JUST LIKE ME | Matthew Canonico
It is a well-established and frequently mocked trope: medical student studies a disease, medical student diagnoses himself with that disease. The phenomenon is particularly pronounced in scenarios that involve vague symptoms or scary, rare, or life-altering diagnoses. A headache is caused by a brain tumor. A racing heart and sweating spell signify an underlying pheochromocytoma. Frequent urination and weight loss must be due to diabetes.
The temptation to self-diagnose was especially strong while studying for the USMLE Step 1, when I was attempting to relearn all the material from the preclinical years of medical school. It’s a universally stressful experience that can wear on any student and make one question one’s own health. Come to think of it, a couple of weeks into my study period, I had lost a few pounds, I was constantly tired, and I was unquenchably thirsty – is something wrong? Everyone thinks something could be wrong, but it never actually is, right?
Disease is indifferent to tropes and stereotypes. By the second week of Step 1 preparation, I had become sufficiently concerned. My fatigue could not be overcome with extra sleep. I was waking up two to three times each night to guzzle glasses of water with no reprieve. I had a notorious sweet tooth, but now I was craving sugar inordinately and incessantly.
I went to see my internist. The next day I received a call that my lab work showed blood glucose over 400 mg/dL and a rather easy diagnosis. After hanging up the phone and brushing off the crumbs of the hefty lemon and poppy seed muffin I had just consumed, I immediately went to meet my new endocrinologist. I received my first shot of insulin, and confirmed by an antibody test that I had Type 1 diabetes (T1D), diagnosed at age 26. My life changed immediately and fundamentally. Through periods of shock and denial, all that was clear was that I would have to manage this – always.
This was clearly and dramatically a new obstacle, but from the outset, I had the sense that it wasn’t wholly negative. At the extreme, it could reframe my career as a vocation and lead me to become an endocrinologist, to make managing this disease not only a personal need but also a key part of my professional mission. At minimum, it would endow me with greater empathy for patients, especially those with chronic illnesses. Regardless, I began to realize the distinct role I would have as part of the T1D community as both a patient and future clinician. As a result, and by necessity, I’ve developed an intimate, ever-growing understanding of T1D and its management, and an appreciation for its frustrating, finicky nature shared only by the few who endure it or care for those who endure it. I have an inseverable connection to patients and peers who share this diagnosis.
Within a few weeks of my diagnosis, I took Step 1 and began my third-year clerkships. On my pediatrics rotation, about three months after my diagnosis, I requested to spend time in the endocrinology outpatient clinic, hoping for new insight about this disease, both personally and as a future practitioner. Unsurprisingly, most of the children I saw were T1D patients diagnosed in childhood, more seasoned in this disease than I. Their steadfastness and acceptance of this condition – children and parents alike – was inspiring.
One patient left a particularly strong impression on me: a three-year-old with T1D, toddling around the room as her mother described in great detail all that she did for her child day-to-day, minute-to-minute, and asked questions about her management. On the child’s arm, reinforced with a thick royal blue adhesive, was a disproportionately large continuous glucose monitor (CGM), and it happened to be the same brand and model of CGM that I wear. The handy device has a small profile, about the size of two or three quarters stacked on one another, but it took up considerable real estate on this young one’s arm. Somehow, she spotted the CGM on my arm, which is relatively inconspicuous to most. In a moment of excitement, she pointed at it, exclaiming, “Just like me!” I responded, perhaps more excitedly, “Yep, just like you!” Though T1D lacks classic physical signs of many autoimmune diseases, our CGMs were visible marks of this otherwise invisible disease – our autoimmune stigmata.
Medicine seems to afford these kinds of moments at a rather generous rate. In an instant, this simple exchange captured our shared humanity. Decades apart in age, we were connected on multiple levels, as patient and future doctor, as involuntary members of the T1D community. While she will likely never remember a time of insulin independence, at 26, I had never contemplated a life of insulin dependence. She nullified that difference with an earnest and even joyful observation about what we had in common—highlighted by a wearable piece of technology. I reflect on the power of a brief, passing interaction, impressed by what can be experienced in such a moment. That moment, and others, remind me to be grateful for these technologies and for the life they allow me and others with this disease to live.
Matthew Canonico is from Nashville, Tennessee. He is a graduate of the University of Notre Dame and is a fourth-year medical student at the University of Tennessee Health Science Center. Canonico is passionate about the narrative and humanistic aspects of medicine. His recent diagnosis of type 1 diabetes has provided him a unique and deeply personal perspective on the patient experience. Canonico is pursuing a career in internal medicine.