My Experience as an American Type-1 Diabetic:

It was perhaps two weeks before my high school graduation. I had loaded my senior year schedule with Advanced Placement classes—five of them—in order to both challenge myself and to give a favorable impression to the universities I was applying to. At the end of May I had completed all five AP tests, and in the interim I was studying for the rest of my finals, looking always forward to that long-awaited reward, the golden chalice at the end of years of hard work and dedicated study. I had felt perfectly terrible throughout this stressful time in my young life—I felt nauseous constantly, my energy levels were severely low, I was drinking gallons of water, juice, and milk every day and urinating every fifteen minutes or so, I had extreme dry mouth, and my eyesight was becoming increasingly blurred and unfocused (which I blamed, consequently, on some experiments we'd been doing with lasers in my AP Physics class). My mother was single and for the majority of my life we were surviving off of Welfare, and although we had access to medical coupons, it was difficult to schedule a doctor's appointment amidst our hectic, stressful lives. So it came to be that one morning I awoke, unable to do anything but lay down and fight my nausea. That day and night I spent curled around the toilet, vomiting to the point of absolute emptiness and beyond, every half hour on the hour for more than twelve hours. As I lay on the couch, convulsing and gulping wildly for air, my mouth so dry I had to peel my lips from my teeth in order to speak, I begged my mother to pray for me and to take me to the hospital. We drove thirty miles into town and I can only remember my mother guiding me up the steps of St. Joseph's hospital, a blanket pulled around me that I might not fall, before I completely blacked out. As they rushed me to ICU, there are brief flashes of memory: the nurses asking me questions—when was my last period, what was my full name—and in an instant of clarity I remember stating “Felicia Raphaela Jeweliette Crawford!”—oddly proud of my lengthy appellate.

When I awoke, my arms were sore and heavy with IVs. My mouth was dry and my mother had gone somewhere—I was alone. The doctor came by and saw I was awake, and I heard the words that would come to define my life more starkly than anything before.

“You have Type 1 Diabetes.”

I asked questions and I absorbed information. Incurable, unpreventable, manageable. The ICU nurses called me a brave, strong little girl; my blood sugar level had been close to 1100 when I was admitted, and many people go into a coma at 600. When I'd mustered the courage, I asked my doctor the hardest question of all—how many years this disease would take from my life. He said, if properly controlled, no more than fifteen.

I have cried myself to sleep many a night recalling those brief, matter-of-fact words.

Throughout my four years in college, here at the esteemed University of Washington in Seattle, I have become decreasingly less and less brave and strong. It is of tantamount importance for me to visit a doctor at least every three months to track my progress and my blood sugar control, to make sure that my kidneys are functioning, that my eyesight is fine and that I haven't lost feeling in my feet. While I was still covered under my mother's medical coupons, this was all fine and good; I was taken care of and my control was decent, for a brand-new diabetic set free into the wide world.

It was not until I had to join the state's Basic Health program that I began to truly feel the need of proper healthcare.

Under Basic Health, I pay a premium each month, and a copay for my prescriptions and doctor's visits. My mother is on one of the lowest rungs of the poverty level; I have no one to look out for me and no safety net to catch me when I fall. I have had to supplement my financial aid with a job for the past three years at my university, and I can assure you that it is no simple task to juggle a 35-hour-a-week job, full-time classes, and a 24/7 disease while remaining both happy and sane. My budget is thus: $575 a month for rent, $150 for bills, a combined total of about $92 for health care and prescriptions, and whatever is left over for food. My monthly income ranges from about $800 to $1000, depending upon the hours I receive at work. There is absolutely no room for any accident, any error, any mistake on my part.

There are, of course, those unexpected miseries that crop up in life: in February, for instance, I had a case of food poisoning. I vomited up my dinner after having taken a substantial amount of insulin and afterward could keep nothing down, not even juice. I spent the next few hours alternately sipping and vomiting juice and crackers, trying to maintain a blood sugar level that would not cause me to enter into hypoglycemia, a coma, seizures, or any equally frightening condition. More than anything I wanted to avoid a trip to the emergency room, because I knew it would cost me a hefty $100 that I certainly did not have. I remained very ill over the next few days and was vomiting constantly, and, afraid to inject myself with any insulin due to that first sick night, consequently came down with a case of hyperglycemia and diabetic ketoacidosis, in which my blood sugar was so high for so long that my blood was poisoning me with its acidity. Ironically, I was sent to the emergency room after a brief trip to University Medical, where I spent several hours attached to an IV as they filled my body with five liters of fluids. It is now July, and I still have not had the excess funds to pay my bill, which is likely around $130 or $140 from a combination of doctor's visits and the emergency room. Petty cash to some, but the difference between meals and bills and rent for me.

In a similar instance, I had another emergency earlier this month. As a preface, I became terribly depressed after my initial diagnosis, when I was but a seventeen year old girl. I would cry, all day, every day, unable to stop. I was so unbelievably terrified of my disease, of my tenuous hold on life, I was so sad that I'd lived what I felt to be an already hard life only to be inflicted with diabetes on the eve of my escape, that I couldn't fathom ever experiencing happiness again. It was, at this time, that I convinced my mother to let me get a puppy, a sweet little guy that I named Ferdinand and who truly saved me from myself, for there is not a heart on this good Earth that can be broken when there's a puppy in proximity. As trite and silly as it sounds, my dog was and is my savior, my strength, and my happiness. Earlier this month, at the age of four—as old as my diabetes—he experienced a seizure of some kind, and with all the love in my heart and none of the logic in my head, I rushed him to a veterinarian. I could only afford the initial exam and one test to make sure it wasn't a heart condition; this bill ended up being around $136 and, although I cringed to write the check, could not in good conscience allow the life that saved me to be lost. To make up for this emergency, I used my needles three times each, although they state “Use once and destroy;” generally I use them twice, but this was an emergency. I did not fill my prescription for test strips, and I stretched my Lantus insulin to last an extra month, saving myself all in all an extra thirty dollars.

In times of need, I have made my medicines stretch in ways that they simply are not supposed to. If I cannot immediately afford more Humalog, I don't eat. If my Lantus is running low and I need to make it last a few weeks longer, I take smaller doses than I should. I always use each needle twice, sometimes thrice, and some months I resort to using expired test strips to test my sugar levels. I should see a doctor trimonthly, but I settle for the once-a-year visit that is the minimum for extending refills on my prescriptions; three years ago I received a bill for $150 due to blood work and lab fees, and have ever since feared and declined extra tests. Indeed, I've declined all but the very barest minimum for sustaining my day-to-day life. My blood sugar control is often terrible, yet without the guidance I cannot afford, I feel positively helpless. My grades are lower than they should be for I often feel hopeless and depressed as a result of my life's circumstances. There have been blacker-than-black moments when I find horribly morbid thoughts cross my mind, where I wonder what might happen if I just take a little too much insulin and try to fall asleep. It's a disgusting thing to admit, a horrific aspect of self that I always immediately quell, but it's the bone-bare truth. I watch movies like Michael Moore's “Sicko” and while I realize its innate bias, I cannot help but wonder why England, France, Canada—EVERYONE—why EVERYONE in this world seems to care about their citizens above and beyond the supposedly great United States of America. I feel as though the slightest misstep could result in my death or my debt, and these days I truly do not know which is worse. Both are an end of life in this country, it seems. And, in both my youth and my limited wisdom, I wonder at the innate sadness of that sentiment: that a mere twenty-one-year-old girl, barely a woman, still so young and inexperienced, could feel as such.

To compound everything I have written here, Washington State's “Basic Health” program is going to disenroll members beginning in August, to save the state a few bucks here and there, probably to fix roads or something. The swell of anger, disgust, and vulnerable hurt I feel, that our state Governor and Congress would choose to punish the poorest and merest of its citizenry, is almost unimaginable. The Basic Health program is for people like me, families like me, who cannot have health care save for the state, who cannot manage on their own and who require it to survive in this harsh existence that we currently refer to as some sort of American dream. As it stands today, as I sit here and write this with tears stinging hot in my eyes, I do not yet know if I will be disenrolled. It perfectly terrifies me; I am paralyzed with fear to think of it. I can barely afford to pay the dues Basic Health demands of me, and by the popular measure they are meager; should I lose my already-weak coverage, I truly do not know how I will survive. I think I could die, in the twenty-first century, in the great United States of America.