To raise awareness of World Diabetes Day, I've decided to post a short excerpt from Spotted. In this scene, Alex is facing a routine medical for his new job...
Alex scanned the posters plastered across the surgery. From nine separate signs, he learned that breastfeeding was good, but assumed that was only for babies and infants. He also confirmed that STIs were bad and committed to making a note of this as soon as possible.
The scruffy appearance of the office and indeed Doctor Taylor did not inspire confidence. The GP’s prematurely greying hair was dry and unkempt and her stained blouse was buttoned incorrectly. Alex was glad he wasn’t actually ill.
‘Is there anything else you think your employers should know?’ she asked, haphazardly ticking boxes on Alex’s form.
‘Don’t think so.’ Alex smiled. ‘I have been quite thirty recently, so you could tell them to stock up the bars!’
‘Thirsty?’ The doctor looked up. ‘Passing water frequently?’
‘Well, I’m parked beside the river.’
‘I mean are you peeing more.’
Alex cut his losses and didn’t explain the joke. ‘I guess so.’
‘Any weight loss?’
‘Hmm. It could be diabetes. Hold on.’ She shambled out of the door.
Alex did a cartoon double-take. Whaaaaaaat?
The doctor seemed very casual so Alex shrugged and slipped back into his trainers. Knowing practically nothing about diabetes, Alex turned to the GP’s wall of facts.
DIABETES was spelt out in sugar lumps on one of the more prominent posters. Alex inspected the list of risk factors and answered the shouty, upper-case questions:
ARE YOU WHITE AND OVER FORTY? No.
ARE YOU BLACK, ASIAN AND OVER
DOES A CLOSE MEMBER OF YOUR
FAMILY HAVE DIABETES? Nope.
IS YOUR WAIST OVER 35 INCHES? Negative.
DO YOU HAVE HIGH BLOOD PRESSURE? Not yet.
EVER SUFFERED A HEART ATTACK OR
ARE YOU AN OVERWEIGHT WOMAN
WITH POLYCYSTIC OVARY SYNDROME? Not last time I checked.
With each ‘correct’ answer, Alex relaxed a little more; clearly, Dr ‘Egg On Her Shirt’ had made a mistake. The GP returned holding several pieces of equipment.
‘I’m going to check your blood sugar levels,’ she explained. ‘Not scared of needles, are we?’
‘Nope,’ he replied. This wasn’t bravado; Alex even had happy memories of his school tuberculosis jab. After his Heaf test, he’d proved immune to the disease and didn’t require an injection; a fact he kept from his waiting classmates. Alex still remembered how horrified they looked as he limped past, clutching his upper arm, face contorted in mock anguish.
‘Give me your hand please,’ the doctor instructed. She placed the nib of what looked like a chunky, marker pen against his thumb and depressed a small yellow button. The machine clicked and Alex felt a sharp scratch. She squeezed below the impact site and a small drop of blood bloomed into view.
She picked up another device. ‘This will tell me how much sugar is currently in your bloodstream.’ The curved gadget, with glowing green display, appealed to Alex’s nerdy side.
‘It should be somewhere between four and eight millimoles per litre.’
‘Of course.’ Alex nodded like he knew what she was talking about.
Protruding from the bottom of the unit was a small plastic strip. She held this in the pooled blood and it acted as a wick, pulling the fluid into the tester. As soon as there was enough for a reading, the screen displayed a rotating egg timer. Dr. Taylor handed Alex some cotton wool for his wound. She sat back at her desk and waited for the result.
Alex now realised how ‘Millionaire’ contestants felt when Chris Tarrant prevaricated over the correct answer; he sincerely hoped the doctor wouldn’t cut to a commercial break. Alex didn’t know the implications of diabetes and all he could think of was an enforced switch to Diet Coke. He tried to shake that particular horror from his mind; it probably wasn’t his biggest priority. As they sat, he began to wonder if maybe he was sick; he was certainly feeling a little queasy.
’Wow,’ Dr. Taylor said after no more than five seconds. Alex was suddenly concerned; ‘Wow’ was unlikely to be followed by ‘Everything is completely normal.’
‘So what is it?’ Alex’s voice caught slightly in his throat.
‘Your blood glucose level is 29.4 Alex,’ The doctor stated baldly. ‘You have diabetes.’
Alex swallowed. ‘Just like that?’
‘We’ll need a urine sample and to take some more blood, but yes. This test is conclusive.’
‘I don’t believe it,’ Alex stammered. For the first time in his life the phrase rang completely true; he was certain she was wrong. ‘I’m fine,’ he explained. ‘And the poster says I’m not at risk.’
‘Those factors are mainly for Type 2 diabetes. Given your age, you’re more likely to have Type 1, insulin-dependent diabetes.’
‘Insulin-dependent? You mean injections?’
The doctor nodded. Alex stared at the floor, attempting to assimilate his years of accumulated diabetic knowledge. He knew Sir Steve Redgrave was diabetic and Gary Mabbutt played for Spurs with the disease. Perhaps Keith Harris had it too, though he might be confusing diabetes with Orville. Alex’s thoughts were chaotic; perhaps the excess sugar was affecting his brain? All he could picture was a green duck in a nappy, shooting up. Hung up on this Trainspotting meets Sesame Street image, he ignored the doctor.
‘I’ll refer you to a diabetes specialist,’ she was saying. ‘They have a clinic on Thursday.’
Alex snapped back to the present. ‘That’s no good. I’m flying to America tomorrow.’
‘To work on a ship. That’s why I’m here.’ Alex indicated the form.
‘Ah, you’ll have to check on that.’ She paused awkwardly. ‘I can’t sign you off, you see?’
‘What do you mean?’
‘The diabetes means you’ve failed your Pre-Employment Medical Examination.’
‘Oh.’ Alex’s stomach was turning inside out; the single syllable was all he could muster.
‘Diabetes is a condition that precludes you from working at sea. I’m sorry.’
Alex sniffed and turned away from the doctor. ‘What am I going to do?’
Ignoring the rhetorical nature of his question, she tried too hard to fill the pained silence. Careers advice wasn’t her jurisdiction so she reached over and clumsily placed her palm on Alex’s forearm. ‘Your first job is to get your blood glucose levels under control. Left unchecked, diabetes is a very serious disease. It can lead to loss of limbs or even sight.’
‘Who said that?’ Alex joked lamely.
The GP’s forced grin didn’t reach her eyes. ‘I’ll call and arrange your appointment; the clinic will explain exactly what you need to do.’
‘That’s good,’ Alex replied, ‘because I have no idea.’
The doctor stared for a moment then rallied herself. She patted Alex’s hand and briskly stood up. ‘You’ll be fine. You’re young and healthy—’
‘Apart from the diabetes.’
‘Well, yes. But you’ll have that under control in no time.’
‘And then I’ll be able to take the job?’
Alex slumped. His parents had used ‘we’ll see’ throughout his childhood; he knew exactly what it meant.
Alex thanked the doctor who promised her receptionist would be in touch. He left the room, clutching two urine sample bottles and a fistful of leaflets.
Alex wasn’t sure where to go or who to call. Ironically, he was all at sea.
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