The Power of a Break

This blog project was originally assigned to me as part of my summer internship, and I was skeptical as to how I would like the exercise. I always enjoyed reading other people’s thoughts and perspectives about living with diabetes, but never really thought about contributing my own stories. However, after a break from blogging, I have decided to pick it up again, as I feel it is personally beneficial to reflect on positive/negative experiences, and maybe someone will read it and learn from my mistakes or be inspired by my achievements. So, here goes my return from my break.

            The concept of a “break” is pretty non-existent for someone living with type 1. This is probably one of the hardest aspects of living with diabetes as breaks are a natural part of life for people: breaks for summer, breaks in between classes, breaks in career choices, etc. Continually thinking about my diabetes gets exhausting, filtering questions, different possible scenarios, checklists of necessary supplies, counting carbs, analyzing blood sugar trends, etc. are thoughts that constantly consume my brain power. I write about this to release some of the burden that not being able to take a break from diabetes causes. It’s hard to constantly keep putting diabetes above everything else in my life especially when I am faced daily with a million distractions that college life presents.

            In the past 18 years, I really can’t think of a time I decided it was time for a mental break from diabetes, but last weekend I made a conscious awful decision to take a break from diabetes. I will refrain from details, but basically I made a handful of bad decisions with poor blood sugars and ended up not being able to control my health independently and needed assistance from others. Just a one-hour break and there I was incapable of caring for myself. As much as this experience was terrifying, I can now say that yes I have taken my break from diabetes. And let me say that I never ever want another one. I knew what my blood sugar was and yet I still made poor decisions, I think in part because I wanted to live my life that day without feeling sequestered by diabetes. I think this is a natural feeling and I am choosing not to beat myself up about it because I have rarely experienced this before, and use it as an experience to learn and grow from.

            I think that my message here for others who have not chosen to take a break from diabetes is to respect the presence of your diabetes in your life and understand that it is a part of you that makes you you. I’ve learned from my “break” and I am relearning to love and appreciate the discipline that living with diabetes requires. Ask me a week and a half ago if I ever wanted a break from living with diabetes and I would have jumped on the offer- ask me today and I will immediately say no thank you. Whether I like it or not, my diabetes is a part of me, and it’s not going anywhere, so I need to make decisions not just for me personally, but for both me and my diabetes. 

            Breaks for people living with diabetes are scary because we have naturally trained our minds to constantly put diabetes at the forefront of our mind, and so when we eliminate that ingredient from our thought process, I think we don’t really know what to do with all the freedom that others constantly live with. As nice as living with an empty forefront of my mind would be, I think I will take my life sans breaks.

Presentation Complete!

Today I achieved a goal of mine this summer and I have to say it feels really good, as achieving goals should feel like. A few weeks ago my manager told me that I was to prepare an article “that we would all find interesting” of my choosing to present to the entire team. Naturally I thought, what can I share with these people who work in the pharma/health care world, that they don’t already know??! With minimal direction and vague instructions, I kind of felt a little lost, so I just started reading databases. I’ve never sifted through online databases for pleasure before so that was a new experience, but after a few hours I started to find some articles that appealed to me on insulin pumps. After extensive work on this article, I chucked it, deciding it was not pertinent to Novo as they specialize in injection therapy. Going out of my comfort zone, I decided instead to talk about education with youth with type 2 diabetes—something I know zippo about. However, I figured I might as well take on a challenge and learn something new in the process. As I got more into the topic, I decided to compare and contrast it to education with youth with type 1—something I am familiar with. I thought it would be interesting for the team to think about type 2 diabetes in a younger population as it is common to think of type 1 for children and type 2 for adults. I know that is what I thought all along growing up. I mean it really is sad that youth are living with type 2 diabetes and we need to think about this more as a society. Obesity becoming declared as a disease?? What is going wrong with our world. Anyway, so my manager had been kind of scaring me for a few weeks about doing a good job on this and not putting much on the slides and having animations and not looking at notes, so naturally I was becoming nervous. But, every time you get up and public speak, it is a learning experience—I don’t do it much at school so I know I have a lot to learn. But when I was up there, after getting my nerves out at first, I became increasingly confident in what I was saying, and even felt like I didn’t need my notecards. The best part was that I think that everyone enjoyed the topic—I urged them to think of the younger population too when you think of type 2 diabetes and I saw a lot of heads nodding so that was reassuring. They pumped me with questions, but I responded without much hesitation or just simply said I don’t know that fact and would look it up, no shame there. Basically I guess that I feel good after presenting, and I’m glad it wasn’t a disaster. If only I could get my stomach to settle and my blood sugar to stay flat before presentations, I would feel a lot better prior!

6 weeks down!

It’s crazy to think how fast my time here is going, and it’s funny because some days I feel like I am looking at the clock all day and others are over before I blink. I was coming up the elevator today and immediately went through the now normal routine of badging my ID to enable access to my floor and I thought back to the first day I rode up the elevator to meet my unknown manager (and manager’s manager too actually) in an unknown department that I had zero clue about. Timid, shy, and severely out of the loop, I wondered why and how I ended up here. Six weeks later, I am proud to say that I feel less timid, more confident, and certainly more informed about the department I have been working in. As much as getting my departments switched at the last second before beginning was a pain, it enabled me to really start from scratch here. I have to confess that I did spend a bunch of time in the month before coming here googling and researching what the heck medical liasions do so I wouldn’t seem unqualified when I started my supposed internship in Medical Affairs. However, I was forced to not have any preconceived ideas about Medical Writing, as I literally had not a clue what people did here! It has been a growing and learning experience for sure- I really wish I did get to have the opportunity to practice writing like a medical writer, but they didn’t have anything that I could help work on. I have talked to enough people about the process, that I have a good understanding of it, but listening and doing are two very different areas.

I met this nurse in the parking lot of my CPR class last night and we got to talking and her career path got me thinking a bit about my own. After getting her nursing degree in her 30’s, she worked in the hospital for about 6 years and then decided to leave and work the 9-5 life in infectious disease. She wanted a change from hospital life. But her face lit up when she said that she was going back (hence the CPR class). She said she hated 9-5 Monday through Friday. She said she didn’t have time for a life too. Although the 3, 12 hour shifts are hard she said, you get to have a life the other half of the week. Although I have no experience with this life, I have gotten a taste of the 9-5 life. By the time I snag a tired work out in after and make dinner, all my body wants to do is lie motionless in bed. It just got me thinking about scheduling and trying to incorporate a life into a career as I know I will want to continue playing squash, start a family, and get involved in community organizations as I get older. I guess it’s just food for thought, but it made me rethink how beautiful everyone paints the 9-5 life.

On a random note, I haven’t worn my sensor in about 3 days, and I feel lost without it. I feel like I don’t know how to manage my diabetes anymore without it. I’m not saying that I am dependent on it because I promised myself I would not get that attached, but I just don’t know how I did it for 18 years without it. I think that I would subconsciously check my blood sugar without going through the process of asking myself if I need to or not because I was accustomed to 10 checks a day…but now that I have had a taste of not checking 10 times a day and only when I need to eat meals or with exercise due to the precise readings of the CGM, it is hard to switch back to that mode. And last night I dreamt that I was man who was drinking a juice box….which is officially the weirdest dream I have had trying to wake myself up to tell myself to check. I clearly was envisioning myself with a juice box in my hand… why I was a man I have zero idea though! These dreams are actually starting to scare me because I what happens if I stop having them and am not on the CGM? I think it’s pretty neat how the brain works especially during sleep to subconsciously try and wake up someone who should not be sleeping. It freaks me out and I am very appreciative of my sensor being able to catch me around 80 rather than my fun times at 50 last night the consisted of me taking apple juice to the face from the container and a few of vanilla oreos I had as I hadn’t gone to the grocery store all week to replace the peanut butter crackers. The importance/necessity of grocery shopping upkeep and diabetes I think is a whole different story I am still working on and I won’t get into!

Nurses at Novo!

The past few days have been a very positive experience for me. I finally met someone who has a nursing degree and background. This was very big for me as I was beginning to feel discouraged at why I was even here as it seems like everyone I have met has gone to Pharmacy school, gotten their PhD, or have only worked in pharma. After getting comments like “well we have never had nursing students here” or “so what made you want to work at a pharmaceutical company in nursing school?”, you begin to doubt why you here. The truth is, I wasn’t a part of the decision to send my application here, and while I am extremely thankful and feel blessed to be working at Novo, I was not part of that election process. Nevertheless, regardless of what some employees have told me, I am here to get another prospective on patient care, and see a different opportunity of where I use my clinical, personal, and nursing experiences in the future.

The first Novo Competency is that the company puts the patient’s first in all that they do. I think this is an imperative quality. Everyone at this company from the executive office, to medical writing, to customer care, IT support, and the people who work in the café, are all here to help in the production of drugs that ultimately benefits the patients. If you want to work in the pharma world, I am learning that you have to pick just where you want to work within this large assembly chain to approve, manufacture, sale, and review the drug. Unfortunately, I think it is far too easy at this company to forget about the patients and to get in your specific bubble of your place within the assembly chain.

After about 4 weeks here I can say that as much as I love the people that work in the medical writing department within SSC, I don’t really have any interest in working here later. I like to write don’t get me wrong, it’s just that it doesn’t make my face light up when I talk about it. I think also that since they don’t have any trials for me to help write up, I haven’t gotten to experience the writing process for myself. Because of this, I have been trying hard to see other areas of the company as there are thousands of employees here that all do different jobs. I have shadowed with the Customer Call Center and Product Safety this week where I met people with clinical backgrounds, and I have a new view on the pharma world.  As I sit in the medical writing floor, about as far away from patient contact as you can get, just 3 floors below me, there are people at the call center directly talking with patients calling with shaking voices worried that their product is broken and crying because they can’t get their insulin to inject. I told the employee I was shadowing in the call center that she was like a hero for these people helping them with their product, and she kind of laughed and said she had never looked at her job that way. But it’s true, as a patient who has called my insulin pump company many times infuriated and feeling disgusting due to high blood sugars, I know how great the call center people can make the people at the other end of the phone line feel. I think that having this interaction with customers would make me feel like I had made a difference in their health and would be satisfying for me.

I am glad that I am working here because I feel like many college students get internships that they hope will turn into immediate jobs right out of college. However, I am learning that this experience is not what I want to do right after college, but possibly 25 years down the road I will want to. I shouldn’t work here next year because I need to get that experience “out in the field” to not only to make myself more marketable as an employee, but to increase my knowledge and confidence interacting with patients. However, talking with people here who have worked the 12 hour shift hospital life for a while, they describe feeling blessed to be working a 9-5 life at a company with such great benefits so they can have their time with their family. It’s important to realize the different lifestyles that a nurse can have and even though I might be able to tolerate a three 12 hour shift/ week life for a few years out of college, who knows if I could maintain that life with a family of my own. I don’t know now, but it’s good I’m getting a snip-it of a different type of work life. I learned more about the incredible benefits that this company offers full time employees and it taught me about how companies should pride themselves of employee recognition (I’m talking about Apple TVs for Christmas gift, sleepover Christmas ball in Philadelphia, 4 week paid vacation, annual bonus, gift card recognition, 5 year gift, health insurance, the list goes on). If the employees are happy, they will do their job in the end benefit the patients. It’s an important lesson to learn that every company or institution treats their employees differently and if I am so lucky in the future to be deciding between 2 different companies or institutions for jobs, then I will be sure to remember my time here at Novo and learning about how well they treat their employees.

 

Do what you dig

 

Today I had lunch with a manager in my department and I found myself learning about really important skills that I can take with me wherever I go professionally. I got the sense that he was trying to teach me lessons through his mistakes, something that I do frequently to younger girls on my squash team and in nursing, there’s no better way to learn. Working within a corporate organization is like learning a new language, there is a science to it, it takes experience and time to master, and each person learns it differently and progresses at their own pace.

• Public Speaking

I think I am just beginning to grasp how important this skill is to have in life. Being able to confidently persuade your audience on what you are speaking about is a talent and something that can provide increased job opportunities. It is important to use any opportunity you have to practice such skills such at a small meeting where your boss is there—maybe you do such a great job presenting material internally that when it is time for the presentation to the VP, boss lady remembers your presentation at the small meeting earlier in the month, and you get the job. Or just putting pictures on the slides so the audience is forced to look at the presenter rather than squinting at the tables and graphs. Or standing to the left of the screen so the audience looks at you then follows the natural path of their eye left to right on the screen. I’m making it a goal to practice my public speaking whenever I can. Volunteering to give presentations at school and finding courses offered at school are where I will start.

• “Do what you dig”

It’s simple. Do what you like in life. Don’t work your life away. He told me stories about people he used to work within the banking world where he thought they  were in the late 50’s based upon the wrinkles and grey hair, only to learn that they were in their early 30’s. Find the balance between wanting a family and also furthering your career aspirations. Take your maternity time and don’t feel guilty about it, you’ll be paying for childcare while you work so you might as well spend that time with your baby. Try and get paternity leave too, more people at home to help. Don’t solely focus on your career because then you will be 45, sick of work and wanting to start a family and realizing it’s too late.

• Keep your private life private

I need to start thinking of myself as a product, something I have to market. When I’m at work, I am trying to do my best to market myself as the competent worker that I am. Therefore, what I do after I leave the door at 5pm stays with me, and me only. I think this is a very interesting idea that I hadn’t thought much about. Say hypothetically, that I tell my cubicle friend when she asked me about my weekend that I went to a concert, found some new drugs a dude was giving out, tried them, went gambling, then hitchhiked all the way to California, but hey, made it back for work on Monday! Now when I’m giving a presentation on work that we are doing, I am suddenly the crazy drug hitchhiker concert lady instead of the competent worker. And maybe that information that I told in secret to a coworker friend suddenly comes out months later out of context, suddenly my career is in jeopardy. He told me that he has gotten lots of facebook requests from novo employees, but he ignores them all as his private life is separate from work. It’s a good lesson for everyone to remember especially the way social media is driving the world.  He also discussed that you don’t have to be buddy buddy with everyone that you work with, but “you get paid to get along with everyone”.

I didn’t ask for any of the stories that helped to create these lessons, but I was thankful for him sharing. I spend so much of my time at school trying to just learn the ropes of the university and hospital setting, that I haven’t even thought of the ropes in the corporate, job seeking world and after this lunch I am more aware of all the lessons that are out there, and I am sure that I will learn my fair share the hard way as well.

 

Type 1 and Athletics

Today I had a very interesting conversation with a manager who is doing an internal journal club discussion on athletics in people living with type 1 diabetes and how this condition does not limit athletes from achieving greatness. Obviously, this is a topic near and dear to me as I am constantly thinking about my diabetes as I play squash on a highly competitive division 1 team. And after 18 years, I am still going through trial and error situations, testing the waters, seeing what works and what doesn’t for me to be able to perform at my peak without worrying about low or high blood sugars.

I found it interesting he was deciding to use 2 swimmers with diabetes who had won many gold medals at the Olympics in his argument about type 1 diabetes and athletics. However, these 2 athletes were diagnosed with their diabetes while they were already at the top of their sport, something unique and different to me where my squash skills grew with my diabetes. His basic argument is that diabetes should not limit athletes at all. I agree with him- it shouldn’t. I’ve met athletes at the top of their sport as well with diabetes, and even a man who has climbed Everest and ran grueling marathons in the Sahara, and yet I felt frustrated after our meeting. And I choose to live my life with the mindset that diabetes won’t come in the way. Probably I was frustrated because my whole life isn’t dedicated to squash and diabetes management, therefore I can’t cookie cut and have the power to manipulate my life like these athletes can. I think I felt defensive to his argument because in some respects I believe, diabetes HAS limited me and my athletic ability. When I think of the reality, sometimes my diabetes does take precedent in my life.  I can think of multiple squash matches that I would love to have back and prepare my blood sugars differently. Or for whatever reason my blood sugars just weren’t cooperating with me that day and it wasn’t something I did incorrectly. Or my coach at the last second sprung on me that we are running sprints before practice instead of usually after.  But, it’s ok. I’m still achieving my goals, athletically, academically, and in life. I don’t know many other chronic conditions that you can compete athletically at a high collegiate level with, and this in itself is a huge accomplishment that not many people are able to have in their lives.

A big portion of his talk is going to discuss energy cycles, interactions with hormone levels, and how athletes with diabetes go through trial and error situations to learn more about how their body reacts to different levels intensity of exercise. Every time I exercise, I feel like I am going through trial and error. Did I give insulin at a different time today? Did I try a new granola bar? How about lowering my basal dose while sitting in lecture? Did I leave 10 minutes early so I could walk to practice and not run and preserve my blood sugar? Is this a normal practice or challenge matches- is there stress and what will that do to me? Am I sipping Gatorade or water? Do I even have enough juice and snacks in the locker, I can’t remember? Did I immediately add back all my insulin right after? How about dinner- did I stick to salad or have some pasta tonight? ….just an idea of the filtering system of questions that I think about every day. I think that the take away message is that these big time athletes have found the perfect equation for them in terms of how they set up their body not only just in general, but their “diabetes body”. They have to- they can’t afford to perform with low or high blood sugars. I still feel like I am finding my equation, and instead of getting upset with myself about that, I realize that this is ok. My life at college is constantly changing, it’s not “cookie cutter” like these professional athletes. I’ve also had diabetes my whole life and sometimes it’s hard to change your routine when you think that is the best you can do because it’s the only option you know.  My conversation with this manager reminded and encouraged me to keep experimenting now, during my off season, to perfect my diabetes management with athletics, and showed me that if I continue to work hard at managing it well, I can work to cut out those instances when I’m playing at 300 or dropping fast from 100 doing court sprints. I have a hard time putting into words what it feels like to be playing squash at 350 to others and it’s frustrating when the months and months of training to get in peak fitness shape can’t even be utilized because your head is in your blood sugars and you’re so thirsty from the high sugar that you can’t even think about what shot you are going to hit next. Or when you think you are crashing on court and all you can think about is getting off court to chug Gatorade and honey to stop feeling heavy and tingly on court and start refocusing on beating your opponent. This mental tug of war contest is the limitation of diabetes that I work to eliminate everyday so I can enter the court just like all of my teammates and opponents do.

Finally, I tried to enforce in my conversation with the manager about the advantages these athletes have over other athletes because of their diabetes. Often, people don’t think of this, and I wanted him to be aware. Often the discipline, maturity, forced knowledge on health and nutrition, and the ability to push through adversity outweigh the limitations that diabetes can cause athletically. Although these are intangible advantages and often hard to describe as well, but I have seen the benefits from them and am confident that I have achieved my goal of playing collegiate squash due in part to living with type 1, and for that I am strangely thankful. 

A taste of education

This morning I had the opportunity to attend a Medical Training meeting and product overview on various Diabetes, BioPharm, and Hemophilia products. I am not  100% sure on the audience’s department  as everyone introduced themselves quickly, but I got the understanding that the attendees were from marketing, but that they did company marketing rather than working with the sales reps of the products. This was later confirmed when basic questions about differences between Type 1 and Type 2 diabetes were asked and in particular about the insulin pens we were discussing—questions that sales reps should have down cold as they are the ones who are out in the field trying to get product sold. The presentation was conducted by people who work within medical information, a team of pharmacists that specialize in responding to health care providers about Novo’s products. Therefore, they need to be thoroughly educated in the not only the products, but also the conditions, products in the pipeline, and competitor’s products. I know I am not interested in becoming part of the Medical Information team as I have zero interest in going to pharmacy school, but the experience did expose me to a type of education within this company that I have been dying to see.

It was astonishing to me that employees of this company were not aware of concepts such as gestational diabetes or insulin pump therapy or the differing types of people that live with the 3 main types of diabetes. It showed me that diabetes education is needed more than I think it is. It’s made me think today that I take my 18 years of growing knowledge for granted. That I know a lot more than I think I do even though I’m learning I need to learn more. I found myself taking notes on concepts I already knew, but writing them down in the presenter’s words—as I am trying to work on my medical vocabulary here. If I want to educate others later on down the road, I need to have the basic vocab so people believe what I am saying, and I need to be able to say it with confidence so my patients believe me. So I’m learning different ways to say the same thing. “My body doesn’t all that it needs to digest my food” is basically trying to say as “Due to an autoimmune deficiency in my body, my pancreas  lacks the ability to secrete insulin, a hormone, that is needed to bind to receptors in the bloodstream to get glucose out  and into the cells to prevent a buildup of glucose and maintain stable blood sugars.” The later sounds a bit better, so I’m practicing when people ask me about my diabetes, to respond in an educated manner.

I even got to do some teaching today, sharing my experiences using the Novo Flex Pen with the safe, one time use needles that once inserted into the patient are safely closed automatically. My trouble with using this pen on patients in the hospital is that as the care provider, you are unable to determine if the needle has gone through the skin,as it is covered by a plastic safety cover, so I found myself asking patients, “ Did you feel that?” to ensure I had administered the medication. That would be absolutely horrible if you just pushed the button thinking the injection was administered, but the needle had not gone through. It was comforting that others had this same worry and it was interesting to discuss.
At one point, the presenter discussed why the Novo twist off needle for only Novo pens was not being promoted by the company anymore and other the regular needle made to fit any company’s product was the main product to promote. Apparently, the company was losing money while promoting due to the popularity of the former product even though this product was in fact safer as it securely fastens on and ensures the patient of so by a loud click in place preventing wobbly needles and fear that the medication was not administered. It bummed me out to hear “because we were losing money”. I haven’t taken enough business classes to fully appreciate the money making side of companies… to me, it’s all about patient care, and if the twist off needle is the safest, I want you to tell me so regardless if your company doesn’t make an extra couple million. I guess this is why I should just stay at the bedside and not in aim to sit in a pantsuit behind a CEO desk.

I also enjoyed learning more about NovoSeven, Novo’s drug to treat Hemophilia in patient’s that have clotting disorders. Basically the drug works to activate the extrinsic pathway clotting cascade at Factor 7 to help the cascade in Factor 8 or 9 depending on the type of Hemophilia that is needed to create a fibrin plug in the bloodstream to stop bleeding, something that these patients have an inability to do.
I got to get hands on experience with Novo’s products today, and it exposed me to a different side of the company. I know that not everyone in this company works behind computers all day staring at Clinical Trial Reports and making Subject ID bookmarks, so it was uplifting to know that there are people who are educating others on why this company exists- to make these products to change patient’s lives. At the end of the day, that is why everyone here comes to work. I was surprised with the lack of knowledge in the company’s products and the conditions they are used to treat among the employees I was with and wish that they would do basic training to ensure a companywide competency in understanding.