Insurance against Loss

In the innermost pocket of my backpack are an insulin pen and three Ativan tabs. They are my insurance policy. The insulin pen contains 300 units of lispro insulin, which would be fatal if injected all at once. But it would take at least 15 minutes to work, during which a person feels impending doom along with a host of other unpleasant sensations as their blood sugar drops. The Ativans, then, had to be taken first – to smooth the ride to oblivion.

The insulin pen expires in 90 days. So that’s how long I have.

Last night during dinner I told my husband that I was quitting my job. For once Brendan was speechless. Then the storm broke, as it always does.

“Why?! Why are you doing this? I just don’t understand. You have a great job! You went to Harvard med school and then Columbia for residency and fellowship! Do you know how many people are climbing and grasping just to get into some shitty med school in the Caribbean? You made it all this way and now you’re just throwing it all away!”

I looked at him, expressionless. It was best to just let the tempest rage on.

He was now red in the face. “Why are you doing this to me?! When we got married I thought you were going to pull your weight financially! We literally just bought a house! How are we supposed to pay the mortgage?” He screamed.

“Well the mortgage is 35% of your after-tax monthly salary, so technically you can afford it on your own,” I pointed out.

“Sweetheart, I work in finance! They fired my boss last year. They wouldn’t have a second thought about doing the same to me at any time. When I first came to New York I couldn’t find a decent job for a year. I had to wash my laundry in the sink because I couldn’t afford to go to a laundromat. That’s how poor I was! I never want to be in that situation again!”

“But sweetheart, you have been working at this bank for twelve years. The CFO loves you. They’re not gonna fire you.” I said.

“That’s so naïve! You have no idea how finance works…”

Caught in Brendan’s torrent of words, I dissociated a little. I hovered above myself, waiting for him to finish.

“You have everything and you’re just throwing it away,” He said. “You’ll never be content.”

I dropped back into my body and focused on him: “I’ve let you talk. Now you listen. I am content. I’ve done everything my parents ever asked of me. Checked all the boxes. Went to Stuyvesant instead of LaGuardia art school. Went to Princeton. Then did everything the premed counselor told me to do so I can get into Harvard Med. I followed everybody else’s perfectly laid-out plan for me so I can end up here, an endocrinologist who’s ruled over by my patients and administrators.”

“Now I get to be everybody’s bitch. Patients can call me at all hours of the day about the most trivial things, and I have to respond within an hour or I might be sued! Even when I’m not on call the call service idiots make mistakes and page me and they get to ruin my entire day. I have low-level anxiety ALL the time. I feel nervous whenever I’m out doing something fun because I might be paged! It’s gotten to the point where I’ll look at a picture of a gorgeous landscape and my first sensation is anxiety because they can reach me if I’m there.”

“This job, this path I’ve gone down to please other people, has colored my sky gray and polluted the waters. It’s ruined everything beautiful for me. I’m content with the lifestyle that goes with it, with eating nice food and going on fancy vacations. But I am not happy.”

“Sweetheart, you never mentioned any of this…” He said.

It’s true, I’ve not talked it about it much. Because if you put these things into words they become real. And when facing the truth you cannot retreat.

The squall died down and we went to bed. In the morning Brendan left early for his job in the Financial District. I pretended to sleep until I heard the front door lock click. Then I got up, transferred the insulin pen from the fridge to my backpack and put in a few essentials. I transferred $200,000 from my savings account into our joint account to help Brendan pay the mortgage, leaving me with $3450.09.  Then I headed to the airport.

I had enrolled in classes at the School of the Art Institute of Chicago. There, I would learn to become a painter. I was going to stay in a hostel and support myself by working at Starbucks. An ex had once told me that they’ll hire anyone and give them health insurance and stock options. Never mind that I don’t drink coffee and made it only once using a Mr. Coffee. This was going to work. It had to. If it didn't then I have insurance in the form of the insulin pen and the Ativans. I was willing to toil, but I was too soft to sleep on the streets and eat from the garbage if my money ran out and I still haven’t made it work.

In the plane, I took out my phone to turn it off before take-off. There was a missed call and a voicemail from Brendan. I debated whether to listen to it since it was most likely a barrage of accusations and reprimands. Might as well get it over with, I thought. I could barely hear his voice over what sounded like construction in the background.

“I love you Sweetheart and I’m sorry I screamed at you…”

The flight attendant gave me a look and I quickly shut off the phone.

My eyes welled up. Sorry, Brendan, I thought. I’m not coming back until I make something of myself on my own terms.

About 20 minutes after take-off an overhead announcement came on: “Attention ladies and gentlemen, we have a sick passenger onboard. If there is a doctor, nurse or other medical personnel on the plane we kindly ask that you come to the rear of the plane to assist.”

I looked around. No one got up. A minute went by. Begrudgingly I walked to the back of the plane.

“How can I help you, miss?” The flight attendant asked.

“You guys are looking for a doctor to help a sick passenger?” I said.

“Oh. Are you a nurse?”

“No, I’m a doctor. What’s going on?”

She looked skeptical. Nevertheless, she let me enter through the curtain. A young woman lay on the floor, pale, her shirt stained with vomit.  

I squatted down and faced her. “Hi there, I’m Dr. Tang. I’m sorry you’re not feeling well and I’m going to help in any way I can. What’s your name?”

“Ashley,” she whispered.

“Ashley, can you tell me what happened? Do you have any medical conditions?”

“I have Type 1 Diabetes. I just started college and got put in a room with a really mean girl. I had to get away from her. I booked a flight home with my mom’s credit card. Maddy threw away all my insulin…” Ashley’s shoulders heaved and she crumpled into dry, racking sobs.

“That’s terrible, Ashley. People shouldn’t treat each other like that. When was the last time you took insulin?”

“About three days ago? My sugar’s been super high and I’ve been drinking water to lower it, but then I started vomiting.”

I looked at the flight attendant. “The pilot needs to take this plane back to New York and you guys need to call an ambulance to meet us at the airport. She’s in diabetic ketoacidosis.”

“We can’t do that,” she said.

“Why not? That’s absurd! This is life-threatening.”

“There is a situation in New York…we can’t land in LaGuardia or JFK. I’ll tell the captain about your medical advice and see if he can land somewhere else as soon as possible. In the meantime can you do anything for her?”

“I don’t suppose you have insulin?”

“I’m pretty sure that’s not part of the emergency medical kit. But let me get it for you.”

I opened the kit – the medications were all for heart- or lung-related emergencies. There was an IV kit and a saline bag though. Ashley’s veins were flat from dehydration but I managed to insert the intravenous line and start the saline drip. Still got it. Medical training in NYC taught me to be really good at drawing blood and putting in IVs.

I used Ashley’s glucometer kit to check her fingerstick sugar level. It read “HI” – the sugar was too high to be quantified by the machine.

There was only 500cc of saline. She probably needs at least five times that. And insulin.

The flight attendant returned from the cockpit and stood over us.

“What’s the word? When can we land?” I asked.

“We don’t know for sure. There are several airports in Pennsylvania but the queues for the landing strips are long.”

I looked at Ashley. “How are you feeling?” I asked.

“A little better, thank you. Thank you so much. I didn’t mean to cause this much trouble.” She said through dry cracked lips. She still wasn’t strong enough to sit up.

“Don’t be silly,” I said absentmindedly, “It’s no trouble.”

I thought about the insulin pen in my backpack which I had taken from my clinic’s sample supply. It was the least messy way to end things if I couldn’t make it as a painter. It was my plan C, my insurance in case of failure.

I said to Ashley: “Do I have your permission to treat you with insulin from my supply? It’s a new insulin pen and it’s never been used.”

“Yes, of course,” she said.

I injected 10 units of insulin into the skin of her abdomen. Usually diabetic ketoacidosis is treated with an intravenous insulin drip, but we can also give patients insulin subcutaneously every 2 hours or so. It was the old way.

I turned back to the flight attendant. “Wait, what’s going in New York?”

“We can’t release information about the situation in New York City yet, but the captain has been given clearance to land in Pennsylvania. He will be making an announcement soon.”

Sure enough, in five minutes his voice came over the loudspeaker: “Ladies and gentlemen, this is your captain speaking. Due to uh, unforeseen circumstances we are unable to continue our flight to Chicago. We will be landing soon in Dubois, Pennsylvania. Thank you for your patience and understanding. Further instructions will be given once we are on the ground. Flight crew please prepare for arrival.”

The cabin broke into cacophony. Thirty minutes later, the plane rolled onto the tarmac.  

Another announcement: “This is Captain Marshall Jackson. On behalf of myself, my copilot James Taylor and our entire flight crew we thank you for flying with United today. We’ve just received updates on the situation that lead to this curtailed flight. Two planes flew into the World Trade Center in Manhattan…we are under a national lockdown…no flights departing….”

My mind went blank. Brendan worked on the twentieth floor of the World Trade Center. I flipped open my phone. There were no new calls and no new messages.

Numb, I listened to the message he sent before take-off: “I love you sweetheart and I’m sorry I screamed at you last night. You deserve to be happy and you were right to quit that job if it made you miserable. I’ll talk to you later. It will be a long day for me here. Don’t wait up for me. I love you. You’re the love of my life.”

I was mistaken about the background noise in his message. It was not construction. It was the sound of things falling apart. I called his number. It rang and rang. I called again, hoping against hope that he - that we - would emerge whole from the wreckage.