Alice on Pill Hill

Having had Type 1 diabetes for 12.5 years, I have had my fair share of endocrinologist appointments. At approximately 3 a year, I have had close to 40 endocrinology appointments. Driven up I-5, taken the Wiedler Exit, dared to cross over a one-way street with a full line of cars blocking my entire vision of oncoming traffic. Walked down the hallway from the parking lot, first with my mother, and then by myself. Taken the elevator to the third floor of Emanuel Children's Hospital. Greeted the staff, hapharzardly filled out the intake form, not ever really answering how much insulin I took at meals or how many carbs I ate at breakfast, lunch and dinner. It's not like it was consistent. Life never is.

I grew up going to Emanuel Children's Hospital's Diabetes Center. I was there before most of the current staff. I was there when they did the remodel and the entrance moved from next to the elevator to the oppposite side of the office, forcing us to make two right hand turns. I saw how the clinic grew with all the children. All the staff changes. How there were always new nurses but they were always so nice.

There was Dr. Hansen. Dr. Hansen was my favorite part of that hospital, and even though he isn't here anymore, he's still my favorite part of that hospital. After he died, they posted a letter he wrote to all of us and put it, along with his picture, on the doorway. I read it everytime I have an appointment. It reminds me of how much he loved all of us and it reminds me of how much I loved him.

It might seem a little strange to have such an emotional attachment to a place that for most people should be deemed the worst place on earth. But it wasn't. It never has been. Emanuel Children's Diabetes Center has always been warm and welcoming, understanding and sympathetic. They don't always understand very well, but at least they try to. I have to give them that.

I grew up at the hospital. They saw me reach 5', which was a big deal since my friend Jenny was always several inches taller than me. They saw me start adolescence, with the evil dawn phenomenon wrecking havoc on my control each morning. They saw me get my license and my newfound independence. They saw me graduate from high school and start a new life away from my parents, and they saw my subsequent abuse of that freedom. They saw me at JDRF's Children's Congress. They saw me at the conferences. They saw me playing with children and trying to calm parents down at the Seminars.

They saw me grow up. And now they are seeing me leave.

I had my very first appointment at the Diabetes Clinic at the Oregon Health & Sciences University in Portland today.

My very first appointment at an adult endocrinologist.

For some reason, it was this revelation, that I was no longer a pediatric patient but an adult patient, that made me feel grown-up. Not getting my license, not graduating from high school, not voting, not selling my website, not even my impending abilty to purchase alcoholic beverages.

I was not going back to Emanuel.

I was very nervous driving up through the forests of the West Hills in Portland on this quintessential Oregon summer day: warm, sunny and bright green. I made sure I left myself plenty of time to get to the hospital, which I ended up needing since I accidentally missed my exit and essentially drove the route to Emanuel before getting back onto I-5 and going the other direction, back towards OHSU.

OHSU is a remarkable institution. It's a medical school, hospital and research center all in one. It's built on top of a hill, which has been nicknamed by Portlanders as Pill Hill. It can be see from almost anywhere in Downtown and East Portland, though for all the years I've been involved in the diabetes community, I have never ever been there.

The twisty roads led me up the side of the hill to OHSU. Since it's on a hill, it's difficult to get a sense of the layout. Luckily, signs were created for the directionally-challenged, like me. They also put in place some very helpful receptionists who pointed me in the right direction. I arrived at the front desk about twenty minutes before my appointment, but I still had my New Patient Intake form to fill out. Oh joy. My favorite question: "Have you had any diabetes education?" My answer: "A lot."

After filling out all my medical history, any current problems, the amount of insulin I take, and whether or not I was pregnant (definitely, definitely not), I was finally called in to do the weight check. Still too much, but we're working on that.

I waited for about 10 minutes in the Exam room before a nice, young Indian woman came in. I was a bit confused since I thought I was going to see Dr. Liz Stevens, who is definitely not Indian, but I didn't want to seem rude. The nice, young Indian woman, who turned out to also be a doctor, asked me lots of questions, including the Ultimate No-No: "So how's your diabetes control lately?"

Dear God, can you please send a memo to all endocrinologists (and diabetes educators while you're at it) telling them to NOT ask this stupid question? Love, Allison.

After basically being asked the exact same questions that were on the intake form (what on earth was the point of filling that thing out anyway?), Dr. Stevens finally materialized. It's always a little funny when someone looks at me quizzically and says, "Have we met before? You look familiar."

We went over my last week (mornings too high, but otherwise not too shabby) and we also discussed going on one of the new continuous glucose monitors for a few days. A loner meter, kinda like a loner pump. Hey, whatever gets me the most for the least amount of money. Dr. Stevens was very nice and she also has Type 1 diabetes and was on the Guardian over the weekend. She liked it, although she said there were issues with accuracy. But she said they were never much more than 20 pts. off, which isn't too bad if you're trying to figure out if you are low, high or normal. I'll be hearing from the diabetes educators in a couple of weeks to get set up with the monitor.

Ya'll can bet I'll be writing lots and lots of commentary.

After the appointment was all said and done, I went on a mission for a cafe or dining area in the hospital. Per tradition, after every appointment I get to indulge in a little bakery item. It was started when I was younger and would be rewarded for a good A1C. Emanuel has a little bakery in the Atrium and my mother and I would always go there after the appointment. I started taking myself there in high school, and the tradition will continue at OHSU. Of course, with the hospital being on a hill, the lobby of the main hospital was on the 9th floor, thus completely destroying any sense of consistency I had for a hospital layout. Eventually discovered the dining room and bought myself an ice cream.

As I drove out of the parking lot, I thought about my experience at this new hospital. I realized it was most likely just the first of many new endocrinologists, and that scares me a little. It's not that I thought I would always be at Emanuel, but Emanuel wasn't just a place I went every 3 months to hear I needed to get better numbers. It was a connection to support, to education, to people who really cared about how I was doing. It was my connection to Dr. Hansen. It was my connection to the things that made taking care of people something I wanted to do. Perhaps I'm afraid that if I stop going to Emanuel I will stop knowing how to carry on Dr. Hansen's dream. I will stop remembering him if I don't read that letter. I need to remember him. I don't want growing up to mean going away.

But, to end on a happy note, my A1C was 7.2, which is the lowest it has been. Ever. In my entire existence as a type 1 diabetic.

I guess Pill Hill isn't such a bad place after all.