by Heidi Willis
"The allergist said there are things in the insulin, you know, additives and stuff, and that maybe she's allergic to that and not to the insulin itself."
"Can you take that stuff out?"
"I think so. He said something about trying purified insulin."
"What do they do, run the stuff through a Brita filter?"
I can't tell if that's a joke or he's serious. Actually, I'm not sure that's not how you get purified insulin. I gather the papers and put them in the file of Ashley's medical history that is growing. "So we just have to switch insulin?" he asks.
"He said that may be all it takes." I go back to cooking so he can't see my eyes. After twenty years together, he'd see that I don't believe this. And if he asks enough, he'd find out Dr. Benton didn't seem to believe it either.
The light in the kitchen is fading as the sun moves to the other side of the house. We don't talk, but I know he's thinking the same thing I am, that two weeks ago we were chowing down on enchiladas and jalapeno cornbread without the slightest idea what insulin was, or that there were different kinds, or that one small, common virus could change our lives so drastically.
~~~~
I forget about the baseball paper until after Ashley is in bed and Travis is dozing in front of ESPN. I go out to the garage where Logan is banging away at the drums and lay the paper in front of him. He stops banging and looks at it, and then at me.
"It's no big deal. I don't even like baseball that much anymore."
"It is a big deal, Logan. What in the Sam Hill are you fighting about?"
"Nothing. It wasn't even a real fight." He moves the paper and starts to pound again, but I grab the sticks.
"Stop it."
He stops, but he won't look me in the eye. I don't remember Lo ever not looking me in the eye, even if it is some I dare you kinda look.
"You're not the fighting kind. What happened?"
"Troy said something, and I shut him up. That's all."
"You shut him up?"
"Yeah. Or shoved him up, more like it. Up against the lockers. But it shut him up, too."
I try to visualize my skinny beanpole boy shoving anyone against a locker, but I don't see it. I find a five-gallon paint can and pull it up to sit on. "Why?"
He sighs, like he knows he ain't getting out of this one. "He said some things. They weren't right, so I had to straighten him out."
"Straighten him out?"
"It's really annoying how you repeat everything I say when you're mad."
"I'd say I'm allowed to be a little upset that my son got in a fight, got kicked off the sports team we was relying on for college scholarships, and then conveniently forgot to tell us."
"You know, Mom, you'd like everything to be my fault, wouldn't you? Did it ever occur to you that maybe I'm not as bad as you and everyone else would like to think?"
I look at his spiked hair and ripped t-shirt, and I can't see the good kid under there at all, but I know he's there. "I don't think you're bad," I say, getting off my makeshift chair. "I think you work really hard trying to make people see you that way, and for the life of me I can't figure out why."
I start to go but Logan fires back. "Well I guess that apple doesn't fall too far from the tree, does it?"
I turn slowly. "What do you mean?"
"I mean, you do a lot of trying to make people believe something about you that isn't true, too."
Red creeps up my neck, hot as a branding iron. "You watch your mouth, Logan T. Babcock. You may be taller than me, but I'm still your Mama."
"What're you gonna do, punish me? I'm already off the team. What more do you want?"
"I want you to stop embarrassing this family by acting like some kinda rebel and start taking some grown-up responsibilities around here. You can start by putting up that drum set and taking out the trash before bed."
I'm almost in the house when he says back, real quiet, "Don't you want to know what the fight was about?"
"It don't matter," I say, not turning back to him. "Fighting's fighting, and it's wrong." Even through the shut door I can hear him banging even harder on those stupid drums, and I wonder where I went so wrong with him.
~~~~
We don't have to wait two days to find out the results of the allergy tests because by morning Ashley's shoulder where they tested her is beyond swollen, the hives on her arm and neck hidden under the puffy redness that's overtaken the right side of her.
On the way to the hospital I call Travis, who was gone when we woke, but I only get his voicemail. I call Dr. Benton's office, which isn't open yet, and get an operator who promises to get him the message. I don't call the school. I don't know if they think the expulsion is proceeding, but I got other bullhorns in the rodeo right now.
I'm no stranger to the hospital anymore, and I greet the receptionist with a howdy as I pull down the shoulder of Ashley's shirt. She immediately shows us to a curtained room and tells us she'll get the doctor right away.
Ashley's been quiet all morning. Quiet, in fact, since we got home from the hospital last night.
"You okay, Babe?"
"Yeah, I'm fine."
A nurse I've never seen comes in with a clipboard. She barely looks at us. "The doctor will be here in a minute. I need to get your information. Which one of you is the patient?"
"The one who looks like her arm is a helium balloon," I say. I get a look for that. "Ashley Babcock." I think of Logan's SAT list week 5: acquiesce. I don't know how to pronounce it, but I know it means what I have to do to get Ashley help.
"Age?"
"Twelve."
"And what is she here for?"
I point to her bloated arm and neck. "I'm afraid she got in Willy Wonka's secret stash of gum last night and things went terribly wrong when it came to the cherry pie part." Ashley giggles, but the nurse gives me a look to kill. Clearly there's no sense of humor in the ER. "She had allergy tests yesterday, and this is what happened."
"Is she taking any medications presently?"
"No."
"Benadryl," Ashley reminds me. "I'm also taking insulin: aspart and Lantus."
"Except for dinner last night you took the lispro instead of the aspart," I remind her. I look at the nurse, whose pen is hovering over the page waiting for us to decide. We're the medical equivalent of Laurel and Hardy. "She's taking aspart, lispro and Lantus."
"Are those insulins?" She doesn't think we're funny. I don't think it's particularly funny that she don't know what aspart, lantus and lispro are.
"Yes." She writes that down. Just "insulin."
"Anything else?"
I look at Ashley and she shakes her head. "No."
"Any allergies?"
I think she must be joking, but there's no humor here, so I point again to Ashley's arm. "Clearly she's allergic to something."
"And do you know what that is so I can write it on the chart?"
"If I knew that I wouldn't be here, would I?"
"Ma'am, I'm just trying to do my job. There's no use being snippy with me."
"I was thinking the exact thing." We stare like two dogs in a fight before she looks back at her paper.
"So no known allergies?"
"No." I sigh.
"And are you the parent or guardian?"
"I'm the parent."
"And your name?"
"Babs Babcock."
"I need your official name, please."
"That is my official name."
"I mean, your given name, not a nickname."
"That is my given name."
"Babs Babcock?"
I can feel myself getting hot under my collar. Ashley still has the giggles. "Yes. That is my given name. Actually my given name was Babs Deanne Walker, but then I got married and my name officially became Babs Walker Babcock."
"Your parents named you Babs?"
"Short for Barbara, except my mother was Barbara and they didn't want people confusing us. Is this important to my daughter's condition?"
"
And you just happened to marry someone named Babcock?" She has stopped writing now and her eyebrows are so puckered they almost touch.
"Is a doctor coming soon? I'd like someone to see my daughter before her arm blows up. Is that possible?"
She seems not at all pleased with me and scoots out her chair with a loud fingernail-across-the-blackboard scraping and holds out her hand. "I need your insurance card, please."
"Of course." At last something that's relevant. "We wouldn't want to leave without making sure you know where the money's coming from, would we?" I hand it to her, and she snatches it from me and leaves.
Ashley bursts out laughing. "Willy Wonka? Do I look that bad?"
"Well, you ain't pretty," I say, trying to smile. But as I look at her wiping happy tears off her cheeks, I think just the opposite.
~~~~
Chapter Thirteen
Dr. Benton shows up a few minutes later, his hair still wet, wearing running pants and a black t-shirt. He could be some model in a Calvin Klein ad.
"Sorry it took a while to get here. You caught me at the gym. So you gave Nellie a hard time?" The twinkle in his eyes told me I wasn't the first to get her goat. "What have your blood sugars been the last 24 hours?"
I hand him the logbook where Ashley's writing down everything she eats and the time and amounts of her shots. He glances through it. "Is there any reason you know why your readings have gone up in the past day? Anything you ate that is hard to calculate? Any snacks you didn't write down?"
Ashley shakes her head.
"I know your mom is here, but you need to tell me the truth. It's really important. We need to find why your blood sugar has gone up 250 points when you haven't eaten anything. Did you miss a shot?"
I think Ashley's going to cry when she shakes her head. "Honest. I didn't eat anything."
He looks at me and I nod.
"Okay, then, I'm going to look at where the allergist gave you the shots. It won't hurt. I just want to see which ones gave you the most trouble back here."
He examines her without any other words. When he finishes, he just says, "I'm going to find the allergist who did the shots. Can you wait a few more minutes?"
He don't wait for an answer because we aren't going anywhere.
"I don't think he liked what he saw," Ashley says.
"Nonsense. He sees stuff like this all the time. It's just an allergy. We'll find out what it is that you're allergic to, and then we stop using it."
It takes a long time before he comes back, the doctor from yesterday in tow. They both look again, without talking, and they leave again.
"Something's wrong," Ashley says. "He's always really nice. He always jokes with me. What do you think is wrong?"
"Nothing's wrong," I say, but I don't believe it. I see the same thing Ashley does, and it ain't good.
When he comes back, he's alone. He pulls up a swively chair, and the twinkle is completely gone.
"What is it?"
"Well, it looks like I was right. Ashley has an allergy to insulin."
"So we just switch, right? That's not too bad, right?"
"It's not that easy. She doesn't have an allergy to just aspart or lantus or any of the others. She has a systemic allergy to all of them."
I search his face for some sign that he's kidding us, but there's nothing. I feel Ashley stiffen beside me. "But I need insulin. Don't I? Don't I need it to stay alive?"
"Yes."
"But I'm allergic to it?"
"Yes."
"Then there's something else, right? Something else I can take?"
"No. There's nothing else."
Ashley looks at me wide-eyed and scared. I'm out of my body, watching this like a scene out of a movie, because this cannot be happening. People who need to take insulin to stay alive don't become allergic to it. God wouldn't do that to people. God wouldn't do that to Ashley.
"This happens. It's really rare, but it happens. You have a systemic allergy. That means it's not just one part of your body, like the place where you give yourself a shot, which reacts. Your whole body is reacting to the insulin."
"Does she have to take medicine on top of the insulin then? Something that keeps her from rejecting it?"
"That's a start, but it isn't that simple. If we keep giving her this amount of insulin, her body is going to continue to reject it, and more forcefully. Already, in just a small timeframe, she has hives all over, and the insulin itself isn't even working. That's why her blood sugar is so high."
"Am I going to die?" Ashley's voice is freakishly high.
"Of course not," I say. Dr. Benton doesn't say this. What he does say are the words I don't want to hear.
"We need to admit her into Children's Hospital again." He stands and lays his hand on Ashley's good shoulder. "We need to get on top of this quickly. There are a couple avenues we can take. The first is to get you on some stronger antihistamines, to see if we can't get your reactions under control. Also, we're going to take you off the shots and put you on a subcutaneous insulin pump."
"A what?"
"An insulin pump. It's a little machine the size of a cell phone that will deliver insulin through a tube directly into her abdomen."
"I'm going to have to be hooked up to a machine?"
"A very little machine."
"For how long?"
"If it works, forever. The good news is you'll be done with shots. The pump will act in place of the shots, kind of like your own pancreas. It will give you a lot more freedom eventually to live a more normal life, too."
"How can it be normal if I'm hooked up to a machine all the time."
"A very small machine. I guarantee almost no one will even notice." When Ashley raises her eyebrows at him, he lifts his shirt and pulls a black gadget off his belt clip and holds it out to her. A tiny tube runs from the bottom of the pump and disappears into his sweats.
She holds the pump, small enough to clamp in her fist, and stares at Dr. Benton. "You have diabetes?"
He nods and takes the pump back. "Since I was three."
"Why didn't you tell us?" I ask.
"Is that the first thing you want people to know about you?" A look of understanding passes between them "I need to shuffle my appointments around today and take care of a few things at the office before I get to Children's Hospital. I'll phone them and let them know you're coming and have them get a room ready. You need to prepare for at least a few days. Can you do that?" I nod. "Okay, then. Have you eaten this morning?"
"No," Ashley answers.
"Don't eat. Can you do that?"
"Yes. I'm not really hungry anyway."
"The high blood sugar will do that to you. You do need to drink as much water as possible, though. And throw out your aspart, but keep the lispro, okay? Lispro is less likely to cause allergic reactions, so that's the one we'll try in the pump."
"What about the Lantus?"
"Throw it out too. The pump uses only one kind of insulin. That will help, too, with the possible allergic reactions. Any other questions before you leave for the hospital?"
"Will this work?" This is me asking, but I see the question in Ashley's eyes, too.
"Maybe." Dr. Benton sits down again. "It might work, but it might not. I told you this is pretty rare. The combination of antihistamines, some good immunosuppressants, and the pump take care of the problem in about half the cases."
"Half? What about the other half?"
"Then we move on to something else."
"What else is there?"
"Maybe we should take it one step at a time. Let's see if this works. If it does, there's no need to worry about what else."
"I want to know," Ashley whispers. "What are the other options?"
He seems to study us before answering, as if he is trying to see if we can take the news. "If it doesn't work, we'll try something called desensitization. It's the same kind of thing we do with people with hay fever and grass allergies. We give shots a little at a time of the substance, incre
asing the amount until you build a tolerance to it."
"You're going to keep giving her the stuff that's making her look like this?"
"Yes. But not in these quantities. In much smaller quantities, so she doesn't have quite the reactions."
"But won't her blood sugar be really high if she's not getting enough to begin with?"
"Yes. Which is why we'll need to keep her in the hospital. We'll have her on a special diet, probably mostly through an IV, and watch her very carefully."
"Does that usually work?" It seems to me if that would take care of the problem we should start there.
"Sometimes. Sometimes not. I'm not trying to be a wet blanket here. I just want to be honest."
"Has anyone ever died because nothing worked?" This is Ashley again, and I'm surprised she can ask the hard questions I can't make myself ask.
Dr. Benton doesn't answer for a minute. He looks like this is as hard for him to answer as it is for her to ask, and I know before he opens his mouth what the answer is going to be.
"Yes." He takes a deep breath. "But very few. Rarely. Very rarely. And I'm not going to let that happen to you, okay?"
I know he can't promise this, but Ashley has complete trust in him, and I let the sentence rest in air.
"Go pack your things. I'll see you this afternoon in Austin. We're going to get you better, okay? This is just a blip on the radar screen. Next year you'll look back on this as just another page in your diary. Or in your scrapbook. Or wherever you ladies keep that information these days."
When he leaves, I expect Ashley to cry, but she don't. She's quiet until we get to the car, when she suddenly blurts out, "The youth group is having a movie night on Saturday. Do you think I'll be back in time to go?"
This is twelve. I know, because I remember it, and it's so normal it makes me laugh out loud. Ashley frowns at me like I'm making fun of her, but I'm mostly just amused at the equal level of importance she gives her health and a social gathering.
"Well?"
"Probably not, sweetie. But there will be others."
She pouts a bit on the way, and for the first time since puberty struck, I'm enjoying it.