Some Post-Op Pondering

So. The hand surgery ate up most of the first Friday of June–a minor procedure to correct a year’s worth of discomfort and pain. Some ten days removed from the surgery, the physical aspect remains simple, straight forward. It’s the mental unease I wasn’t prepared for. The procedure corrected a condition known as “trigger finger,” something diabetics are prone to. This development was the first to fall into the category of “complications” stemming from my disease.


Office visits with my endocrinologist have a rhythm to them. I arrive a few minutes early, check in with the secretary, exchange small talk pleasantries. “The same insurance?” she asks, her heavy Latin accent chewing up syllables.  My answer is always “Yes,” in part because diabetes is impossible to manage without insurance, but mostly because it’s too much of a hassle to change.

From there, I wait. My endocrinologist graduated from the Dr. Gregory House School of Bedside Manner, so I’m glad most check-ups are with the nurse practitioner. Her office is small–a desk dominates the space perpendicular to a patient’s exam table. We speak briefly about life, work, family, and our mutual friend’s one-year-old son–how everything is crazy, how our kids are getting too old too fast, and how we still can’t believe our friend’s luck having another baby well into his forties.

Then we discuss my numbers. Blood Sugar numbers.

Diabetes is a numbers game. And I hate numbers. Depending on how the numbers read over the past few weeks, she makes adjustments to my dosages. Then there’s a quick physical exam. I sit on the table, the crepe paper crunching with each slight shift. She checks my breathing, my heart beat, then thumbs my thyroid, my ankles. Finally, she draws three vials of blood for testing.

This is all normal. It happens during at every visit every three months or so. But after I settle back into the chair opposite her desk, and she begins inputing notes in my file, her normal question is met with an abnormal answer. She asks if I was having any other issues, and while normally the answer is no, this time, it’s yes.

I describe to her the discomfort I’d been feeling in my hand for the better part of a year. The pain had grown progressively worse over the last several months and I realized it wasn’t simply soreness or a bruise. That’s when she said it:

“It’s diabetic nerve damage.” She nodded from behind her desk. “Let me give you the name of the orthopedic we work with. He’s really good.”


Trigger finger is a painful condition that causes the fingers or thumb to catch or lock when bent. It happens when the tendon in the finger becomes inflamed, preventing the tendon from gliding easily through the tissue that covers it. Diabetes is a cause, and it’s a condition more common in women and tends to happen most in people 40-60 years old.

hand
It’s a half-inch scar. Size doesn’t matter.

The symptoms start small–soreness at the base of the affected finger. The most common symptom is painful clicking or snapping when bending or straightening the finger. The catching sensation tends to get worse after resting and loosens up with warmth and movement. It’s not a dangerous condition by any means, but it can affect quality of life. I spent months thinking it was soreness from yard work, or a bruise, but by the time I was ready to talk to my doctor about it, I couldn’t serve myself coffee with my right hand in the mornings. I couldn’t shoot a basketball correctly.

After meeting with the orthopedic, I was given three options: wear a splint for 6 weeks and see if that helps, take steroid injections that might help and will certainly shoot up my blood sugar, or corrective surgery.

 


An intern removed my stitches. He was going to use a suture removal kit, until the nurse handed him a new suture knife. He took to it like a child with a new toy. It was a moment before he got the feel for it. He mentioned my stitches were wrapped tightly. No shit.

The surgeon and his bow tie came in after–I had to wait a while. He showed me a few exercises I’d probably go over with the PT, then mentioned it was weird to have a case of trigger finger in someone before the age of forty. He also said it’ll probably happen again.

“You’ve got nine other ones.” He wiggled his digits in some perverse spirit finger promise.  “At least you’ve got me for when it happens again.” With that, he left.


Type 1 diabetes increases the risk of developing several medical complications, but the risk of these complications decreases with better blood sugar control. Diabetes is a game of numbers.

Tigger finger lines up with diabetic neuropathy, or nerve damage. The biggie for me, and most diabetics, is blindness caused by diabetic retinopathy. It’s the leading cause of blindness among working-age adults. Yikes. Then there’s other stuff like heart disease, kidney damage, and even depression, known as “diabetic distress.”

Like I said, diabetes is a numbers game. What’s my blood sugar? What’s my A1c? How many carbs am I eating? What should my insulin dose be? How many hours will it be until I need to eat again? It’s stressful, dare I say, distressing. “Diabetic Distress” seems like a silly name for it, but I get it. According to the American Diabetes Association (ADA), it’s more common than clinical depression and affects almost half of all the people with Type 1. I feel like I struggle sometimes, but I’m not sure I suffer from this complication.

My biggest question when pondering these complications had to do with life expectancy. Good news on this front though. According to the Juvenile Diabetes Research Foundation, life expectancy in people with Type 1 is no different than the general population. A 2012 study published by the Diabetes Journal found that people with Type 1 diagnosed between 1965-1980 had a life expectancy of 69 years, a marked improvement compared to those diagnosed in the 15 years prior, who had an average life expectancy of 53. I was diagnosed in 1993, so I’m probably immortal.

A1c Table

Unlike Alice, this rabbit hole I fell down has a solid, sane floor. Of all the numbers in this game, A1c is probably the most important. The Hemoglobin A1c test measures, generally, the glucose concentration in your blood. Red blood cells live about three to four months, so this measure indicates what percentage of the hemoglobin is glycated (read: covered in sugar) during that time. Non-diabetics measure less than 5.7%. Pre-diabetics measure 5.7-6.4%. Diabetics measure above 6.5%. Most doctors set a diabetic’s A1c goal at 7% or below, and while that still puts us at risk for long-term complications, it’s the best bet. My last A1c was 7.3%. Not my best work, but not terrible.

 


The hand surgery ate up most of the first Friday of June, leaving a little scar as a reminder. The orthopedic was good. Less than two weeks out, I’m already closing my fist.  I have an appointment at my endocrinologist’s office coming up soon, and I’m sure there will be a new rhythm to that visit, a new A1c number. Diabetes might be a numbers game, but I’m a pretty good player.

What Coaching Has Taught Me About Writing…

So. As coach Herm Edwards famously said: “You play to win the game.” This is true at the professional level of sports, and this idea certainly filters down all the way to Little League–despite the belief in “tanking” by some professional franchises. As a coach of more than ten years now myself, I understand Coach Edwards’ sentiment, but there can be more to a game than winning.

For a writer, “winning” might be defined as publication. As someone who fancies himself both coach and writer, I understand there’s more to this game than “winning” literal  and figurative contests. There’s value not only in loss, but also in process. (Insert your favorite Joel Embiid meme here.) For me personally, I’ve pulled three specific elements from Coaching that can help me as a Writer: Preparation, Discipline, & Creativity.


basketball-courtBasketball is my game. While it wasn’t the first sport I played as a child, it was certainly the first one I excelled at. (I didn’t like all the running in soccer and I couldn’t hit a baseball to save my life–unless, of course, you count turning away from a fastball and getting plunked in the shoulder-blade as “hitting.”) As coach of the women’s varsity team at my high school, I learned very quickly the necessity and value of communication. I needed to communicate my vision not only to my elite players, but also to those still learning the game at the end of the bench. That’s where Preparation came in.

In basketball, preparation is important. High School coaches have a finite amount of time with their players, and those players are often juggling myriad responsibilities that pull their attention in a number of different directions. Without being prepared, without knowing my vision and where I wanted to be by the end of practice, I would waste the two hours I had my girls. My team needs to master the fundamentals, as well as ready themselves both mentally and physically for the games ahead. They hate conditioning, but it’s an integral part of that physical preparation. The mental fitness includes developing a positive, willing and winning mindset.

Preparation is important for me in writing as well. Sure, some writers can craft a story from the seat of their pants, but that’s not me. I need a vision of where my story is going. I need a vision of who my character is at the start, so that I know how they are different by the end. I need an outline to generally guide me along my intended path. And finally, I need to develop a positive, willing, and winning mindset, despite what my inner-critic might think of the work-in-progress. And this is where preparation and discipline come together.

As a basketball coach, discipline is a must. Yes, the atmosphere can be fun and funny (we are playing a game after all), but that doesn’t mean we’re not taking the competition seriously. In order to succeed on the basketball court, you need to master the fundamentals of the game. It’s about “muscle memory,” doing something so often that you don’t even have to think about it to do it correctly. Basketball is a process-oriented game. As coach, I need to scaffold skills to put my girls in a position to succeed. As a team, we need to develop winning habits. But a crucial aspect of Discipline is Accountability. If a player doesn’t perform to the level at which they are expected to perform, then they must be held accountable in some way.

In my writing life, Discipline is the element I struggle with the most. I lack the necessary discipline to really call myself a writer, and I know if I don’t develop those winning habits or that necessary muscle memory that I’ll never “win” the publication game.  I need to physically condition myself to sit my ass in the chair (as author John Dufresne commands) on a regular basis. I need to hold myself accountable. I need to engage in the process in order to see the results. And it’s through the process that creativity comes to life.

Creativity in coaching is far more than just drawing up an innovative out-of-bounds play.  In reality, drawing the plays themselves is probably the least creative aspect of the art of coaching. Creativity in coaching is finding new solutions to old challenges, finding another way to communicate vision, and, perhaps most importantly, being adaptable. The ability to adjust to the players in front of you, to adjust to the opponent across from you, is far more important than the playbook you’ve spent years assembling. But this is often the most difficult, and perhaps selfless, aspect of coaching.

IMG_3887In writing, creativity if often the easiest part. It certainly is for me. Writers get to play god in the worlds we build, but I need to understand there have been others playing god in their own worlds for far longer and far more successfully. That’s where adaptability in creativity remains integral. I need to avoid the derivative, the cliché. I need to find that new solution to an old challenge. I need to find a new way to communicate my vision. I need to change with the times and evolve right along side these genres as they blend and meld and birth new versions of themselves.


Coaching basketball is an important part of my life, just like writing is. Both have their difficulties and both have their rewards. As a coach, my vision for my teams is that they master the fundamentals, prepare mentally and physically, be unselfish (contribute, cooperate and share), be alert and aware, adapt, and persevere. Those are all lessons that I know my players can move to other parts of the life beyond basketball. Each one of those elements aids me as a writer, but of those elements Preparation, Discipline and Creativity can help me the most toward my goal of winning the writing game.