Almost free-association on some firsts in my life. Almost.
Tenley is the first person I ever knew to have diabetes. She is also the first person I knew at the time of their diagnosis--I knew her as the girl across the street for as long as I could remember. We were great friends, very close, and she was like a sister to me. She is a year older than me, and was probably 7 or 8 when she was diagnosed. I have a vague memory of her mother, Ann, crying. I remember my mother crying too. I was little and, I imagine, deliberately insulated from what was going on. I didn't know much about Tenley's diabetes, except that she was "very sick." Something to do with sugar, but I didn't understand what. When she came home after several days, she seemed fine to me. As a kid, that's what was most important: she seemed okay, so the details didn't really matter.
She is also the first person I thought of when I was diagnosed with diabetes at age 17. Something to do with sugar, but I still didn't really know what.
Alvin was one of my neighbors back then, I think, though I wasn't quite sure where he lived. He seemed to be in the neighborhood often, and he walked everywhere, so I figured he must have lived nearby. He was the first person I knew who was very "different." That was how I thought of him. I wasn't sure why he was different, but he was. He seemed nice, was always cheerful, but by the same token was scary to a little kid like me as well. I don't remember him clearly enough, but as I look back I now understand that he was mentally retarded and also probably had cerebral palsy. Tenley's older brother Tim had made Alvin a walking wheel, or at least that's how I thought of it--I'm not really sure what to call it. I think it was a bike wheel on a long metal handle, with a bike grip and an odometer. Alvin took it everywhere, and he would proudly tell people how far he had walked. He was especially enthusiastic when he'd see Tim and announce how many miles he had on his odometer.
I always looked up to Tim. He's a few years older than Tenley (Tracey is in between Tim and Tenley, and Todd is the oldest of the four). Though a few years older than me, Tim still seemed too young to ride the orange, gas-powered dirt bike that he sometimes brought across the street for me to look at (and attempt to lift). I was in awe of that bike and of Tim's being able to handle it. I loved that he would hold it up and let me sit on the seat, twist the throttle, and practice my "vroom vroom vroooooooooom" voice, silently wishing the engine was running when doing so.
Tim was diagnosed with type 1 diabetes years later, the first person I knew who was diagnosed as an adult. Since I had been diagnosed at 17--almost an adult--he turned to me for advice and information during his post-diagnosis maelstrom, and then later too, when things settled down a bit. I was still in college--nowhere near medical school yet--and remember that being the first time that someone specifically sought health advice from me.
Paul--father to Todd, Tim, Tracey, and Tenley, and husband to Ann--was my first dentist. He gave me my first filling and my first Novocain. He is the first person I knew who chewed tobacco, and their house was the first place I ever saw a spitoon. He's the first person I knew who hunted, and the first person I knew to pour so much passion into hunting. He trained retrievers and hunted ducks, and the family dogs--always big--were the first dogs I feared, and the first I grew close to once the fear began to ebb.
Ann is the first second-mom I had. During those formative years when we lived across the street, from age 2 to 7 for me, she seemed more like another mom than a neighbor, and I always thought of her that way--another mother-type who happened to live across the street. (Neighbors, to me, were only people who lived next to you, not across from you.) After we moved a couple of miles away, our families remained very close. When my wife and I began dating, Ann was the first to tell me "She's a keeper!" She was also the first to really mean it, and to make sure that I knew that.
That was 18 years ago. Life has led me away from that area--not extremely far, but far enough that I grew apart from their family. My parents and sister have stayed close, and they would give me updates from time to time. Ann is the first real smoker I ever knew, so I wasn't especially surprised when I learned that she had been diagnosed with lung cancer. I think I was still in medical school at the time, but already knew lots of statistics about it--how low the survival rates, how poor the prognosis. Ann did great from all I heard, but I expected the worst. Lung cancer treatment often seems good at first, but it tends to return, usually relatively soon in the scheme of things, which is why the five year survival is so low. I kept expecting to hear about a recurrence, only I never did. I kept hearing updates about Ann and Paul, their kids and grandkids, and they were all about life--not about cancer. Eventually I got used to this--this anticipation of bad news never delivered--and without realizing it, that feeling became so familiar, and the lack of bad news so consistent, that I began to feel like it would never come. Even though I believed that Ann's cancer would come back, it truly felt like it never would, and that Ann would just keep on going forever.
At the same time, my medical career was progressing, and I was gaining ever more experience with numerous conditions, from birth to death and everything in between. I have cared for many patients at the end of their lives, and I hope and believe that I have helped many to have greater peace when they have ultimately died. I have known many patients who have transitioned to hospice to complete their journey through life. I have become comfortable--or at least at peace--with end-of-life and hospice. Though sad and final, it seems to be more natural when appropriate, especially in contrast to the endless and sometimes torturous things people may otherwise endure in our life-prolonging and cure-oriented health system. First do no harm.
Ann has been in the hospital all week. She has been there before. But today she transferred to hospice.
I am not as accepting as I am for the patients with whom I have traveled this path. While friendly, they have been patients, not friends--at least, not my friends. Ann is the first friend I know who has entered hospice. I have believed for a long time that this would eventually happen, but I have grown accustomed to this expectation being unmet. So I was surprised. I was unprepared. I am sad. As the evening and then night have gone on, I am beginning to be accepting. I am remembering--sometimes smiling, sometimes aching.
I am reflecting, on so many firsts.