by Peter Corris
I couldn't conceal this state of affairs for very long, especially after experiencing several very severe hypos after falling asleep at night. On these occasions Jean was unable to get me to take sugar and was forced to call an ambulance and enlist the aid of the paramedics.
These incidents naturally caused Jean great distress. She couldn't trust me when the children were in my sole care, as they frequently were, and when she flew to Melbourne after her mother suffered a series of strokes and apparently did not have long to live, she had to arrange for friends to stay with me and the girls. But she did not feel she could impose too long on the friends and flew back – on a night when the most severe of these hypos hit.
Usually, the paramedics were able to inject glucose and bring me around but this time, when I had terrified Jean by shouting and throwing myself violently around the room, bouncing off and bloodying the walls, she had to take the children next door. I fought the ambulance men like a berserker, but remember nothing of this. A second team had to be called to overpower me and I emerged from this episode with a broken collarbone and a torn arm, from thrashing about and resisting the glucose needle.
Through literary agent Tim Curnow came the offer of two long articles on the search Ruth Park and her late husband D'arcy Niland had conducted in America for people there who had known Les Darcy. I was the obvious person to vet the articles and to select photographs from the large collection Ruth had at her house in Palm Beach. It was a hot day when I travelled up there by bus and walked a fair distance to the house.
She was charming and amusing and we got down to work on the selection. That is almost all I remember of the meeting.
Later, when I woke up in the casualty ward at Royal Prince Alfred, I had a dim recollection of a taxi. Apparently, after we had picked the photos and made arrangements to have them copied, I had become confused and Ruth had called for a taxi to take me to the bus stop. In the taxi, just before the hypo hit with full force, I asked the driver to take me to Glebe. On the way I sweated and raved and he took me to the nearest hospital to home – again, RPA. He also took 20 dollars from my pocket for his fare.
The doctors in Casualty expressed great concern at my condition. It had taken a massive injection of glucose to bring me around and they wanted to know why I hadn't taken the glucose tablets I was carrying, and why I had nothing on me to indicate I was a diabetic. The answer to the first question was that these hypos were so sudden and severe that I became too confused too quickly to act rationally. The answer to the second was bravado and irresponsibility.
13Getting better
'You came very close to the tin cup and the white cane.'
Dr Warren Kidson, 1979
Alarmed by my condition, the doctors called in Dr John Burgess, a distinguished endocrinologist who had rooms in the hospital's medical centre. Not surprisingly, I have little recollection of our first meeting. John has since told me that the hypo was so severe that initially I was disoriented and would have had difficulty remembering events over the previous 24 hours, and for some time later. He suggested it might be more convenient for me to see him than Warren Kidson, given that I lived so close in Glebe.
This was insightful of him. The truth was that I was not keeping in as regular contact with Dr Kidson as I should have done. The doctors sorted the matter out between them and I became John's patient.
I found him sympathetic but not without severity. I told him of my drinking habits, which still were not always under control, and of my history of retinopathy, hypos and the recently adopted fitness fetish. He recommended that I change my regimen to one involving three injections per day: Actrapid, the insulin that lowered blood sugar quickly, before breakfast and lunch; this plus Monotard, a slower acting insulin, before the evening meal.
The object was to approximate more closely the way the body naturally produces insulin to cope with the intake of food. Of course, the amount of activity remained a variable, but it was far safer to run in the morning after a smaller dose of insulin than it had been previously after the dose designed to last most of the whole day. I have continued to consult with John Burgess or an endocrinologist once a year and to have extensive blood tests to monitor my condition.
Twenty years after the initial diagnosis, I began to adopt a responsible attitude towards the disease.
This change spelled an end to the incapacitating, hospitalising hypos, but out of vanity, pride in my new fitness and sheer stubbornness, I continued to run too much and too far and eat too little. I was testing more frequently and trying to achieve a better balance, but I was still ignorant of many of the elements of control.
The 'piss strips', improperly used, yielded unreliable results and I frequently miscalculated. I still had severe hypos, so Jean's fears were not allayed, and after the many deceptions I had practised (including concealing ambulance and hospital bills from her), she was understandably distrustful of me.
Although John Burgess inspired confidence, this was not true of all his colleagues. Some time after coming under Dr Burgess' care I went into hospital to have a vasectomy. I had the operation under a general anaesthetic and, despite having advised the doctors about my diabetes, I came around to find that I was receiving a glucose solution through a drip. I pulled the needle out and tested my urine, only to find that the sugar level was sky-high. I spent hours then walking up and down the corridor in a rage, insisting that I needed the activity to reduce the blood sugar. I had been told that the aftermath of the operation was like a 'kick in the nuts', but I suffered no such discomfort. Perhaps I was too angry to notice.
My reaction to this medical foul-up was a positive sign. I had begun to care passionately about good control and I resented every urine test that was above the accepted range. I was seeing diabetes as a central fact in my life and the management of it as essential to my well-being and happiness, and my effectiveness as a parent.
Jean and I moved to Coledale on the south coast and I continued with my fitness program, running along the coast road fringing the beach, swimming and running back. In fact I became obsessed with it and swam all year round, whatever the weather. I managed to cut down on my drinking and, with a lot of grass to mow, wood to chop, and some water-carrying for Sofya's horse, I became fitter than I'd ever been. The diabetic control improved markedly and when I reported to Paul Beaumont on the anniversary of the end of my laser treatment he pronounced the retinopathy 'quiet' and congratulated me.
After 20 years as a diabetic I had finally earned some praise for my discipline. It meant a great deal to me and it was confirmed by the blood tests which were to become an annual event under Dr Burgess' direction. For probably the first time in 15 years I was in a fairly sound biochemical condition. My eyesight was irreparably damaged: I had lost most of my peripheral vision and the capacity to adapt quickly to changes in the degree of light. But it was functional and I had sufficient acuity to continue to hold a driver's licence. Other damage and disturbances would emerge as years went by, but I had pulled out of the spiral that would have left me blind and incapacitated. As Dr Kidson said, in a phrase that has remained with me ever since: 'You came very close to the tin cup and the white cane.'
14Going straight
Lush is a testimony to the value of insulin. After a lifetime of receiving the hormone her body could not provide she was more active than most women her age. She was trim, attractive and wore fashionable clothes with taste and style.
– obituary of Mrs Phyllis Lush, 1916-98, The Australian, 6 July, 1998.
If meeting Fred Hollows provided the psychological and emotional stimulus for me to take responsibility for my diabetes, technical improvements in the 1970s and '80s helped the process along. I can't remember exactly when I switched from the glass and metal hypodermic (with all the attendant maintenance and storage hassles) to disposable syringes, but it was liberating to do so. Somehow, the light, cheap throwaway syringes made the whole process seem less of a nuisance.
It certainly made it easier to
inject while visiting or eating out. I suspect most diabetics get a few more injections out of each syringe than just one, but I never use them so that they became blunt. Provided very cheaply by a government-backed scheme, they offer no incentive to be over-economical.
As mentioned before, the great breakthrough in daily management came with the glucometer. Compared to the units available today, only half the size of a cigarette packet, my first glucometer was a clumsy affair. Bought in the early 1980s, it cost $500, which was a stretch for me at the time. It was easy to use and accurate, however, and allowed much greater flexibility in balancing the key elements of control – diet, insulin and exercise. As it happened, that glucometer, perhaps resembling an electric shaver or some such useful item when zipped into its carry bag, was stolen.
By this time I was a fairly well-known writer and I managed to get an item on my loss printed in 'Column 8' of the Sydney Morning Herald, but there was no response. I had to take out a loan to buy another one because there was no way I was going to be without it. Nowadays, the glucometers cost less than $100 and it's possible to have one at home and one at work or one for travelling. Like insulin and the syringes, the testing strips are subsidised and comparatively cheap. I sometimes test four or five times a day when I feel the need to know exactly how the blood sugar level is moving.
While I haven't read a great deal about the disease, I did finally read The Diabetic Life, and reviewed a recent excellent book: Understanding Diabetes: Managing Your Life with Diabetes, for a Brisbane newspaper.4 I watch the press for reports on research into the disease and try to stay abreast through such programs as the ABC's Health Report. I'm not a 'joiner' so I've never been active in the superb work done by Diabetes Australia, but I did give the guest address at a recent conference held by the organisation in Sydney. I was also delighted, when asked by Dr Kidson, to contribute a story to the magazine Conquest, to knock out a Cliff Hardy yarn involving a young diabetic. I didn't do much in the way of research, but as a way of giving thanks for my lucky escape, I give a regular donation to the New South Wales Guide Dogs Association appeal.
Diabetes is on the increase and it's estimated that there are as many undiagnosed diabetics in the community as those who are being treated. These people are in danger of the most severe consequences – blindness, impotence, loss of limbs – and I am happy to stress these dangers when asked to make statements to this effect. In 1998 I gave a talk at the Redlands Community Hospital to a group of diabetic patients, mostly, but not all, Type-2 sufferers. This group met regularly with nurses, doctors and dieticians, as well as occasional blow-ins like me, and I was impressed by their knowledge and the responsible way they went about insuring their lives and their usefulness because that's what the proper management of diabetes comes down to. I also liked their senses of humour – they laughed at my jokes.
My research into the disease included noting prominent people who suffered from it: HG Wells, Ernest Hemingway and Peter Lalor, the hero of the Eureka Stockade, among many others. I wrote an article for The National Times in which I interviewed some diabetics and got their stories, among them the late Norm Gallagher, former strongman of the Builder's Labourers Federation, and the remarkable Mrs Phyllis Lush.
Mrs Lush developed diabetes in 1921 at the age of five and her father secured an early batch of insulin from Canada from the laboratory of Drs Banting and Best, who'd made the discovery. The insulin arrived wrapped in cotton wool, in the care of the purser of a P&O liner. When she received her first injection she weighed less than 10 kilograms and was close to death. An energetic and disciplined person, Mr Lush later married a doctor and lived for 76 years, enjoying good health until near the end. The Guinness Book of Records credits her as the longest known surviving insulin-dependent diabetic. Her story should be made known to all diabetics for its inspirational value.
Like all writers, I've drawn on my personal experience in producing my books. The mother of my fictional detective, Cliff Hardy, I've drawn as a poorly controlled diabetic creating unwanted drama in young Cliff's life. Diabetes figures in the first of the Hardy novels, The Dying Trade, but most prominently in Cross Off, in which a ruthless hit man, a diabetic, has a hypo at a most inconvenient time.
Another shot almost had him. He was drenched in sweat and his fingers slipped on the pistol grip. He ducked down and suddenly felt his vision blur and his strength ebb. He rubbed his hands across his eyes. He couldn't focus… He'd forgotten to eat mid-morning and all the activity and excitement had sent his blood sugar plummeting. He felt in his pocket for barley sugar but he had none. Must have dropped it. In a few minutes he'd be as weak as a kitten. He needed sugar fast.
I've been there. I knew how to write that scene.
15Life with diabetes wasn't meant to be easy
'Diabetes is an immune system disorder and immune system disorders tend to cluster.'
Dr Paul Beaumont, October 1999
The consequences of poorly controlled diabetes are disastrous. In my case, even once I'd committed myself to achieving and maintaining good control, things continued to go wrong. Diabetics commonly develop cataracts which, in days gone by, meant they suffered restricted vision and had to wear thick-lensed glasses.
Cataracts developed in both my eyes and required treatment by the mid-1980s. Luckily for me, again, the technology had improved: the implanting of intra-ocular lenses, replacing the lens that has become opaque, could restore a patient's normal vision. The IOLs, implanted in a quick operation under local anaesthetic, have given me the vision I presently enjoy. It's far from perfect, but I can drive, watch films and hit a golf ball – sometimes. I don't wear glasses to read.
The work begun by Fred Hollows and continued by the Fred Hollows Foundation, has brought the benefits of this technology to Eritrea, Nepal and Vietnam. Previously, cataract sufferers in Third World countries could not afford the lenses and there were no surgeons competent at the operation. Hollows pioneered the teaching of the technique to Third World doctors and the Foundation's lens factories in Eritrea and Vietnam are producing the lenses at an affordable price.
Thirteen years after our first meeting, when he had treated me with the contempt I'd deserved, I met Fred Hollows again. I was commissioned to help him write his autobiography. I got the job because I had a reputation for writing quickly and time appeared to be short as Fred was suffering from advanced cancer. This time we got on well and work on the book progressed rapidly. We finished it within the time Fred had been expected to live and in fact he survived for a further 18 months, enabling him to promote the book. This promotion – and Fred's involvement in several controversies at the end of his life – helped it to become a best-seller. At last count it had sold more than 100,000 copies, most of the proceeds going to the Foundation.
I had a series of blood tests while I was working on the book and couldn't wait to tell Fred my glycosylated haemoglobin readings – a very good, 6.1 result.
I reminded him of what he'd said at our first meeting and he clapped me on the shoulder. 'Good boy,' he growled. It's a moment I treasure.
As things stand I'm routinely congratulated by my endocrinologist and ophthalmologist on my good health. Paul Beaumont – who sees no reason why I shouldn't retain my present vision for the rest of my life – chilled me when he told me some years ago that the prognosis for a diabetic presenting with retinopathy as severe as mine had been in 1977, was 'the same as for someone with stomach cancer – six months'. This is because most such patients would have been much older than I was, obese and unable or unwilling to change their habits.
I do have various biochemical disturbances to contend with – low thyroid activity and a raised prolactin level among them. These are controlled by medication. More recently I have been diagnosed as having a gluten intolerance, a common occurrence among diabetics. It is an immune-system-related condition, which diabetes is coming to be seen as, and such conditions tend to occur in clusters. Gluten intolerance, or coeliac disease, if untreated, inhi
bits the body's ability to absorb certain vitamins and minerals and can increase the risk of cancer and osteoporosis. Happily, the treatment is simple: the adoption of a gluten-free diet. These days gluten-free breads, biscuits, cereals and pastas are readily available, so the inconvenience is minimal – although the extra expense is annoying.
Like most long-term diabetics I've suffered a certain degree of vascular damage which has reduced my ability to achieve and maintain an erection. A recent survey showed that only a tiny proportion of Australian men experiencing difficulties with potency seek medical advice. This is the height of ignorance and stupidity. Simple and completely effective therapy is available to solve this problem.
CONCLUSION
In one of the best book launch speeches I've ever heard, Frank Moorhouse advanced the idea that published writers should be compelled to contribute a biopsy, a tissue sample, for preservation in the National Library. Critics of the future, he asserted, might learn more about the mainsprings of their creativity from this than from minute study of their works.
Moorhouse was joking of course, but in fact there has recently been a considerable interest in the medical condition of writers. William B Ober's brilliant book, Boswell's Clap and Other Essays: Medical Analyses of Literary Men's Afflictions,5 is an example. Apart from Boswell's venereal disease, Ober discusses Swinburne's masochism, the madness of certain eighteenth century poets and Rochester's premature ejaculation, amusingly and with some critical effect. Tom Dadis' The Thirsty Muse,6 is a revealing study of the alcoholism of Fitzgerald, Hemingway, O'Neill and other American writers.
Mostly, the writers themselves have been too busy going about their creative work to discuss their medical conditions, but John O'Hara wrote about his addiction to cigarettes, Gore Vidal has mentioned his drinking and William Styron has written penetratingly about his life-and-death struggle with depressions.7 While not keen to place myself among these giants, it might be of some interest for me to have contributed this account of the disease that has been central to my existence. I have indicated the overt use of it I've made in my writing, but whether it has had more deep-seated effects, I cannot say.