Two months after I turned five years old, I had a mandated pre-kindergarten physical where my mom mentioned my recent insatiable thirst and incessant exhaustion. I had been spaced-out and not acting like my typical self in the previous weeks, so fatigued that I was sleeping in until 11am on the days that I didn’t have to wake up early for preschool. The doctor brushed it off at first—it was July, it was hot, I was spending a lot of time playing outside. My mom wasn’t too worried at first either—I was going through a growth spurt, and we had just gotten a new fridge with a water dispenser that seemed to fascinate me. The doctor decided to order a basic test just to assure that I was completely fine. 

Less than an hour after we arrived home, my mom’s ringtone filled the room, a haunting harbinger that signaled the trajectory of the rest of my life. 

“You need to bring her to the hospital now,” the doctor told my mother over the phone in a tense, hushed tone, “The results came back, and she might have type one diabetes.”

One of my earliest memories is sitting in my hospital bed while nurses streamed in and out of the room every hour or so, poking and prodding at my tiny uncalloused fingers. I kept thinking that each time would be the last, until yet another rosy-cheeked nurse dressed in teddy-bear themed scrubs would stroll in, needle primed in hand. I got so tired of them puncturing holes into the tops of my fingers that I locked myself in the bathroom attached to my hospital room and had to be lured out by my parents, only convinced by my mom promising that she would let me wear her clicky high heel shoes if I came out. It’s a defining moment of my life, reminding me that the four years I lived without diabetes almost feel like they didn’t really happen, that this has always been my identity. There has never been a “before” for me—my entire being has occurred in a state of “after”. No matter the age, when you receive a diagnosis, your life is suddenly fractured into two distinct pieces. You weren’t sick, and now you are. You were a person, and now you’re a patient. Who were you before? Who are you now? Will you—could you—ever feel the same again? 

Not long after my hospital stay, I met her: Dr. Griffin, a short woman with light brown hair that fell to the bottom of her back. She had round glasses that she was almost constantly fidgeting with as she reviewed my chart, and was usually wearing a tan-colored cardigan, a floor length skirt, and athletic sneakers that could efficiently get her from room to room around the hospital. As I quickly learned, she was going to be my endocrinologist. An endocrinologist, they told me, is a special doctor who knows all about the pancreas. The word felt foreign in my mouth when I repeated it back. Endo-crin-ologist. 

The first time I stepped into her office, my eyes were drawn to the enormous mural on the wall. Golden yellow sunflowers, slightly askew, blown over by the wind coming in from the west. The other rooms around the hospital had murals too—pirate ships and snowball fights and sinewy ballerinas twirling in place—but these sunflowers captivated me like no other.

We sat across from each other, me, sandwiched in between my parents; her, in a shiny black swivel-chair next to her computer. I felt secure tucked between them, noticing a hint of my mom’s perfume in the air—the same fresh, flowery smell that she sprayed on my stuffed animals when I had a nightmare—and absentmindedly clasping and unclasping my dad’s watch.

“Annie, do you want to play with my stethoscope?” she offered. I gingerly took the cold, metallic instrument from her hands. It was the ultimate gift to a five-year-old: something exclusive and special, only for the chosen few to wield. I had spent the remainder of July in a state of perpetual confusion about what was going on, but I knew that it was about me; I heard my name sprinkled throughout conversation, interjected with “autoimmune disease” and “no cure”. But all that mattered to me was getting to hold that stethoscope, so shiny that I could see my warped reflection in the bends of the metal. While the adults discussed blood sugars and carbohydrate intake, I pressed the chestpiece against my mom’s heart, and then my dad’s, and then my own. I closed my eyes and listened to the thumping sound. Steady and constant, my concrete sign that my body was still on my side in some way. 

My diagnosis was a medical mystery. Most type one diabetics are not diagnosed until they are in the throes of diabetic ketoacidosis—when their blood sugar is so high that acids have started to build up in the blood and destroy them from the inside out. In the months leading up to an eventual diagnosis, they tend to become skin and bone, seeming to be inexplicably ill, teetering on the edge of death. The normal blood sugar for a non-diabetic person is in the range of 90 to 110, sometimes gently gliding slightly upwards or downwards depending on the last time they ate. Conversely, many type one diabetics have a blood sugar of 500, 800, 1,000, or beyond at the time of diagnosis. I was the outlier: diagnosed unusually early, a picture of health except for my basic symptoms that could’ve been attributed to a multitude of reasons. After my diagnosis, my medical team made an unusual decision: I wouldn’t start insulin yet, but rather, I would live under the restraints of a strict, low-carb diet. 

Eggs. Peanut butter. Vegetables. Protein. Regimented, structured, orderly. 

When other kids brought in cupcakes to class for various celebrations, my teacher would solemnly walk to the cabinet, and pull out a puppy sticker or Hannah Montana themed pencil that my mom had pre-purchased for me instead. At birthday parties, while plates stacked with thick-crusted pizza and fluffy white cake were gleefully passed around, I snacked on roasted almonds and sipped from tiny water bottles flavored with Crystal Light. Kids in my class looked at me with confused wonder in their eyes, bewildered by the fact that I wasn’t partaking in their joy.  

“Don’t you want cake? Why don’t you have anything on your plate? Do you not like it? Are you going to have some?” they asked.

I sat there quietly, feeling grotesquely Martian among my peers. I never knew what to tell them when they asked; the answers to their questions were something that I barely understood myself. 

A little less than a year later, I started insulin. My mom said she couldn’t take it anymore; her heart ached when she saw the way I cried after I got home, wanting so desperately what I just couldn’t have. Being on insulin meant that I could eat more than lean proteins and low carb snacks as long as I got a shot before. Being on insulin meant that I could have pizza, and cake, and just about everything else the other kids were having. Being on insulin meant feeling a little more normal. 

                                                               🌢 🌢 🌢 

I went to see Dr. Griffin every six months, like clockwork. As I got older, inevitably, so did the mural. While I sat in the pleather-cushioned chair in her office, I noticed little cracks in the paint—subtle, but undeniably present. Harsh sunlight streaming in through the open windows faded the vibrancy of the colors from golden to a dull yellow. It was markedly different than it had been, but still beautiful in a comforting way. It was like my favorite pair of sneakers; soles worn out, and laces unraveling, and canvas muddied. It was like my favorite book; pages dog-eared, and quotes underlined, and spine cracked from midnight re-readings. It was my mural. 

 Eventually, she stopped offering me her stethoscope. It was expected—I was twelve, free floating somewhere in the in between of childhood and the teenage years. Like most twelve-year-olds, I was desperate to be taken seriously, to be treated with an air of cool indifference. I sat up straight in the chair, ever-so-attentive, soaking in everything she told me. She fiddled with her round glasses, crossed one leg over the other, and clasped her hands together. 

“Annie,” Dr. Griffin held an unwavering gaze on me, “you gained about two pounds since the last time I saw you. It’s fine for now, but don’t gain any more weight.”

The words catapulted themselves into the air and sunk into my chest like a round of bullets. In rapid succession, I tried to cycle through everything I thought I knew about my body. I was lanky, towering above almost all of the girls in my seventh-grade classes. My blood sugars were consistently in a healthy range, only sometimes temporarily raised by hormonal changes from the oncoming tidal wave of puberty. All of my health markers were ideal. Up until this point, I had never considered my weight to be an issue—but now it had become a source of chastisement. Before that moment, my body image and my physical health lived in vastly different planes of existence. After that moment, it seemed as if the two had become inextricably linked. If I gained weight, not only was I failing to uphold an acceptable image in my head, but I was letting my doctor down. I didn’t argue, or disagree, or try to question her orders. Instead, I took her words and cradled them delicately in my hands. Who was I to think otherwise? She was the doctor; I was the patient. If she said it, it must’ve been true. It had to have been true. 

“Okay,” I vowed to her, “I won’t.”

After that appointment, it was like a switch had flipped in my mind. Every time I grabbed a flimsy carboard box to check for the carbohydrate count—precious information for a type one diabetic—I felt my eyes drift higher, higher, higher to the calorie line. I grabbed product after product from my pantry, flipping and scanning and adding. Each label felt like a punch to the gut. It was all too much, I was all too much, why didn’t I know that before she told me?  

Two weeks later, I went on my first diet. I counted and counted and counted until I didn’t have to count anymore. I had it all memorized. 

Having an unhealthy relationship with food feels like getting out of bed the morning after a sleepless night. It’s all-consuming, and maddening, and hollows you out into a shell of yourself. I was exhausted when I convinced myself that I wanted a chalky protein bar for breakfast. Counting out exactly 12 almonds to pack with my lunch drained me. Making macaroni and cheese with chickpea pasta, Greek yogurt, and reduced-fat cheese left me with dark rings under my eyes. 

Eggs. Peanut butter. Vegetables. Protein. Regimented, structured, orderly.

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When I think about the doctor’s appointments that I went to during the peak of my disordered eating, there is a certain level of detachment that takes place. The feelings that those memories evoke are too raw, too omnipresent in the world, too much of a reminder that I couldn’t protect the past versions of myself who didn’t know any better. When I slide into those memories, I can feel the invisible string between my brain and my body snap, each side pulling me in a separate direction, each calling me to follow one and ignore the other. I have to consider it from a different perspective, as if I could float out of myself and watch it all from above.

Before every single endocrinology appointment starts, a nurse comes out to the waiting room and calls your name. By age 13, this procedure is second nature. She sits you down and wraps a blood pressure cuff around your arm, watching it tighten like a python entrapping its prey until the machine finally beeps and the blood rushes back into your fingertips. She tells you to take your shoes off, orders you to stand tall against the wall with your head straight, and records your height into your file. These numbers are essentially meaningless to you.

And then she makes you step on the scale. It’s exactly what you’ve been waiting for. The scale you have at home was purchased sometime in the early 2000s, and shows the wear and tear of time. You can never be sure how accurate that scale is, so you both relish and fear the moment that you get to step onto that medical grade metallic platform. As you creep towards it, it feels like a punishment and a reward all at once. 

The number always shows in kilograms. You wonder if it’s because they don’t want patients to know or obsess about their weight, especially since it’s a children’s hospital. But that’s silly, you think to yourself, because googling a kilogram to pound converter is laughably easy. Besides, even if you couldn’t figure it out yourself, Dr. Griffin would tell you. She always tells you. 

When you type the numbers into that converter, your fingers shake with impatient, uncontainable energy and you can feel your heart pounding against your ribcage so quickly that you almost swear you can hear it. The page loads, and as it turns out, you have finally succeeded. Your weight is lower than it was at the last appointment. 

You walk into Dr. Griffin’s office with a different energy today. You feel like you’re bursting at the seams, eager for when you can go home and tell everyone about your accomplishment. When she confirms to you that you have lost weight, you can’t stop a smile from plastering itself onto your face. She congratulates you on a job well done, and you finally feel like you’ve done something right, and you can ignore all of the bad feelings swimming around in your head for at least an hour.

She asks you the same questions that she always does. What are you eating? When are you eating? How many carbs are you eating? Are you exercising? 

You answer each question, including even the most minute details like the good patient you are. She is pleased with your answers about food, but you admit that outside of gym class, you are not exercising. 

“If you keep up the way you’re eating and add in exercise,” she angles her swivel-chair in your direction and gives you a tight-lipped smile, “the weight will just melt off.” 

🌢 🌢 🌢

When I was 16 years old, I stopped looking in the mirror. 

Every morning followed the same basic routine: first, I stepped into the bathroom, lights off, averted my eyes from my reflection, and brushed my teeth. Then, I walked over to my dresser, plucked out a sweatshirt that was three sizes too big so that I could cover every inch of my body, and pulled it over my head, narrowly avoiding a glance in the floor-length mirror nestled in the corner of my bedroom. I took every precaution I could to avoid seeing myself—if I didn’t see it, I could erase myself for a little longer. I wouldn’t be forced to crawl back into the corners of mind and confront the ugly thoughts that constantly looped in the background of my mind headfirst. I thought that if I could avoid the mirror, I could outrun the reality of my existence. 

Finally, before I left for school, I went to the kitchen and packed my lunch for the day. I used to eat a peanut butter and jelly sandwich for lunch nearly every single day. I loved everything about it, from the seedy multigrain bread my mom always bought, to the sweetness of the (sugar-free) grape jelly, to the salty crunch of chunky peanut butter. I loved that my dad brought a peanut butter and jelly sandwich for lunch every day when he was in school, and how it felt like a longstanding tradition between the two of us. I loved the routine, the simplicity, the familiarity. 

But when I was 15, I had another regularly scheduled appointment with Dr. Griffin. We sat in the same chairs, by the same table, in the same room that we had been meeting in for ten years. 

“Annie,” she said to me, in that way she always did. “What do you usually have for lunch?”

To a casual listener, it sounded like an innocent question. But I knew. I had years of careful training at this point—my ears could pick up the subtle shift in the air. There was always a specific intonation in her voice before she delivered her blow, something that would make hot tears roll down my cheeks the whole forty-minute drive home.

I told her. A peanut butter and jelly sandwich, with a side of fruit, and sometimes I bring another snack if I’m hungry, but really it depends on—

“That’s too much. If you want a sandwich, you should only use one piece of bread.” 

I had already stopped ordering hot chocolate on Sunday mornings when my family went to our favorite local breakfast spot. I had already stopped bringing a bag of cheddar-flavored Goldfish to school for a mid-day snack. I had already chosen an Angel Food cake on my birthday instead of the marble cake that I really wanted. The more I tried to fulfill Dr. Griffin’s wishes, the more I fed into the expectations of being a teenage girl. Being chronically ill and a young woman is a complicated dichotomy. There is a near constant erasure taking place, a war being waged on the body from all fronts. The medical system will handle the brunt of the work, reducing patients into numbers and diagnoses and paychecks. We as patients handle the rest, whittling down the rest of ourselves into nothing to appease our doctors and nurses and peers and crushes. Chronic illness typically demands the pursuit of genuine health—wholesome and nutritious foods, balanced exercise, hydration, and rest when needed. Being a teenage girl is a whole different beast. Women—especially teenage girls—are expected to diet, to stay thin at all costs, to be in the physical prime of their lives. We are raised on hundred-calorie cookie packets and Diet Coke and Splenda. We are fed lines like “a moment on the lips, forever on the hips” and “nothing tastes as good as skinny feels” and carry them with us wherever we go. We survive on the idea that we are only our bodies and pray that we’ll receive the admiration that we are trained to desire. 

No matter how hard I tried, nothing I did was enough for me to gain Dr. Griffin’s coveted stamp of approval. 

I stared at the wall. The sunflowers looked more wilted than ever. 

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When I was 19 years old, I decided to switch endocrinologists. Quite honestly, the idea had never struck me until my mom brought it up one day in passing. My parents had come into appointments with me when they managed the majority of my diabetes care, but as I took over most of the responsibilities, I began going in alone. While they didn’t see most of my experience firsthand, they knew what Dr. Griffin was like. Before I started going to appointments alone, there had been a few occasions where Dr. Griffin had criticized my family’s decisions too. Regarding my care, she judged my parents for letting me pick what kind of insulin pump I wanted, saying that I wouldn’t make the right choice. In terms of our personal lives, she questioned why our family decided to do foster care, telling us that it simply wasn’t a good idea and that she didn’t know why we were doing it. While I struggled to stand up for myself, my mom was able to shut her down with ease. She is bold and extroverted and welcoming, able to talk to anyone and make a friend anywhere we go—but she will defend me and our family at any cost. 

“We’re letting her pick because she doesn’t get a choice about having to take insulin, but we want to give her a choice about how she gets her insulin,” she would say, locking her hazel eyes directly onto Dr. Griffin, while her highlighted shoulder-length hair rustled around her shoulders. “And we don’t have to explain or justify our decisions.”

They knew that Dr. Griffin was blunt to a fault and number-focused in her treatment, but I don’t know if I ever properly communicated the gravity of the situation until I had begun to process it myself in adulthood. Somehow, it had never even crossed my mind that that I could permanently sever the ties between us, that I could cut the cord of a 14-year long doctor-patient relationship. For most people, it seems unfathomable that one should have a say in the doctor-patient relationship. It’s easy to get lost in the fact that the doctor has spent years and years in medical school, investing hundreds of thousands of dollars to specialize in learning how to treat whatever plagues you. We are trained to obey our doctors from the moment we are born; be a good girl for the doctor and you’ll get an extra sticker at the end. It feels natural to assume that they deserve total authority and control. The truth of the matter is that the doctor-patient power-dynamic is deeply skewed. Doctors may have spent decades studying the body, but the patient is the one who knows best about their own situation. 

I’ve realized that part of my mind kept Dr. Griffin frozen in time in that special place, where she was the woman who gave me her stethoscope and let me listen to my heart. But that reality only existed for a moment in time. She was that woman, but she was also the woman who had a devastating impact on the way that I view myself. I trusted her, and more importantly, I trusted her words. I came to her new and intact, a lump of fresh clay. And she molded me, guiding me to tear off pieces of myself until I didn’t really look like me anymore. I tried so hard for so long to get it just right, but my edges were always too sharp or too rounded out. I don’t like the version of myself that I was when I was hyper focused on getting it all right, the one who was misled and irritable and spent far too much time thinking about daily calorie allotments and whether or not I would permit myself to eat dessert. 

When I made the switch, it almost felt too painless: just a five-minute phone call and a request to meet with someone else. 

The older I get, the more the lines have blurred. I don’t know if I would have struggled so much if Dr. Griffin never told me the things that she did. I don’t know if self-hatred was bubbling within me anyway, if perhaps it was inevitable, and Dr. Griffin just helped to expedite the process. I often find myself wondering: did she realize she was cruel or was she simply just too clinical? Did she know that her words would embed themselves into my mind so deeply that I can watch them play out like a film scene? Would she care if she did know? 

Some people may think I gave her words too much weight. Some people may think that a doctor’s bedside manner is irrelevant as long as they are able to provide good medical care. But shouldn’t good medical care include the mental well-being of a patient? If a doctor doesn’t listen to their patient, or consider that their words hold a deeper impact due to that doctor-patient power dynamic, are they really providing good medical care? How many girls and women are brushed off, told that their pain is nothing, told that they’re being overdramatic? Doctors not listening to their patients can have deadly outcomes; every year in the United States, there are approximately 40,000 to 80,000 deaths attributed to diagnostic errors. Furthermore, women are given less pain medications post-surgery than men despite reportedly having higher pain levels, on average spend more time in emergency room waiting rooms, and typically take longer to be diagnosed than a male counterpart. When my mom visited a new doctor to address symptoms of brain fog and fatigue after being diagnosed with an autoimmune disease of her own, he asked her if maybe the issue was really just anxiety or depression. Does any of that sound like good medical care? 

Sometimes I don’t know who to blame or how to blame or even if I should blame. Instead, I have recently found myself trying to make peace with my body; she has endured misplaced blame and unjust treatment for far too long. On my worst days, I still can’t stand to see her, and I can feel the 16-year-old version of myself desperately clawing her way to the surface, willing to tear flesh and shatter bones to make me listen. But on other days, I stand right in front of the mirror and look at her—really look at her. It’s a peaceful moment that has stemmed from such violence, us sitting together in silence, apologizing to each other without having to even say a word. 

A few weeks after I stopped seeing Dr. Griffin, I read a statistic that type one diabetics are twice as likely to struggle with disordered eating. It makes sense when you think about it, as the disease is so centered around food and control and numbers being perfect. Depression and anxiety rates are higher for type one diabetics too, which can contribute to an additional increased rate of body image issues and eating disorders. And, of course, some people are naturally predisposed to these afflictions regardless of diabetes. I’ve decided that the specifics don’t truly matter. There are so many possible reasons that fellow diabetics would struggle with their body image that it’s nearly impossible to narrow it down to a singular catalyst.

And yet I can’t help but wonder if they all had a Dr. Griffin too.

My new doctor—Dr. Torres—is a tall woman with a soft accent and black hair cropped to the edge of her chin. Her office is plain, with solid-colored blue walls. I miss my sunflowers, but she has never made me cry.