For Lent this year I'm giving up sleep. This was not a deliberate choice. It was thrust upon me last month—upon all of us—by the sudden death of Sally, our daughter Dara's diabetes-alert service dog. For the past two years Sally has accompanied Dara everywhere, able to sense a rapidly rising or falling blood glucose level through the genius of her doggie nose. She was trained to alert Dara to these potentially life-threatening changes with a lick to her hand, prompting her to do a finger-prick blood test and correct any irregularities before they result in a medical crisis.
Even at night—especially then—the vigilance continued, as she learned to rouse Dara from sleep with a lick, a nudge, or a bark when her sugar level swung out of control. Besides being my daughter's cherished companion, Sally sitting guard at Dara's bedside allowed me to sleep more peacefully than I had in years. At 33, Dara is no longer a child, but the complications of dealing with her diabetes remain beyond her grasp. She lives with us still, planning and cooking all our meals, but depending on us—and on Sally—to help her manage her diabetes.
We had expected Sally would have a service dog's normal working life of 8 to 10 years, after which she would retire with honors, to remain a beloved pet in our home and even assist us in training her successor dog. Instead, sudden liver failure ended her life at two-and-a-half, and left me to my former sleepless nights and endless worry.
It's an hour after midnight and I'm wide awake. Freezing, actually, standing beside Dara's bed shaking her out of a sound sleep. Because I need to use my hands freely, I've peeled off the padded, foam-filled sleeves and gloves I wear at night to keep my arms and hands from swelling—a chronic side effect left over from breast cancer treatment several years ago. In contrast to my sulky attitude toward waking up in mid-dream, Dara is unfailingly gracious about obliging my middle-of-the-night requests for a blood test. I have no idea why she is so pleasant about it. Perhaps because she remembers past medical emergencies and is only too glad to avoid a repeat. But more likely it's because she's an unusually agreeable person with no axes to grind. I find her inspiring.
I aim the flashlight and steady the tray that holds her blood testing supplies, while she cocks the lancet device and presses it against her finger. She flicks the trigger that stabs the point into her skin. A drop of blood swells on her fingertip, and she slips it onto the test strip. Heads together, we stare at the meter as it counts down the seconds—5, 4, 3, 2, 1—until a digital blood glucose level appears in the window, telling me what I need to know. We share the intense focus of casino gamblers hunched over their slot machines, hoping this time everything will align correctly and we can claim the jackpot: in our case, a couple more hours of worry-free sleep.
After the mental gymnastics of figuring out what to do with the information I've read off the meter, and making whatever corrections are necessary to assure a few more hours of crisis-free rest, I struggle back into my lymphedema night garments and crawl under the covers of my own bed. Bob's hand reaches out and folds around mine, a silent thank you. I'm comforted.
But once fully awake, sleep eludes me. My mother-mind races through a review of the next day's responsibilities. I still need to put up the seasonal decorations—the plastic spring flowers, wall posters of chicks and lilies, a centerpiece of painted wooden eggs. It's my favorite holiday season, but for us it has a history. It's a time when Dara's blood sugars are even more unpredictable than usual. The changing activity level of this busy time of year and the excitement of Easter anticipation cause frequent severe blood sugar drops, with their threat of sudden unconsciousness and—at least in her early years—convulsions. Every Easter has had its own crisis, but one still stands out, from the year Dara was thirteen. Even these many years later the memory of it is vivid with the sharp detail of exhaustion and fear. I lie in the dark, remembering.
* * *
3:08 a.m. Good Friday. The day is appropriate—that remembrance of the clashing convergence of forces: appearance and reality, indignity and majesty, death and triumph. Jarring juxtapositions, outcome uncertain.
I find myself in a rocking chair, swathed in a blanket. Everything in the room has an air of haste and disorder, though the earlier chaos has passed. I'm aware of the heavy, homey peanut butter smell from the untasted sandwich on the desk; the uneven illumination of tiny white Christmas lights draped over the bedpost, long past their proper season; and my attention to Dara's every movement as she settles under her covers in her bed beside me.
Diabetes is a series of unscheduled events, spiking a suffocating lifestyle of regulation and monitoring. Meals are timed and food portions weighed and measured, insulin administered in a prescribed rotation of injection sites on her stomach, thighs, and buttocks. Exercise is monitored and must be compensated for by carefully-calculated snacks.
That's where I went wrong this time. We took a walk together after dinner, and I didn't realize it was more exercise than usual. In retrospect, of course—and given the added clarity of this dark and silent hour, my mind swept clear by crisis—it is obvious. I should have given her extra carbohydrate with her regular bedtime snack.
Well, I didn't, and within hours of going to bed Bob and I are roused by Dara's gasps. I grab the tube of glutose—a gel of concentrated sugar—that I keep in a bowl beside my bed. She is already convulsing when I reach her, but her eyes, the only steady point in her thrashing body, find mine and focus on me, begging help. I bite off the tip of the tube and squeeze some of the mixture into Dara's mouth.
"It's okay," I tell her, and I see her trusting me, dropping the terror even as her body coils uncontrollably. "Swallow," I say, and in a split second of calm she manages it. But then the seizure grips her and her eyes retreat. Helpless, she is suddenly beyond my reach.
"Glucagon!" I shout at Bob, and he dashes to the kitchen, pawing through the cupboard where the emergency supplies are kept. He returns with the glucagon kit in hand, and while he holds Dara I fumble with the packaging. Though I've needed glucagon for Dara only once before, years ago when she was a preschooler, I review the instructions often, and I'm both surprised and gratified to find my response now near automatic. Snapping open the plastic case, I stand the two tiny vials on the desk top. I half-fill the syringe with air and force it into Vial One, the diluting solution. Then inverting vial and syringe together, I hold them to the light and pull the plunger down, watching as the barrel fills with clear liquid. Out of the syringe and into Vial Two, which holds a dry, white tablet.
My mind seems suddenly to be composed of strata, a sedimentary formation in varied hues of meaning. At the top, I'm aware of Bob and Dara behind me, Dara's body communicating its rigidity to mine as though by some physical link. Directly beneath that awareness is a chant-like repetition in my mind of the numbers 9-1-1, along with the sincere hope that we can avoid involving paramedics. Beyond their representing the trauma of IVs, the emergency room, and hospitalization, I am even aware of the alarm the neighbors will feel if the fire truck and ambulance arrive, and I'm sorry for them and for the minutes of anxious waiting they'd endure. I see them standing at their windows or huddled on porches, pajama-clad or with jeans thrown on, and sockless, shoelaces dangling—until somehow information reaches them in whispered snatches: "Insulin reaction, pretty severe this time; got an IV in; off to the emergency room." This news, passed from house to house. And then the waiting. Please, God, no paramedics.
Deeper still, a layer of consciousness is reviewing biological details. How glucagons—a hormone—releases stored glucose from the liver and rushes it into the blood stream, nourishing the glucose-starved brain cells, restoring peaceful function to the whole body. In diabetes it's the pancreas that is the villain, since it ceases to manufacture the hormone insulin, necessary to allow body cells to use the nourishment catered by the blood. So we inject the insulin daily, and we hope our calculations match the unpredictable and temperamental demands of Dara's body. Sometimes we're wrong.
Amazingly, some other stratum of mind has taken over with the glucagon. I watch, almost an objective observer, while my hands shake Vial Two and withdraw the reconstituted brew back into the syringe. I check for air bubbles and, finding none, attempt to inject it into Dara's bared thigh. The muscle is tensed and as resistant as leather, but I drive it in anyway, listening with some part of my mind to my own sharp intake of breath.
In that instant I've done all that is humanly possible to do. The silent mystery of body chemistry takes over. I wonder, while I mutter reassurances to Dara, if the rush of glucose into the plunging current of her blood is as clumsy and shaken as my own efforts have been.
Within minutes Dara's body slackens and she's reduced to simple shivering, her eyes struggling to refocus. She emerges into consciousness slowly, in a kind of culture shock. "What's that?" she asks about my pale hand covering hers, about her bed sheets, about the familiar digital meter I produce to test the level of her blood glucose. She stares around the room, wide-eyed, as though seeing everything for the first time. My insides scream for the reassurance that she's all right, but I hold my tongue, offering only welcoming phrases, giving her time to return from the frightening far country she's been traversing alone. It's another half hour before coherence returns.
5:00 a.m. Dara's dozing now, between bouts of vomiting, a reaction to the glucagon. She can't eat the peanut butter sandwich that would help stabilize her blood sugars, but even so she's out of immediate danger.
And I am keeping this vigil, recording hourly finger-prick blood test results, periodically swabbing out the plastic barf bowl. The strata of my brain are subsiding again, trapping memories between the layers like fossil imprints.
* * *
We've lost the safety net of Sally's vigilance, and the sudden shock of being thrown back into that pre-Sally whirl of worry and sleepless nights is dizzying. There will have to be another dog, but training a new one will take a very long time. First the months of teaching simple obedience—sit/down/stay, of course, and walking beside Dara without pulling. And socialization—learning to tolerate crowds, noise, and narrow misses with other people's grocery carts. All that before we can tackle the scent training, alert signals, fetching Dara's diabetes supplies when she's disoriented from a low blood sugar. In the meantime I scramble to figure out how best to fill the role Sally played in our lives.
Dara, on the other hand, adjusts with grace. In these dark nights, when I rouse her for a blood test, she wakes smiling, happy to avoid an emergency no matter how that happens. Despite the pain of her loss, Dara is aware she needs to replace her special friend. She brought it up herself within days of losing Sally, and I asked her preferences. "Next time," she said, completely serious, "can we get a dog without a liver?"
I'm comforted by the way my daughter has handled her grief, asking without embarrassment for the help she needs, whether it's a sunny yellow gerbera daisy to put in her window or time alone to sort out her feelings. After tonight's blood test, in the middle of a long hug, I tell her how proud I am of her.
"What for?" she says.
"For being sad in your own good way," I tell her. "For knowing just how to do this very hard thing."
She nods into my neck. "You just take one step," she says, "and then you take another one."
I have great mentors in my kids.