LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Friday, June 29, 2007

Of camels and straw

Me: I want to eat.

ParaPump: are you sure?

Me: yes, I’m sure.

ParaPump: are you really, sure?

Me: yes, I’m really sure.

ParaPump: are you, really, really sure?

Me: yes, I’m really, really sure.

ParaPump: are you really, really, really sure?

Me: oh-for-Christ’s-sake-just-give-me-some-fucking-insulin!!!!!!!!

And that, dear readers, was the end of my MedT pumping days. The Cozmo is back on my belt to take care of all the direct life support duties and the ParaPump remains next to it with only the life insurance duties. I never thought I’d miss my old garage-door opener Guardian as much as I do. The ParaPump makes a sad CGM-only device, but it is better than nothing at all. It basically is just the same as the original Guardian except for the fact it is not loud enough to let you know when you are in trouble. Oh, yeah. And the mini-link transmitter, being smaller and taking up less skin landscape, is waaaaaay better.

A drug rep passing through the clinic this week asked me, “why are you wearing two insulin pumps?” To which I replied: ‘because I’m twice the diabetic!’

But the truth of the matter was, even after more than two months, I could never get use to jumping through sooooooo many hoops to do the simplest of things. My life is busy. Time is short. I don’t have the patience to deal with a clunky pump interface. I decided my life would be more worth living with two boxes on my belt again, and a pump that is easy to use. I also came to realize how much I relied on the IOB screen for making treatment decisions. I always do a fingerstick at bed time. A BGL of 120 with no insulin on board is a very different situation than 120 with 4.8 units on board.

You can get that info out of the ParaPump, if you have three hours to surf menus, and you have to enter fake bolus and carb data to get there, which you must then cancel. By then, of course, you’re in insulin shock and unconscious. But assuming you do get the Active Insulin data from the B-wiz it will be wrong anyway. MedT only tracks correction insulin. ParaPump assumes any insulin applied to food is cancelled out. Well….maybe. Maybe not. What if the pumper counted the carbs wrong? What it I ate 65 carbs of spaghetti but bloused for 125? I’ve got a dangerous boat-load of insulin on board that the ParaPump is ignoring.

Now, there is a new-and-improved Cozmo pump with an on-board carb data base, hypo manager software, and the ability to set basal patterns by day of the week, and more, but I’m still using the “old” Cozmo because I’m on Smith’s Medical shit-list. Here is how that happened:

Around the first of the year I got a huge bill from Smith’s for pump supplies. They had re-stocked me just after the end of the year, so Blue Cross didn’t pay a dime. My 1K deductible had reset to zero. Had Smith’s sent the supplies a week or two earlier I would not have paid a cent.

So the first quarter is always my brokest time of year. No weddings. Little lab work. It was lean times, and we were scraping by on my clinic income (non-profit, remember?). So I paid late. But I did pay. The next month I got another bill, for the same amount. Which I threw away, assuming the checks passed in the mail. The same thing happened the next month.

Then I called to see where I was on the upgrade list, at which point I was told I would not be allowed to upgrade ‘cause I was a deadbeat. I was told I had owed Smith’s a significant chunk of money since January of 2006. Six? You gotta be fucking kidding me.

After some digging it turns out this is what happened: for unknown reasons Blue Cross sat on a Smith’s claim from the year before for over 16 months before rejecting it and it became my problem. The folks in accounting admitted that even they were unaware of it for over a year, but that it was still a year over due so I was C-U-T O-F-F.

Well, I had a hell of a time just paying the current bill, much less a year old one I was unaware of. Can I make payments?

No. We do not accept partial payments.


So I did the only thing I could do. Nothing. Each month a new bill came. And I threw it away. I had a stash of extra sets, ‘cause I had been wearing them for four days rather than three. Then I used the ParaPump for a couple of months.

Now when I decided to give up on the ParaPump and return to the Cozmo, I could no longer use the CozMonitor. Why? Because of new insurance. Here is how that happened:

Our Blue Cross went up soooooooooo much we could no longer afford it. It was around $650 per month with a $1,000 deductible and $2,000 out-of-pocket. Pretty much like being uninsured, actually. So with great fear, I took the insurance at the clinic. This met I was forever committing to working for someone else rather than for myself, which I’ve done for over two decades. I knew that once my individual insurance was cancelled I could never get it back. T-1 is “automatic denial” for insurance. After all, insurance companies don’t want to insure people who might actually use their insurance.

This was a terrifying moment. What if the clinic fired me? Or closed? Or if gas hit $5 a gallon and I couldn’t afford to drive over any more? This was a big step. I would forever be giving up my complete freedom. But I did it. Now my new health master is Presbyterian.

Pres won’t pay for FreeStyle test strips. They’ve negotiated a special rate with AccuChek (read AccuChek gives them a kickback for forcing all of us to use their products). Actually I’ve gotten fond of the Aviva meter. I just wish the damn thing had a back-light for night time ops. Memo to AccuChek: Diabetics do need to check their sugar at night.

So now, instead of having a meter attached to my pump, I have Aviva meters scattered across the landscape of my life. One at the lab. One at the clinic. One in my Go-bag. One in each car. One on my night stand. I’ve actually gotten use to it.

One thing I really liked about the ParaPump was the plastic holster. The Cozmo has various leather cases that I don’t think too much of. Now that I wasn’t using the attached monitor it occurred to me that I could use the plastic holster that Smith’s used for the Cozmo in pre-CozMonitor times, if it was still made. A quick search of the Smith’s on-line store located the holster. Clear so the color of your pump will show. Mine is black, so no real benefit for me, but still, a nice idea.

I called to order where upon I was reminded that I was on the shit-list. Can we use this card number to clear up your debt? No, it is a debit card and there is about $42 in my account. If you run it for the supplies it will be declined.

But now enough time had passed that all of the sudden they would take payments. I’m told that once I’m paid up I’m part of the family again. Hopefully by fall I can report on the new Cozmo features.

But meantime, I can’t tell you how much happier I am, and how much less stressed my life is using the Cozmo pump. It is amazing how big a difference it makes having an easy to use pump.

Now if some one asked me to recommend a pump I’d have to say….. I’d have to say…. “sit down, this is going to take a while.”

Saturday, June 23, 2007


Ok, I’ll play along…. I haven’t done one of these blog games for a while. Too mission-focused I guess, which is probably bad for the soul. Time to have fun. Six had this earlier in the week. She got it from Nicole at CouriousGirl who got it from Hannah at Dorkabetic who…Actually I think Hannah is Patient Zero this time. Usually it is impossible to figure out where these things start. I guess I got in early.

Without further rambling:

1. Wil.
2. Lee (short for Liam, which is short for William).
3. PrintCrafter.

1. My eyes—blue.
2. My beard—same as Dad’s.
3. My chest hair—now seriously salt and pepper.

1. My spaghetti arms.
2. My nose.
3. Well, hell, I can’t think of anything else. Even the nose was a stretch. I guess I’m pretty much content with the way God made me, crappy pancreas and all.

1. Swedish.
2. Scotch-Irish.
3. French.

1. That my son might get hurt by nature (we have mountain lions, rattle snakes, scorpions, and last night I killed two monster centipedes in the house—one an eight-incher).
2. That my son might get hurt by people (a lot of sicko’s out there).
3. That I might get even poorer (our income is at 10% of what it was 8 years ago—yeah, you read that right; we’ve lost 90% of our income).

1. My “Go-Bag” with all the back-up pump stuff and ER sugar. The bag itself has varied over the years, but has generally been some sort of camera bag. Currently it is a National Geographic Earth Explorer bag. Very macho in a globe-trotting photojournalist kind of way.
2. A camera (which one depends on what I’m doing). Generally a Nikon FM3 with a pancake lens loaded with B&W film.
3. A wood-handled folding razor knife with belt clip. Lives inside my right pants pocket, clipped to the side closest to the seam. You’d be amazed how many boxes I end up opening in a week.

1. Insulin pump (and not the one you think I’m wearing, more on that next week).
2. Torn blue jeans (lab day, bound to spill something on them anyway).
3. Film Preservation Society T-Shirt.

1. Jesus Christ Superstar.
2. Chicago.
3. The King and I.

1. The entire soundtrack from Last of the Mohicans.
2. “Home” from Marc Broussard’s Carencro album, one of the best pieces of music ever, ever, ever done; although I really don’t care for the rest of the CD.
3. “Orange Crush” by REM.

1. Intelligent conversation.
2. Spontaneity.
3. Sense of Adventure.

1. My little son’s adorable face (a clone of his mother’s, with her eyes too).
2. The panoramic sunsets from my back porch, an un-obstructed view of the horizon for as far as the eye can see.
3. Anything made of stainless steel.

1. Diabetes (seriously, my patients who embrace this disease as a challenging and interesting hobby do better).
2. Hiking with the little one (I’ve been a bit of a slacker on this, time to get back out there!).
3. Well, that sucks. I guess I really don’t have any hobbies. No time.

1. I want to pay off all my debts (not going to happen).
2. Be intimate with my wife, who is totally not interested since Rio was born.
3. Fly a twin-engine airplane again. Or a helicopter, which I’ve only done once.

1. President (hey, we really need a new one).
But seriously I’m not considering anything. I’ve already got three careers right now: diabetes educator, photographer, lab owner. In the past I’ve also been: successful business owner, un-successful business owner, commercial pilot, newspaper photographer, law enforcement consultant, radio DJ, security guard, paper-boy, and fish-tank cleaning technician (my first job).

1. Any where over-seas.
2. Any major, exciting city. (Hey, we live in the kind of “relaxing” place most people go on vacation, I need some adrenaline! Give me museums, art, culture, a pizza at 3 a.m.!)
3. Space. As in outer-space.

1. Rio (my pride and joy!).
2. Morgan (his older sister who we lost before she was born).
3. Diego (son of friends, also a star of a Nickelodeon cartoon).

1. Win a Pulitzer Prize for Photography (yeah, not too likely now that I’m no longer in the news biz, but a guy can always dream).
2. See a tornado (hopefully without it being the very last thing before I die).
3. Hold a grand-baby in my arms.

1. I love gadgets.
2. It doesn’t bother me to eat desert first.
3. I don’t use hair-care products (other than shampoo, and I don’t care what brand so long as it does not smell like flowers).

1. I have no interest in cars, or working on them. I’m not even sure I know how to open the hood of my Honda Accord.
2. I’m affectionate, I’m not embarrassed to tell me wife I love her, even in front of the “guys” or co-workers.
3. Crude remarks by other men always shock me. My brain just doesn’t process crude.
4. Most of my friends are women, I like clothes, I like to shop.
5. I hug, cuddle, kiss, and wrestle with my kid.
6. I like art, museums, and plays. Even an opera now and again.
7. I NEVER watch sports.
8. Well crap. I guess I’m an honorary “chick.”

1. Too old to crush, but Katherine Zeta Jones is pretty hot.
2. So is Halle Berry.
3. And so is Nicole Kidman in an elfin, other-worldly ethereal way.

Sunday, June 17, 2007

The Question

The question took me by surprise and I didn’t know how to answer. I found myself staring into his eager brown eyes, anticipating my answer, while the gears in my head spun. “Ummmmmmmm…..” I said to give myself more time.

It all started at our bi-annual diabetes circus. That’s what I call it. Of course that’s not its official name. I think the official name is the Diabetes Health Fair. But it is a circus. All we are missing is an elephant and clowns. And cotton candy.

The Lion’s Club has a mobile eye screening lab in a massive RV that can barley make the turn to get into the clinic parking lot. We have a volunteer eye Doc come in and do basic eye screens for the un-insured (most of my patients). One every ten minutes. All day long.

We have a specialty footwear firm come in and do foot screenings and fit custom shoes when needed. The dental side did screenings for gum disease and the like. Drug reps who want some face time with end users set up booths in the lobby. The brand new ambulance was parked out front for everyone to gawk at. We do blood sugar screenings of Type 3s and anyone who happens to drop by.

It’s a long day and I’m the Ring Master.

At lunch one of the foot guys, who happens to be a T-1 like me spied my pump.

That’s when he asked the question: “Which pump do you recommend?”

You know; I don’t know. As a pump, I really don’t think that much of the MiniMed product. I think that as a pump, the CoZmo is light years ahead of the MedT product. It does more and is more user friendly. It’s like in the really old days when you compared the early PCs to the Early Mac computers. PCs were chincy with their info……

You can do things faster (like eat) and with more info at your fingertips with the CoZmo. Medtronic prides itself on being a medical device company. The ParaPump is very much a medical device. On the other hand, I get the feeling that the CoZmo was designed and built by diabetics. It is made with the user in mind. It is friendly.

The ParaPump is built with the mission in mind, user be damned. Medtronic seems to view it as a tool that we must learn to use. Smith’s understands that we must live with these devices 24-7. FOREVER.

I’ve been using ParaPump for quite a while now. Long enough to get use to it, love it, and hate it. It requires all three.

So if I think the CoZmo is better why didn’t I just say so and why is the ParaPump still snuggly on my belt? Three letters: C-G-M.

Continuous Glucose Monitoring. I felt one hypo a while back but I’ve been in the low 50s a dozen times since with no clue save my late-to-the-party alarm system, which never the less saved my bacon each time.

Truth be told: at this point, if I could, I’d go back to wearing my CoZmo pump and my old garage-door-opener Guardian. Too bad the new elegant little MiniLink transmitter won’t talk to the old guard. But, there is no more getting the transmitter for the old system. Even though it was big, ugly, had no graphic screen, and required me to wear two boxes on my belt; it did what I required most. It woke me up when I needed to be woken up. It never failed to command my attention. It was loud enough.

So why do I still wear the ParaPump? Because I’m chicken shit. I’m afraid to be without my CGM. Life is too dangerous without it. I could set it’s basal rate to zero and use it as a stand-alone CGM and then put my CoZmo back on; but its not THAT bad of a pump. Why have two boxes for no real reason? Although I may do that for a while when I run out of my supply of MedT infusion sets. I’ve got four months of CoZmo sets in boxes that I hate to let go to waste….

So maybe this guy doesn’t need CGM. Or maybe he couldn’t afford it if he did (a common problem). But in the back of my mind I was feeling that it was on the cusp of malpractice to recommend anything but the pump that had integrated CGM capability.

Sure the guy could wear a CoZmo and then get the by-all-reports excellent new Guardian with it’s sexy slope alarms. I assume it suffers from being equally shy volume wise, however. Or he could wear a DexCom, although its users don’t seem to stick with it. Or he could wait for the missing-in-action Abbott Navigator. If Navigator ever gets out of the FDA, and If it works, and If Smith’s mates it with a CoZmo then Medtronic will be in trouble. But that’s a lot of “ifs.” It may not happen. Not soon anyway. MedT may have the integrated pump/CGM market to themselves for many years.

But it is too bad to have such a lovely CGM married to such a poor pump.

Friday, June 08, 2007

A letter to your chance to add your two cents

I got an interesting e-mail recently. From a guy at MedT. He asked if I’d be willing to provide a “wish list” of things I’d like to see in the next generation pump. This is such a great opportunity I want to open the floor up to all of you. Via comments, this is your chance to tell MedT engineers what you want to see in Paradigm 2.

Here’s my wish list:

1. Alarm volume that really works. And I want it to both beep and vibrate at the same time, if I choose. I want the alarm volume to be user selectable from dainty to sooooooooooooooo loud the entire room will turn and stare. I want it to be able to wake the dead because one if its jobs is to make sure I don’t join them late some night while I am sleeping. I also want each alarm to have it’s own distinct personality. The original Guardian was great this way. The kind of noise it made told you the kind of alarm you were having. ParaPump tries to do this, but the alarms are too low in volume to be any use at all even in the summer (I can’t imagine how it will be under winter clothes. Serves me right for wearing a device made in sunny California. Note to MedT engineers lounging on the beach: in the rest of the country it can get pretty damn cold and we have to add layers.). Also, ParaPump’s alarms are so short you can barely make out the difference in sounds. Longer alarm time, please. It wouldn’t bother me to change batteries every week if I that is the price I need to pay for these features.

2. A home screen that isn’t blank. We got all this cool info, but ya’ gotta press buttons to get at it. Let us leave the pump wherever we want. Most of us will leave it on one of the CGM screens I’ll bet.

3. And speaking of the screen….what about a color one? Higher res too. We could do some fun stuff with the hypos and hypers on a color screen. Or if you combine items 2 and 3 you can take a page from cell phones and computers and let the user import a low res image file of their kid, spouse, or pet to personalize the device. I feel you MedT folks cringing as you read this, but I’ve got news for you: this really isn’t the medical device you think it is. You know how most people virtually never leave home without their cell phones? Well, we pumpers literally never leave home without our pumps. I spend more time with my pump than I do with my wife and child combined. Why not make it fun? For kids could we put some games on the pump? I’m old enough to still love my PDA but my phone doesn’t even know what time it is. If it were a VCR it would be flashing “12:00” all day long. Why can’t a pump do more? I carry the PDA for a carb data base. It’s also got a few key phone numbers like Lotta Burger in Santa Fe and my PCP’s FAX number. I use the calculator to figure out tips at restaurants. Did I tell you all the story of trying to buy a new PDA at BestBuy? The pimple-faced 12-year-old sales clerk tells me they don’t stock PDAs anymore. Seems they are passé with the advent of “smart phones.” But I like my dumb phone, I told the kid. That was pretty much the end of the conversation. Anyway, you can still get PDAs from the Palm Store on-line. Sorry, I digress. But it seems to me like this kind of simple minded stuff could be in a pump. I want to be clear, however, I do not want my pump/CGM to be one and the same as my cell phone. Some lines should just not be crossed. That’s like mating with monkeys in my book. Besides which, it seems cell phones are always running out of juice. You could actually talk your way into DKA if your phone and pump were one in the same, right? But aside from that, why shouldn’t a pump be the ultimate consumer electronic device for the diabetes population?

4. On the more practical side I want an Active Insulin (a.k.a. IOB or BOB) status screen. And I want to choose how to set it. For those of you who don’t know there are two approaches it active insulin. Whether or not to count just correction insulin or to count correction and insulin assigned to carbs. I like the more comprehensive approach myself. MedT does it the other way, with some good justification that is too complicated to cover right here and now. I just think we should be able to choose. But at a minimum, give us the results without having to enter a fake bolus in the wizard and then scrolling foooooooooooooooorever.

5. I nearly short-circuited my laptop by drooling on the keyboard when I was reading about the new version of the Guardian. It has slope and predictive alarms. I want those on my ParaPump, please.

6. And speaking of alarms and the like, let us set different alarm thresholds for day and night.

7. I think you should make the transmitter flesh colored. Anyone’s flesh. Chinese flesh color will be just fine. I’ll still look better against my Caucasian skin than this yucky cream color. Or go the other way and make it look like jewelry. Make it shiny silver with a medic alert symbol on it.

8. Let the remote power the bolus wiz.

9. Rethink the menu system altogether. You shouldn’t have to press that many buttons to do routine things, like eat. You know, we are pretty smart people. We can handle more than four buttons on our devices if that’s what it takes. I’m sure that some of the engineers worry about the fact that a large number of pumps are worn by kids. No firm wants to try to get both a juvie pump and an adult pump through FDA. But trust me, kids nowadays are way more tech-savvy than us oldsters. They can handle it.

10. Let us choose how many hours of CGM data to display.

11. Let us set different basal rates for different days of the week so we don’t have to manually change patterns for the weekend.

12. Keep the clips. I love them, especially the “holster” style belt clip.

13. Last item (for now!). Keep CareLink online. It’s great for visiting the Doc. But I still want to see smart software. I want CareLink to analyze my data, not just display it in pretty graphs. I want it to look at my basals and give me tips about changing my settings. Of course it will have to have five million liability waivers and consult your doctor statements, but still, let’s do it. Think of it as one of the first steps in the journey to a closed-loop pump system.

OK, diabetes blogosphere. That’s my wish-list. Now it is your turn. Tell MedT what you want to see!

Sunday, June 03, 2007

Joy… and the risks of “going native.”

Note to readers: still recovering my health, I’m going to switch to weekly posting on Sundays for the time being. Thanks for understanding, I’ll do my best to make the weekly post worth reading!

The three days per week that I work over at the clinic I car-pool over with E, one of the RNs, who happens to live even more remotely than I do, ten miles south of my place. At the clinic they call us the Easterners, which always strikes my ear strangely as I grew up thinking of myself as a Westerner.

But it is technically true, we hail from an hour East of the clinic.

It’s great to have someone to share the ride with, both for company and for economy, given that our gas is now on the cusp of three-fifty a gallon.

When I started at the clinic I worked twenty-hours per week, two ten hour days. Then they added a third day. Then a fourth. Then I began to burnout. The hours, the travel, my age, my overall health. I went back to three days per week.

When E started, she also worked three days per week, but a different three. I did Monday, Tuesday, Wednesday. She did Monday, Tuesday, Thursday.

About a month ago E told me she was thinking of switching to M-T-W too, as she hated driving over on her own. Her fear: she might go native.

I took my eyes off the road for a moment to take a long gaze at her. Huh? What do you mean, ‘go native?’

“Well,” said E, “I’m worried that with four days off in a row, I won’t want to come back to work on Monday.”

As I generally love my job I laughed. I’m not laughing now. I’ve got war paint on my cheeks, feathers in my hair, a camera in my hand and I’m not due back in my office at the clinic for another six days…..let me tell you the story:

It started over a week ago. Sunday before last, to be precise. I was at the lab (reminder for old readers/FYI for new readers: by economic necessity I am a renaissance man with two un-related careers). I got to feeling….funky. You know that kinda of achy, sweaty, oh shit I’m coming down with something feeling. So un-fair! All winter long at a clinic full of sick, coughing, sneezing, puking people and I don’t get so much as a runny nose; and now on the cusp of summer I get sick?!

Of course the timing couldn’t be worse, I had an epic week ahead of me. Monday, Tuesday, and Wednesday me and my crew where to go into the school system and do weight, height, blood pressure, and fingersticks on every kid from fourth-grade through 12th. About 500 kids altogether.

This was somewhat unprecedented and it is all my fault. Or the fault of my big mouth, anyway. We had a school-based clinic that ran afoul of a conservative school board. (Read: abstinence only crowd on one side; RN who gives condoms to kids who ask for them on the other. Religion and health care ethics collide. We got kicked out.) So we had some left over grant money. I wandered by the executive director’s office at the wrong time. She called out to me and asked, ‘how would you spend three-thousand bucks on diabetes in the school system.’ Without thinking I replied I’d fingerstick test every kid in the schools. Make it happen, I was told.

Turns out I was in uncharted waters.

What followed was a six month baptism in politics, which after many meetings, an impassioned pitch to the school board, letters to parents, etc…..finally came to be.

By the way, we were horrified to learn that 40% of our elementary kids had elevated BGLs. Yikes! My program has been re-focused towards school based early-intervention. We are going to start teaching real health-ed and nutrition from kindergarten upwards starting this summer.

I digress. So that was my Monday, Tuesday, Wednesday. I got progressively sicker each day, but kept afloat by the frantic pace of many, many fingersticks (and a little bit of hand-holding the needle phobic).

Then my “weekend.” On the docket: Thursday a wedding rehearsal two hours away. Friday: photo job for the Santa Fe Opera. Saturday: the wedding shoot. Sunday: post production of digital files. Got to get the Opera disks ready for Monday delivery. Plus, for the first time in weeks, lots of lab work. It was the most photo-heavy week of the year. I was sooooooooooooooo looking forwards to it. And I was sicker than a dog.

But these are not the kind of commitments you can back out on. And even surviving in an exoskeleton of Sudafed and Caffeine I had an absolute blast. It was the most photography I’d done in a compressed amount of time in years.

There I was, spinning around the dance floor with no partner. My right hand wrapped around the camera, the wrist strap holding it firmly to me like a glove. With lightning fast auto focus I shoot one-handed to keep my quarry at ease until the last second. With a 4 gig card onboard I can shoot a thousand images without “reloading.”

The heavy camera bag full of lenses and spare power packs on my shoulder is like an extension of my body. I don’t feel it. I don’t knock things off of tables with it. From so many years as my partner I am as aware of it as my own arms or feet.

I am in my element. This is who I was met to be. The observer. The watcher. The capturer of truth. The camera and I become one.

Photographing. Real photographing…action…people…capturing moments in time and preserving them. This is where I feel most alive. I’ve had cameras since I was five years old. At everything else I’ve even done I feel a bit like an imposter, like I don’t really belong. But with no formal training, no degree, I feel I belong behind the camera. I know I’m good at it. I must exude confidence, because those who watch me in action know I’m good without seeing my work or my long string of awards dating back to high school.

Even sick, it was a very good three days. Then Monday came. Time to go to the clinic.

I hadn’t quite gone native…yet. But the hard weekend and long hours took their toll. About the fifth time one of my co-workers said, “Hey, you look like shit, you should go home and go to bed,” I began to believe it.

My first patient of the day was a 94-year-old-man. His first meeting with me. I try not to breathe any of my germs on him and instantly feel guilty and selfish for coming to work at all. Ten minutes later my presence on the planet and in my office at the clinic is justified. As part of the routine first visit I inquire about his feet. His feet are fine, he tells me, but there is this little thing on his leg. He pulls up his pant leg to reveal a five-inch diameter bright red infection disc with a pussy ulcerated sore in the middle. “Should I worry about this?” Oh yeah. I dispatch him at once to the main clinic for aggressive treatment.

Then I give up and go home to bed. Well, to the couch. I doze and watch Walking with Cavemen on Discovery Channel. Then I snooze through assorted Star Trek Voyager episodes. I crawl into bed at 9 p.m. and sleep until two in the afternoon the next day. I stake out the rest of Tuesday on the couch again. By Wednesday I’m feeling human enough to curl up with my lap top and start editing the 2,000 + images we shot at the wedding.

I’m real happy with the work. Then the Italians email. Our sexy new sample albums will be here on Friday. I’m so excited I can hardly stand it.

I wrap up the day pawing through a Travel Smith catalog. Love their stuff, but I’m not rich enough to shop there often. Their inventory fits my self image of the globe trotting adventure photographer. Truth be told however, Motel 6 is actually my idea of roughing it. Still, the clothes make the man, right?

When ParaPump reminds me the sensor has run its course, I’m caught off guard. I had totally forgotten I was diabetic. I mean, I was boulusing and everything, but it fell to the background. I did it automatically and didn’t give it a thought. I didn’t let it consume all my waking moments.

So I’ve still got the weekend full of fun photo stuff and Monday off. Will I go native? Will I be able to drag my sorry self back to work on Tuesday? Will I be happy to be back….. or?