Trying to Diagnose Disease - Med Student Style

My best friend from medical school is wickedly smart. She is currently a successful ophthalmologist, married to a great guy, and mother to an almost three-year-old girl. She's coming in town tomorrow, and we are going to see Avatar. I can't wait.

We used to stay up late studying together at Barnes & Noble, quizzing each other from old test banks after all the important solo work was done (interrupted, of course, by phone calls about the latest doings on "Days of Our Lives." I think soap operas were designed for sensory-deprived medical students - I can't imagine stomaching the repetition and inanity in my current life stage - but it was incredibly fun to dissect at the time). She is a former coffee-shop waitress, and introduced me to the flavored steamer - a nice hot pre-sleep milky drink that subsequently carried me through both pregnancies. She always made a few points higher than me on our tests - she was like the proverbial carrot that kept me studying.

On our third year clinical rotations, she developed hives. It was strange. We immediately assumed the role of medical student detective, trying to determine the source. She tried the non-latex gloves in the OR, to no avail. I remember one weekend, we decided to put all of the plants in her apartment on her back porch, to see if they were the culprit. We regarded her fish Kumar, named after the author of our second year pathology text, suspiciously - even though he was an unlikely candidate for her troubles.

The hives worsened, and became a chronic problem. She visited an allergy-immunology expert, and was loaded up on a triple-drug regimen, in order to try to gain relief on a Christmas trip with her parents to visit her brother in Italy. One night, shortly after returning from Christmas vacation, she called me frantically from the grocery store.

"I am standing in the aisles, looking at the signs for aisle content, and I can't read them. They're blurry. I've always been able to read the signs. What can this mean? I'm scared."

She went to an ophthalmologist, the next week. The ophthalmologist listened to her history, gave her an eye exam, and told her - let's look at your sugar. I am worried. It was sky high. She was diagnosed, in her early twenties, with Type 1 diabetes, about six months after her hives presented. As soon as her diabetes was treated, her hives disappeared.

I spent the next few years sharing the effects of being diagnosed with, and learning to manage, a chronic health problem. Her fears of mismanaged sugars were physically manifested in her patients at the hospital - gangrenous limbs and kidney problems. I witnessed her denial, anger, and ultimate acceptance of having to daily monitor and manage her condition by administering insulin shots. Her struggle with deciding to use an insulin pump - worries over having a constant physical reminder of her disease and ultimate relief over not having to worry so much about leaving the OR to administer her shots.

Last week, she gave a talk in the town she practices in about her experience with diabetes. We e-mailed back and forth - me reminding her of small details she had forgotten, and she sharing with me struggles I had missed - I must have been busy with a new baby or a difficult stretch of residency, and hadn't been the person she leaned on, at the time. She emphasized, at the end of her talk, that she was in charge of her illness not because she was a doctor, but because she gathered information and tools, and chose to live a healthier lifestyle. She was interviewed by a local TV station. She called me, when it was all over. I asked, "How did it go?"

"Well, a lot of the audience had Type 2 diabetes. And I think I spoke to them. But the most rewarding part was when a 14 year old girl, who had just been diagnosed with Type 1 diabetes, came up to me with her parents at the end of the talk. They were all practically in tears. They were still stuck in the overwhelming stage of new diagnosis, and so happy to find a resource, a successful one (if you can consider me a success - she is so humble), and they got my number. They want me to be her eye doctor."

I am so proud of my friend. She is a success. I can't imagine having to grapple with a chronic illness in medical school, but I have encountered many others who have, in med school and in my residency and attending career. Testicular cancer. Breast cancer. Heart transplants. It amazes me. Makes being a mother in medicine seem not so tough, after all.