The amount of sugar, more properly called glucose, in his blood was low because he was injecting insulin daily, and had evidently miscalculated. The insulin drove the sugars out of his blood and into his cells, and did an overly enthusiastic job of it, and so he found himself trembling and disoriented. I know the feeling. Since I developed diabetes, I have had this experience many times. Let me tell you what it feels like: the life is draining out of you. Your bodily energy is like a sink filled with water, but somebody has pulled the plug and your very vitality is slipping away. You may feel melancholy. You may have the shakes. If you’re sufficiently low, the shakes can be so bad that you have trouble pricking your fingertip to squeeze out a drop of blood so the glucometer can tell you just how low you are. Sometimes you feel so wretched that it does not even occur to you that you are low. But eventually you figure it out. I know all the numbers. Let me tell them to you. If you are eight or above, you’re definitely too high. Not good. High blood sugar levels can lead to nerve and organ damage. If you are between six and eight, it’s not so bad, but not optimal. When you are fasting, if your blood glucose reading lands between four and six, you’re spot on. Where you are supposed to be. Where a healthy person with a healthy, functioning pancreas would be. Although for me, I start feeling bad at anything under five, and distinctly awful if I am at a four. If I am at three, I would probably be shaking so badly that I could not prick my own finger. Under two, and I would not be conscious. I’ve had one or two readings over the years between 2.9 and 3.1, but thankfully they’ve become rare as I’ve become more adept at anticipating what food, exercise, and insulin mix I need to stay in a better zone.
I usually guess my blood sugars before I take them, because I’m that kind of guy. Make a game of it, run the numbers in my head, try to guess — by what I’ve eaten, how much I have exercised, how many metformin pills I have swallowed, or how much insulin I have injected — just exactly what my levels will be. What I most like doing is guessing how much my blood sugars have dropped over the course of exercise: say, after going out for a one-hour jog. In my case, they can easily go down five points. I could start a run with a blood glucose reading of ten, and finish it at five. That would be quite typical for me. Sometimes I drop more, or less. Sometimes I finish a run higher than it was when I started. That’s either because the liver kicked in and drove some glycogen into my bloodstream, or because I drank too much Gatorade in the course of the run. That’s the other thing. I don’t like to be anywhere without access to two things: my glucometer and some apple juice, in case I am having a low. If my blood sugar is going to betray me, I want to be prepared.
I don’t mind watching my blood rise and fall over the course of a day. Doctors and nurses tell me that keeping close track of my blood glucose levels is one of the best ways to keep it in a healthy range. You’ll know very fast if you’ve been eating too much, or injecting too much insulin, or failing to hit the right balance of food, exercise, and drugs. Other things, of course, can throw you off track too. Stress drives up the blood sugar count. So does being sick, such as having the flu. Although there is no cure for diabetes, millions more people would die or be incapacitated had it not been for the work of the Canadians Frederick Banting (who won the Nobel Prize for his life-saving research), Charles Best, and other scientists, who discovered that the use of insulin produced by the pancreas could stave off the ravages of the disease by helping diabetics keep their blood sugars at healthier levels.
Every part of our body craves blood. No part of us can do without it. But the body is a sensitive beast. It is humbling and striking to realize how acutely the body reacts to the tiniest fluctuations in the chemical composition of the blood. Through the natural physical processes of blood, we see the march of human life. We see fathers passing blood legacy on to sons; mothers mourning their unborn children when the blood mistakes the fetus for a foreign body; a nation in a test tube of blood — equipped with citizens working to keep the “economy” circulating, a government to maintain our infrastructure, an army to defend against foreign attackers. Blood, indeed, is the stuff of life.
BLOOD IS MEANT TO REFLECT our humanity. In the Old Testament, the lamb’s blood on the doorposts of the Hebrews signified the innocence and the vulnerability of the Israelites in the time of Egyptian slavery. Indeed it inspires the Jewish tradition of Passover, celebrated by millions today. A soldier, having been injured on the battlefield but having survived to return home later, is said to have shed blood for his or her country — and this is meant to confer valour and honour on the soldier. We are supposed to respect him or her more, precisely because they have lost blood for their nation, or for the goals of their people.
We now know that people have different blood types, but the fundamental sameness of our blood — its colour, texture, and functions — is supposed to link us as human beings. This is what William Shakespeare says in creating the character Shylock in his play The Merchant of Venice. Shylock, a Jewish moneylender, is intent on extracting a pound of flesh from the defaulting debtor Antonio, who has previously insulted him. However, as the play unfolds, the tables turn against Shylock. He learns that he will not be allowed to cause any loss of blood in taking Antonio’s pound of flesh. In addition, Shylock is accused of conspiring against the life of a Venetian citizen. When his situation looks desperate and he is anxious to establish that he is just the same as those who would accuse him, Shylock — a Jew — says to Salarino: “Hath not a Jew eyes? Hath not a Jew hands, organs, dimensions, senses, affections, passions? Fed with the same food, hurt with the same weapons, subject to the same diseases, healed by the same means, warmed and cooled by the same winter and summer, as a Christian is? If you prick us, do we not bleed?” Shylock’s plea does not save him from defeat and humiliation: he must forfeit his property, will his estate to a daughter who eloped with a Christian suitor, and convert to Christianity.
Blood filters through our consciousness thanks to Shakespeare and countless other writers, and we feel its rhythms the same way we sense the natural beauty of the iambic pentameter. Blood resides in the drumbeat of our hearts, but it is also deeply embedded in the tempo of our language.
What, after all, is a bleeding heart but a contemptuous reference to a person who cares too quickly and superficially for the plight of others? If you are bloody-minded, you concern yourself overly with gruesome matters. When we think of blood sports, we have in mind the activities that celebrate not just killing but the spilling of blood: the way foxes might be torn about in a hunt, or the way picadors stab a bull so many times that it is weakened and all its blood streams across its ribs and onto the earthen ring in the bullfight. A crowd that calls out for blood is your collection of rabid hockey fans when a scrap breaks out on the ice, or the instantly formed circle of high school kids around a pair of fighting students, each group hungry to see blood spill. If you are a cold-blooded murderer, you are no longer quite human but rather have been likened to a reptile with an entirely different — and distinctly unhuman — blood system. If you have blood on your hands, well, you’ve done something terribly wrong and people have either figured it out or they surely will soon. Blood on the hands pretty well guarantees that people will want to see you brought to justice. We all know that getting money back from the tax collector who was, perhaps, too exuberant in the exercise of his duties is like extracting blood from a stone. If you have a blood brother, you have opened up your flesh to that of a friend who has done the same, and in exchanging bloody skin surfaces you have created a bond that runs as deep as — or perhaps even deeper than — family. If you have bad blood in your family, everybody knows that it would be foolish indeed to marry you, because you obviously fall short of having a respectable moral code. If you are out for blood, you have violent intentions and you should know better. Let’s hope that someone brings you to your senses, and that blood stops pounding in your temples. If you have royal or so-called blue blood, millions of people will look up to you and possibl
y agree to keep paying taxes to keep you in Buckingham Palace, and in our collective imagination, your corpuscles are indeed of an elevated, unusual, and vaunted quality. If somebody makes your blood boil, you have become so upset that you have temporarily lost your humanity and become another sort of animal entirely, whose blood is allowed to change temperatures radically. If somebody says of you that “blood will out,” you know it is an insult, to the effect that your family characteristics cannot be concealed. In a sonnet called “Blood,” first published in the Nation in 1928, the American poet Robert Frost wrote: “Oh, blood will out. It cannot be contained.”
Blood, indeed, filters into every aspect of our language and defines who we are: in our emotional states, in our social ranking, in our state of innocence or moral guilt, and most important of all, in our relationships to each other.
Blood is truly the stuff of life: a bold and enduring determinant of identity, race, gender, culture, citizenship, belonging, privilege, deprivation, athletic superiority, and nationhood. It is so vital to our sense of ourselves, our abilities, and our possibilities for survival that we have invested money, time, and energy in learning how to manipulate its very composition.
TWO
WE WANT IT SAFE AND WE WANT IT CLEAN:
BLOOD, TRUTH, AND HONOUR
I FELT A WAVE OF EMPATHY when I watched Paula Findlay finish last in her triathlon at the 2012 London Olympics. The Canadian crossed the line crying and in obvious discomfort. Findlay is an elite athlete. Prior to the Olympics, she had won numerous international triathlons, been ranked number one in the world, and considered a medal favourite in London. General Mills, the cereal company, was using her image on boxes of Reese’s Puffs. However, on an August day in London’s Hyde Park, Findlay, twenty-three at the time, was the last of fifty-five female competitors to cross the line after a 1.5-kilometre swim, a 43-kilometre bike ride, and a 10-kilometre run. Posting a post-race description on her blog, Findlay mentioned that her swim went poorly and her bike ride even worse, but that she felt wobbly and powerless after running the first of four 2.5-kilometre laps. “I pulled off to our team doctor, crying that there was no way I could physically finish three more. He encouraged me to pull myself together and finish if I could, I’d be more satisfied with crossing the line than not. So I ran three of the most painful, embarrassing laps ever, being lapped by the race that I was supposed to be a contender in, humiliated and screaming at myself inside.”
Findlay had recently come off a hip injury, but another problem contributed to her poor showing at the Olympics. In a blog post five weeks after the race, Findlay wrote: “I had some blood work done about a week after I arrived just to make sure that everything was normal. I was feeling tired but assumed this was just an effect from training hard again. Unfortunately the numbers came back with some of the lowest iron levels that the doctors had ever seen. It is a simple but quite serious problem that likely had a huge impact on my race in London, and got overlooked because of the focus on healing my injury.”
At the time that this book was going to press, Findlay appeared to be not just healthy and fit but a threat to her competitors again. In March 2013, she won one triathlon in Florida and another in Austria. Competitive sport is unforgiving. Bringing a serious iron deficiency to the starting line of the world’s most competitive triathlon is akin to missing an organ or a limb. You need the iron to produce the blood cells to carry the oxygen to keep you in the race. Minus iron, you will finish in the position that someone, from some country, must occupy: dead last. Findlay competed with honour at the 2012 London Olympics. But she would have had more success had her blood been in order.
Watching the Olympics, I wanted to reach through the TV screen and give Paula Findlay a hug. I thought her courageous to complete the race. I believe that it takes as much courage to suffer and finish last as it does to vanquish all your competitors and run away with the gold medal. I am not an elite athlete and have never been one, but I could certainly identify with finishing last in a running race — something that I had experienced many times as a teenage middle-distance runner.
I began to dream, at the age of eleven, of becoming a champion runner. By the time I joined a track club at the age of twelve, I had a plan in place. The year was 1969. One year earlier, American 200-metre sprinters Tommie Smith and John Carlos had raised their fists to make the black power salute as they stood on the podium with their gold and bronze medals at the Mexico City Olympics. They were expelled from the Games and vilified back in the United States, but I loved them for their daring chutzpah and for their fearlessness about expressing black pride. I had no thoughts about imitating their protests, but certainly wanted to achieve the same degree of success and fame. The blueprint was clear. By the 1984 Olympics, by which time I would be twenty-seven, I expected to win the gold medal in the Olympic 5,000-metre race. I would hang behind the race leaders for the first 3,000 metres, surging to break their will (and empty their lungs) until the 4,500-metre mark. At which point I would accelerate again, steadily pulling away from my last rival over the final 150 metres. I would cross the finish line 20 metres ahead of the next runner.
This grandiose dream was all to please my father, although I didn’t understand it at the time. A hard-working, domineering, charismatic, brook-no-dissent-at-home African-American immigrant to Canada, my father had little interest in relaxation, except when it came to turning on the “boob tube,” as he called it, to watch westerns and sports. While he whooped and hollered at the athletes on the TV screen, I studied him. Dad had three sporting passions, all left over from the near-religious worship of sport that had marked his own upbringing in the United States: boxing, football, and track and field. In our household, two athletes in particular became my father’s obsessions: the heavyweight boxing champion Joe Louis, also known as the Brown Bomber, and the track and field star Jesse Owens. Both sprang into international prominence as a rebuttal to the notion of Aryan superiority in Nazi Germany, Louis by trouncing the boxer Max Schmeling in 1938, and Owens by winning four track and field gold medals in the 1936 Summer Olympics in Berlin.
I decided that the most effective way to secure my father’s everlasting admiration was to become the most successful runner in Canadian history. By the age of thirteen, I was training daily and keeping a detailed logbook of my workouts. By fourteen, I often trained twice daily, getting up to run five or ten kilometres before school and doing intervals on the track in the afternoon or evening. I undertook my first very long runs by the age of fifteen, twice running the entire thirty-two-mile Miles for Millions — a fundraiser for charities that was massively popular in Toronto in the 1970s. Thousands of Torontonians hit the streets once a year to walk the thirty-two-mile route. I chose to run it. The second time I ran it, I believe I was one of the first participants to finish. But I am not entirely sure how many people finished ahead of me. It was meant to be a walkathon, not a race, and the walkers were spread out along the streets of Toronto, many hours behind me. I arrived at City Hall so early that nobody was there to greet me. Thousands of people who had the good sense to walk the route crossed the finish line over the next twelve hours — long after I had taken the bus home, had a bath, bandaged my blisters, eaten a bowl of ice cream, and gone to bed.
After Miles for Millions, I continued to dream of Olympic glory. Kipchoge Keino, the Kenyan superstar whose strength was said to derive partly from drinking cow’s blood, had won the gold medal in the 1,500-metre race and the 3,000-metre steeplechase at the 1972 Olympics in Munich. I thought about Keino and renewed my private vow to achieve my goal. I trained through sore shins and blood-filled toenails, and although I was getting faster as I aged, my competitors were progressing much more quickly. At fifteen, I was no closer to winning any significant races than I had been at the age of twelve. When I went for Sunday training runs on hilly country roads in southern Ontario with the other teenagers in my track club, I would soon be left far behind the others to ward off unlea
shed country dogs alone. What must have been patently obvious to my coach, friends, and parents, but which took time to dawn on me, was that I did not own the body of a person destined to be, or capable of becoming, a great or even a good athlete.
Finally, when I was sixteen or so, my track coach — David Steen, a Toronto Star reporter who had twice won the gold medal in the shot put at the Commonwealth Games — suggested that I take an “oxygen uptake” test to determine how effectively my blood transferred oxygen to my muscles. It was an unpleasant stress test, carried out on a stationary bicycle at the Fitness Centre in Toronto. While pedalling to exhaustion, I had electrodes taped to my chest and a mask locked over my mouth. By measuring the air that I expelled, the test would reveal how well I processed oxygen. I was a skinny, ultra-fit teenager who was logging about seventy kilometres a week in training runs, but the test did not reveal the athletic profile of a runner.
In writing this book, I asked Steen about his memory of this test. He said he thought it indicated that I had 75 percent of what would be considered normal cardiorespiratory capacity. I remember words a tad more blunt. I recall him saying, in a playful but concerned way, that the test suggested that I had the lung capacity of a forty-year-old smoker. Our memories coincide on one detail: the results were so pathetic that Steen, whom I loved and admired, encouraged me to give up running and specialize in English literature.
The suggestion wounded me, although I now know that it blended love with insight. At the time, I understood that I would have to change the way I approached running. I would still train and compete. But I would no longer dream. I discovered that it was an absolute, utter lie to say that any person can accomplish any goal if only they set their mind to it. I had run into the limits of my own blood. It could carry and deliver oxygen only so well. Well enough for me to develop decent calf muscles and to finish Miles for Millions hours ahead of legions of walkers. But not well enough to beat any serious runner on the track. I learned to focus, instead, on the pleasure and calm that came from pushing myself physically. I would make my heart pump for its own sake. For the joy of exercise, and for the sense of accomplishment. I did not have the body of a champion runner, and no amount of training would enhance my lungs, heart, and blood enough to get me there. I had to honour myself by understanding my own blood better and adjusting to my limitations.
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