Be Careful What You Piss For

It’s disgusting, of course. I am disgusting. I think that again and again as I refill my idiotically large cup at a Burger King soda fountain, somewhere just south of Miami. If it hadn’t taken so long to get through immigration, I wouldn’t be reduced to this, but after three hours of staggering towards the man with the stamp, anything will do.

Recently I’ve been avoiding this kind of junk; I started making an effort with diet and exercise last year when I took a commission to write about kite-surfing in Egypt. Since then I’ve been following a programme of cardio, weights and healthy food. When running, I regard my sprint finish as a treat. Feel dizzy when lifting weights? Good. My gut has been evaporating by the day. I’ve been working so hard that I’m constantly hungry – and thirsty for that matter. But best of all, because my engine is burning so much fuel these days, I can indulge my sweet tooth and get away with it. Thus the benefits of being a Herculean athlete.

I’m not short of motivation, but occasionally I remember two of my favourite writers and say to myself: remember Hitchins, remember Fante. The cancer did for cigarette and whisky champion Christopher Hitchens, while John Fante also burned the candle at both ends for too long (“And it gave a lovely light,” as Hitchins would say of his own excesses) and was ultimately eaten up by diabetes as a result. By the time the disease killed him, Fante, my literary hero, was a multiple amputee, blind and half insane.

Annoyingly though, in America, attempting to eat healthily for a decent price is damn near impossible. I’m here for a month, travelling from Florida to Massachusetts and already I’m feeling the pinch. Wine is half the price of pomegranate juice; a fruit salad is three times as much as a bacon and egg muffin; a white sandwich loaded with grey, steroid-laden mystery meat costs less than making your own avocado-on-wholemeal alternative. The game is rigged and the poor don’t stand a bloody chance.

But healthy eating isn’t at the forefront of my mind when I stumble into a Walmart in Georgia. No, I’m much more concerned by the fact I very, very nearly pissed my pants on the way in here.

That’s not a metaphor.

Being an athlete requires a huge amount of fluid intake. I’ve been chugging litres of Powerade since getting to the States, but, perhaps because of the heat, I can’t shake this thirst. My poor bladder can barely cope – I’m chucking so much fluid at it that I’m not sure I’ve been able to go more than a couple of hours without needing to piss. And still the thirst won’t go away. It’s a strange price to pay in pursuit of physical improvement, I suppose, but along with the inflated price of healthy food, this must be the way of it.

In more ways than one, I’m relieved when I get to New York City. Firstly, I know I’ll never be too far from a toilet and secondly, I can get back into the gym and fend off the American junk food. One morning I head out of the hotel to get a (multigrain, no butter) bagel for breakfast and have to stand aside for an almost perfectly spherical woman to order a bacon, egg, peanut butter and jelly muffin, only to complain there isn’t enough jelly on it. As she barks out this order, she rolls up and down the counter, stalking her breakfast like one of those malevolent Rover balls from The Prisoner.

Not that my own diet is always exemplary. A week later on Cape Cod, having wolfed-down four courses of seafood, I launch into a gargantuan chocolate brownie and ice-cream mud pile, perhaps a thousand calories or more. There’s another grim morning just outside Boston where I order four different things in IHOP. That’s essentially enough pancakes for eight normal people. I eat until I think I’ll puke on the table. What does it matter, though? My body is more than coping with this.

When I get into Boston proper, and back in another decent hotel with a gym, I’m feeling virtuous again, but with all the exercise and the unseasonably hot weather my thirst is getting out of control. And still I’m pissing and pissing, and after a while it starts to feel as though I’m trapped in a kind of hell. I’m like a cartoon character that’s been riddled with bullets – I guzzle anything I can get my hands on, only for it to leak straight out of me. I wake up most nights, my tongue arid and cracking, my bladder on the brink of rupturing.

On the second day in the city I very nearly get caught short again, this time on the otherwise enjoyable Duck Tour. Pathetically, I feign nausea and have the bus/boat stop in the middle of the city so I can dash off into the nearest bar and piss for one entire, blissful minute. The Duck has gone when I come back out, so I immediately order a water. And a beer.

During a long walk out to Fenway Park the next day, around my fifth toilet stop inside three hours, I finally accept that something is up. I promise myself to go and see someone when I get home.

Another week later and I’m getting ready for a stag weekend in Brighton, but not before I’ve been to the doctor for a blood test. Yesterday I told him about my thirst and he demanded I come back to give a sample. He seemed confident that he’d have the results back later today.

Same day results? As much as I love the NHS, I accept its limitations and this isn’t an episode of CSI. How is that efficiency even possible?

Having fasted the night before, when the nurse puts the needle in my arm, it doesn’t take long for me to feel like I’m dying. “Are you OK?” He asks as the life drains out of me. I try dig deep into my British reserve and nod. Then tunnel vision creeps in and my focus shifts to some other dimension. “Are you absolutely sure?” He asks again. I concede that I’m probably not, and he ushers me to a bed, grey and shaking.

Twenty minutes and a peanut-butter and jam sandwich later, I’m on the train to Brighton feeling better, eager to start drinking and to see my friends, most of whom I haven’t seen in months. But when I catch up with them, several feel the need to comment on how thin I look – a theme most of my family have ploughed for the past few months. I maintain that I’m a Herculean athlete and proud of my new shape. “But it’s your arms, they’re so… small,” says one of my closest pals. He squeezes my wiry bicep, looking like an unimpressed farmer at a livestock auction.

Where, but where are the compliments? I’ve spent months running, lifting weights, working as hard as my schedule and willpower will allow. I decide to ignore their comments and get drinking – I’ve found that beer is wonderful for this blasted thirst.

A couple of hours into it, our group has swamped the side of one of the bars on Brighton Pier, commandeering every seat in the sunshine and doing a fine job of putting anyone else off going near the place. Someone cracks a joke at someone else’s expense, then my phone rings and I shuffle off to answer.

“Something, something, diabetes, something, something, hospital immediately, something, something, ketones in your blood…” says the doctor. I look back at my friends and think he’s probably wrong, for one thing, and for another, if I’ve had this for the last few months, one more night won’t make the blindest bit of difference. I only tune back in when the doctor says, “I appreciate this isn’t the news you wanted to hear this weekend.” I thank him, tell him not to worry, hang up and walk immediately to the bar to order a double tequila.

From there the rest of the night dissolves into a series of fairly squalid, nightmarish images: comforting the groom when he gets inexplicably teary; talking to a couple of strippers then having to leave in a hurry when I confess that no, I don’t actually want a dance; and lastly, back in the hostel, violently vomiting into a shower cabinet while one of my friends has a shit a few feet away. I clearly and distinctly remember him complaining that stray fragments of my puke were splashing out onto his legs.

The following morning is too bright, too shiny and too loud. My thirst has never been worse. I go down to a local newsagents and pay far too much for three litres of fluids that are either creamy or sugary or both. Once I’ve stopped trembling I explain to a few of my pals that I have to pop up to the hospital, but that I’ll be back in time for pub golf, day two of the stag.

As I walk along the promenade to the Royal Sussex Hospital, it’s difficult to separate my hangover paranoia from a raw fear of what’s to come. Either way, I feel awful – and I need to piss. When I get to the doors of A&E I stop in my tracks, consumed by dread. To my surprise, I find myself thinking of my grandfather as a 16-year-old, lying about his age so he could enlist to fight in World War Two. Before stepping inside, I tell myself that, logically, some of his courage must have filtered down to me – and besides, I do really need the toilet.

The next 48 hours are a blur of needles and tubes and brilliant, caring nurses and me babbling nervously and doctors saying odd things like: “You’re obviously very sick…”

“But,” I want to say, “I feel fine. Save for this stupid thirst and the last remnants of a hangover, I’m really quite well. In the shape of my life, in fact – weigh me, you’ll see. There’s obviously been a wee error somewhere and you’ve got the wrong man. However, I love the NHS and you’ve all been so lovely that you’ve got nothing to worry about, just let me out for the pub golf and we’ll draw a line under it, what do you say?”

Of course there’s no pub golf for me, there’s not much of anything, really, just lying in an increasingly foetid bed, listening to a cocktail of fluids being pumped into my veins. Insulin to bring my stratospheric blood sugar down, then dextrose to bring it back up again. I imagine working out how to take over my pancreas’s duties is a bit like flying a hot air balloon: up a bit, down a bit, occasionally a disastrous crash.

Despite the serious tone of all the professionals who come into my room, it all feels very temporary, like everyone is wasting their time. But I’m a patient patient and luckily I have my phone with me. For a second I consider Googling “diabetic ulcers” but have a jolt of fear so powerful I almost pass out. When I finally drop off to sleep I dream of wild boars eating my feet.

Type one diabetes is an auto-immune disease which, aside from making me sound like a case on an episode of House, has resulted in my immune system turning against my pancreas. One doctor tells me it’s odd that I should develop it given there’s no family history, and especially as I’m the wrong age, sex and colour.

The number of type one and type two diabetics across the world is rising. The latter can be largely explained by our increasingly woeful diet and poor lifestyle choices crippling our pancreases (“Hey man, I want more jelly!”). Not so with type one. It’s more like MS or Crohn’s in that, for reasons unknown, the body begins to behave in an unreasonable way and attack itself. There are a number of theories about why these kinds of disease are on the rise, from overly sterile childhood environments to, the one I give most credence to, the lack of hook worms in our guts.

The logic follows that for tens of thousands of years homo sapiens evolved with worms in our bellies, then all of a sudden, in the wake of the industrial revolution, our lives became more sterile and the largely benign parasites were eradicated. But our immune systems had become so used to fighting that in this new, bleached world they look for formerly harmless things to battle: peanuts, pollen, pancreases, penguins. All the Ps.

There is currently no cure for type one diabetes and unless one is found in the next five years I can assume I will have to live with it for the rest of my life. My pancreas isn’t quite dead yet, but after five years it’s likely my immune system will have wounded it beyond repair. In any case, it’s reasonable to assume that something relating to the disease will eventually kill me. I’m OK with that now, but for several weeks and months after the diagnosis it felt as though doom was following me like my shadow.

I was losing weight and failing to put on muscle because my victimised pancreas couldn’t produce enough insulin, which would have converted all the sugars and carbohydrates I was consuming into energy and/or kept me fat. Instead the sugar was stuck in my blood, so my body started to break down tissue as an alternate fuel source.

Simultaneously I was craving sweet things because my body was telling my mouth to find more sugar so it could halt this cannibalism, not knowing there were tonnes of the stuff trapped in my veins nearby. Meanwhile, my kidneys were complaining that my blood had turned to sewage – their response was to try and literally piss it all away. It was them who demanded more and more fluid so they could try and flush out my system, punishing me with the accursed thirst when they couldn’t do their job. On my first night in hospital, my kidneys finally relented and let water back into my system. The nurses poured 10 litres into me. I awoke the next morning a 15lbs heavier, unable to recognise myself in the mirror. Four weeks later 15lbs had become 30lbs. My weight-loss had been an illusion all along.

So it’s a life on the needle for me, with typically four self-administered injections a day to take over the insulin production my pancreas can no longer manage. If I don’t take care of myself, like John Fante, I will possibly go blind and have to have my feet amputated. Even with good control, owing to other complications the condition will cause, I can now expect to live for a decade less.

But I won’t allow the disease, injections, blood sugar crashes and all, to force me to do any less – I just need to condense everything into a slightly reduced time frame. I think my man Fante would approve. In his 1939 masterpiece Ask The Dust, speaking as his bombastic alter ego Arturo Bandini, he gave advice to new writers, which as I read it now could just as easily apply to newly diagnosed diabetics:

“I would caution them never to evade a new experience,” he wrote. “I would urge them to live life in the raw, to grapple with it bravely, to attack it with naked fists.”



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