? At what age do you say, if your control is out of whack for many years, you could lose your vision or your foot. Or if you fail to take your insulin for a few days, you can end up in the hospital. Or if you don't take it for a longer period, you can die.

Garrett was diagnosed seven years ago, at age three. At the time, we told him that he had to take insulin shots so he would feel good or wouldn't get a bellyache. That worked for a while, but he figured out soon enough that the insulin did more than that. When he was five or six, a friend told him that his birthday party would be at a minor league baseball game in another city (we live in the Boston area). When the boy said that no parents were invited, Garrett immediately motioned to me - indicating that I too had to come, because I had to give him his insulin. Even at that age, Garrett knew that he wouldn't make it through the night, or maybe even a baseball game, without his shot.

And then just couple of months ago, we were in the car, and Garrett asked, “Daddy, before they discovered insulin, how long would you live if you got diabetes?” I don't know how many 10-year-olds think about their own mortality, but I'm reassured that Garrett knows exactly what his insulin does.

This will be a pivotal summer for Garrett. He has gone to Camp Joslin for the past three summers, and will again in a few months, but he is also going - for the first time - to a non-diabetic sleep-away camp. He will have several friends at his new camp, and his sister will be there too, but he will be the only child with diabetes. We have every confidence in the staff, but Garrett will have to assume more responsibility for his care than ever before.

Our biggest concern is severe hypoglycemia, in which he bottoms out at night or on the lake and places himself in real danger.

I want to convey to Garrett how important it will be to check his blood sugar and to be vigilant - and that he is responsible. Fortunately, I have such a teaching moment to share. Call it “the Miracle of Route 24.”

My book about diabetes, Cheating Destiny, was published in 2006. I began my research right before Garrett's diagnosis, so his first year with the disease is chronicled in the book. I wrote about one incident that Garrett vaguely remembers. We've talked about it in general terms over the years, but never the specifics. I thought the details might scare him. But a few months ago he asked me if I wrote about it in the book. I said yes. He was curious, so I asked him if I could read it to him, and he agreed.

We sat down on the couch, my arm around him, and I opened the book to Chapter 7.

Garrett read aloud the chapter title: “New Lows.”

I began reading: The chapter describes how a couple of months after Garrett's diagnosis, I drive him to an indoor soccer practice and, while he's playing, I detect a slight emptiness in my stomach. The practice ends, and as we head for the car, I sense something is wrong with me, but I don't know what. We get into the Honda Pilot, and I recall seeing the red light on the dashboard signaling that Garrett's door is open, but I don't react to it. When we reach the main street that leads to Route 24, I don't know which way to go. We get to the entrance ramp, and I accelerate onto the highway.

With a watchful eye on my son, I continued reading:

As we drive down the highway, I pass several exit signs, but I'm not sure which exit to take or how to get home. I'm frustrated because we're going to be late for lunch. I have the wherewithal to call Sheryl on my cell phone and tell her that I can't figure out where to go. I don't remember what Sheryl said, but the conversation ends and I continue to drive. The red light still indicates that Garrett's door is ajar, but I don't respond . . . I'm in the far right lane, probably traveling about 45 m.p.h.

I've had many reactions in my life, but very few that I couldn't treat on my own. The symptoms are usually overt and pronounced. I can feel my body trying to claw its way back to normal, at least until I can eat or drink something. But this one is different. No autonomic symptoms have surfaced, no counter regulatory hormones have been triggered, no warnings have been recognized. I continue to drive, lost. My brain is shutting down, but I don't know it. I am falling into the abyss, gently and quietly, with my son in the back and cars flying past us. All is peaceful.

Thump!

We're off the highway, grazing branches and scraping leaves. Very briefly, I feel terror, but before I can react or even register what is happening, the car stops. Actually, it flips like a 4,400 pound pancake.

Garrett, sitting on the couch, has been listening intently, but now he chimed: “I remember that! We went into a puddle!” He betrayed no fear but recalled it like an adventure.

I continued reading. According to a police report, I said, “the car failed to stay in the lane and drove straight for approximately 300 feet until it rolled over and came to a rest on its roof in a water drainage area.”

I looked at Garrett on the couch. “You were right. We were in water.”

He beamed with delight at his keen memory.

I read on, describing how the impact of the accident “jars me back to life, though I'm now sitting upside down in the car,” and Garrett yells at me from the backseat, “You have to be more careful!”

On the couch, Garrett chuckled when he hears that he reprimanded me.

I describe to Garrett, from the book, how the seatbelt kept him secure and the door never opened. The windshield was cracked and dented, but it didn't shatter. I got out of the car and stepped into the water as I opened his door - he was still wearing his purple soccer uniform and shin guards, but he was unharmed. Then a lithe woman with brown hair appeared. She said she saw me drive off the highway. She's a nurse and has already called an ambulance. She asked if we're okay. I said yes, I just needed to get my son out of here.

I lifted Garrett out of his car seat, and we made it up to the highway. A state trooper was waiting for us, and I explained what happened.

I stopped reading. Back on the couch, Garrett still showed no emotion, no fear. I now came to a part in the chapter that I decide to censor. I wrote what the state trooper said after I told him I had diabetes: “I know what diabetes is all about,” he says. “My mother died from it a few years ago. She was 55.”

I wanted Garrett to understand the realities of diabetes, but there was no reason for him to hear that.

I start reading again. I describe how I asked the woman who helped us for her business card so I could properly thank her, but she refused to give it. I wrote (and now say aloud to Garrett):

I'm fairly confident that, even without her, Garrett and I would have made it to the highway safely, but we'd have no way to call for help. If I had been injured or immobilized, she might have saved our lives. I later discover her last name on the police report, but she apparently didn't disclose her first name, so I have no way of reaching her. Strange. She's willing to save my life, but she doesn't want to reveal her identity. Perhaps she doesn't trust me, or perhaps she's just a good Samaritan who feels she does not need to be compensated or recognized. I'm sure our paths will never cross again, but I'll always remember her as Garrett's guardian angel.

Garrett, on the couch, was rapt. I asked him if he knew what a “guardian angel” was. He shrugged. I told him it's an angel that comes down from the heavens to protect you. He nodded.

Reading from the book, I describe our experiences at the hospital - how I got into an argument with the nurse because she wouldn't give me orange juice without a doctor's authorization. She wanted to give me an IV instead. (My blood sugar was 62, but I was coherent.) I also describe what happens when Sheryl arrives.

I tell her how sorry I am for everything. She hugs both Garrett and me and says, “I wouldn't trade you guys for anything.”

I continue the story. When we later went to the car lot where the tow company took my Pilot, we see that the car is smashed like an accordion.

“You were in that car?” the guy who towed the car said.

I nod.

“I can't believe you're alive.”

The heft of the car probably saved our lives. Sheryl looks on the bright side. “It needed new floor mats anyway.”

I also describe how the hospital sent us an invoice.

I received a Band-Aid for my finger and was charged $799; Garrett got a peanut butter and jelly sandwich and was billed $598.

Sitting next to me, Garrett howled with laughter. “Five hundred and ninety eight dollars! For a sandwich?” I explained that anytime you go into a hospital emergency room, you're going to incur a big bill, no matter the treatment. Fortunately, I told him, his sandwich and my Band-Aid were covered by our insurance.

Back to the book: In describing the power of insulin and why you have to be so careful with it, I read:

I'm reminded of Nietzsche's line: “That which does not kill me, makes me stronger.” With insulin, the inverse is true: “That which makes me stronger, can also kill me.”

Garrett's never heard of Nietzsche, but I think he gets the point.

Though there is more to the chapter, that ended my reading of it. I explained to Garrett what had caused my low blood sugar: I had had an unusual amount of exercise that past week, and even though I tested before we left in the morning, the combination of the insulin on board and the exercise caused me to bottom out. I told him that after the accident, I went on an insulin pump, which has given me better control, and I always travel with my meter now.

“Okay,” he said.

He knows his mother won't read the book because it makes her cry. So now Garrett asked, “Was that the sad part?”

“Kind of,” I said.

I tried to make my larger point. “The reason I'm reading this to you now is so you know to be careful this summer,” I told him. “You have to do 'tester' to make sure you don't go low, and you can't expect anyone to do it for you.”

He already knew this. We've talked about it. He's just excited about going to a non-diabetic camp. The car accident from so many years ago? He has no bad memories, no nightmares, no questions. He understands the life-and-death nature of diabetes, the risk of falling off the precipice, but he probably thinks I worry too much.

He's 10 years old, and he's got more important things to consider. When I finished, I got up from the couch, and Garrett flipped on the TV. He wanted to watch the baseball highlights.