Reviewed by Michael Bryson

Because I work with computers, I spend a lot of time sitting and making small, repeated motions with my wrists. This causes tightness in my shoulders and on a fairly regular basis I get a dull pain in my lower back. I should stretch more, I know. I try to stretch everyday, but I don't follow a routine - and I only make a half-hearted effort at it. If I stretched more often - and did a better job of stretching - I would probably feel better. Why don't I? It's not that bad, I tell myself. Besides, it's an inconvenience.

After reading Highs & Lows, Michael Twist's personal account of life with diabetes, I tried to think of how I would react if I was suddenly told I had a chronic condition that required me to shoot myself with a needle twice a day plus strictly monitor my diet and blood sugar. The only chronic condition I could identify in my life was my minor back pain. Stretching is inconvenient? If I can't be pro-active in looking after my back, I assume I would struggle mightily with the 24-hour concern that an out-of-balance blood sugar could kill me.

Twist belongs to an elite club with membership dues I only begin to understand.

Twist was sixteen when doctors diagnosed his diabetes. Rushed to hospital, he suddenly found himself with a set of concerns that will follow him for the rest of his life. The World Health Organization estimates that by 2010, 237 million people around the world will go through life under similar circumstances. Twist's story, then, is one of many. He has written it to help those like himself, young people who suddenly find themselves in a vastly different world and who are forced to come to terms with a lot of information they probably never thought they'd have to deal with. He's also written it for the rest of us, to help us see what life in the diabetes club is all about.

The lack of decent information is the dominant theme of this book. Twist feels the information he was given upon diagnosis was inappropriate to someone of his age group. It was out of date and too technical. The reader senses he felt pulled in two directions: a nurse tells him he'll get used to giving himself needles; his doctors impress upon him that the diagnosis isn't something he will ever get over. Twist is also highly critical of the language medical professionals use when talking about diabetes. In particular, he rebels against the notion of being called "a diabetic"; he prefers "a person with diabetes."

Well, whatever. 

By playing this kind of game, Twist leaves himself open to the charge of being over-sensitive. On another page he tells us that the root for "health" means "whole". By this definition, he says, a blind person can never be healthy because he or she can never be whole. This is specious logic. Meaning expands beyond literal definition. There are healthy blind people and unhealthy blind people. Twist's point, however, remains a good one. He is trying to say that as someone with a chronic condition, the medical profession defines him as chronically unhealthy - and he is not prepared to accept that label. Unfortunately, his challenge to the MDs' simple-mindedness could use some complication of its own.

In fact, the book as a whole suffers from a conflict that Twist can never quite articulate - and therefore can never fully resolve. What does it mean to live with a chronic condition? Is it a heroic struggle to get through each day? Or it is a semi-ordinary existence with a strong emphasis on routine and contingency planning? Maybe it's a bit of both. The reader is left with a similar impression to the one Twist reports upon his diagnosis: diabetes is more serious than you think it is; diabetes is not as serious as you think it is. Perhaps what Twist is articulating is simply what it is like to come to terms with living with a chronic condition. There are good days; and there are bad days; but the background music never changes.

Finally, Twist hasn't much good to say about anyone working with diabetes in any official capacity. Doctors, nurses, drug companies, and the Canadian Diabetes Association are all targets of Twist's criticism. At times, this is an angry book. The reader assumes that anger is a natural response to being told at the age of sixteen that your life will be different from now on - and that if you don't follow the new rules, you will die. Twist's anger, however, is communicated in the tone of the narrative. It is not addressed as a subject in itself - which is a pity, because if Twist had been a more emotionally revealing narrator, then this would have been a more compelling book.

If you know nothing about diabetes, this is probably not the best place to start. However, if you know someone - particularly a young person - who is looking for information about "people like them", then Highs & Lows would likely be a useful book to encounter. It's like a self-help group between covers. There is value in sharing. There is value in listening. But only a select group - even if it's as large as 237 million - will ever know the true costs of membership.

Michael Bryson is the publisher/editor of The Danforth Review.

Read fiction by Michael Twist in The Danforth Review.

We acknowledge the support of the Canada Council for the Arts. Nous remercions de son soutien le Conseil des Arts du Canada.