Learning to Live With diabetes

For a long time I despised myself as a person with diabetes, because I despised my condition as a sign of weakness and apparent inferiority. This spontaneous adoption of negative attitudes towards disease makes it impossible for patients with chronic diseases to accept their state. They must therefore work to free themselves of this attitude. This is not easy, because they are constantly reminded of it. For example, I experienced this common prejudice at first hand when I began hemodialysis, despite the sensitivity and tactfulness shown by the doctors and nurses at the first session. In this state, the patient very soon becomes just another object, especially for the medical staff. The patient is a fistula, a weight that needs monitoring, and then a "grouch" demanding to be "unplugged" on time, because he cannot stand another minute of this humiliation when life is going on somewhere else without him. It was while I was having dialysis that I felt most aware of the proximity of death, of my death. During those hours, when I was on the receiving end, I was not living, I no longer existed. All that was lacking to make me completely dead was the unconsciousness of a corpse. I was overcome by an insurmountable lassitude. And then, when I was liberated from the machine, there was the sadness of having had to endure all this. What kept me going was the richness of the life I was fortunate enough to lead outside dialysis, and the intermittent hope of a transplant (intermittent, because once I was on the list I did not think about it all the time). I did not look on it as an improbable and dreamtof release, but looked forward to it as a guarantee of a personal future. My journey -from supposedly healthy child, to adolescent and then adult with diabetes, to kidney failure patient, to successful transplant recipient - has perhaps led me to some rather unusual conclusions about disease and health, and their paradoxical relationship. When I was condemned to certain death from dehydration and acidosis, the insulin injections that saved my life did not cure me at all. On the contrary, from my perspective, this medical intervention actually marked the beginning of the condition. I entered a new state, characterized by its chronic nature, in which "good health" seemed only to entail the constant strain of attempting to achieve a precarious balance, whilst simultaneously waiting for the onset of the inevitable "complications." However, at the darkest moment and, paradoxically, thanks to it, I was offered a double transplant and the opportunity to begin a new life. This is why I consider myself the living embodiment of that wonderful phrase in Friedrich Nietzsche''s Ecce Homo: "Sickness is a way of looking at health." How then do I define good health today, when it is still conditioned by a treatment, the benefits and dangers of which are all too present in my mind? I would say that good health is a process defined as much by pathol ogy as by treatment. This understanding involves me as much as it does my doctors. It is a practice and a culture in the sense of something that you have to cultivate and maintain, like happiness, something that enriches itself from itself. I feel that I now have a better relationship with my body, with my fellow humans, and with the world than ever before. The medical revolution To conclude, I would like to add, paraphrasing de Sade in his famous satire on the French Revolution, "Doctors, one more effort." The medical revolution is on the march, and not only because of the remarkable discoveries that marked the 20th century. What is changing, what must change, is the relationship with the patient, and the very notion of the patient. Today the passive patient is an anachronism - or a failure. The great medical revolution will occur when it becomes obvious to everyone involved in medicine that the patient is a person, an individual. And it is not only doctors who will have to make this effort. Today''s patients, with their consumerist outlook, also tend to see themselves as passive objects.