Please Bring Me a Tasty Milkshake

by Greg
At anchor, Luperon, Dominican Republic

Aside from her innate charms, described earlier here, Luperon has sentimental value to Paula and me. In our cruising of '98-'99, an active hurricane season and my impending death turned our stop here into a five month stay. These events were a bit stressful, and so we bonded with the cruisers and locals here at the time, and we bonded with the place.

This was in the northern Bahamas. I got even skinnier.

From the time we left Annapolis, we were roughly 4-1/2 months getting to Luperon. The whole time, despite the fact that I was eating a huge amount of food, I was getting skinnier. Thanks to the sailing life, my arms and shoulders were in good shape, so I just figured the skinniness was because I had gone from software guy to active sailor-man: "woohoo - I'm 18 again - I can eat whatever I want!" I was always hungry. By the time we got into the Bahamas, I was also extremely thirsty, but it was the tropics, so it made a certain amount of sense. But by the southern Bahamas, the hunger had gotten maddening. I was exhausted. I would fall asleep not long after dinner, thinking of eating, and wake up chewing, having been dreaming of eating. I was very hungry.

By the time we got to the Dominican Republic, I was one very skinny boy at 135#. (When we left the states I was in good shape, not much fat, and weighed 155-160#.) When Paula and I look back on the pictures, we can't believe neither she nor I thought much of it, but when changes like that happen gradually, they are less noticeable. In those days, the cruising hangout here in Luperon was Kiwi John's. I used to go there and chug glasses of orange juice, one after another. Ok, sure, they had rum in them, but it wasn't the rum I was after.

Not too many days after arriving in Luperon, we went horseback-riding in the mountains with other cruisers we had just met a few days earlier. Midway through the ride, we stopped at a small farm for a Dominican feast. I ate what
-ever I could get my hands on. Across the table, a female cruiser did the "I can't eat the rest of this honey, do you want to finish it?" to her partner.  He said no, and I said "I'll take that" and cleaned the plate, leftover chicken bones and all. We had just met these people. The hunger had driven out any social graces.  Not long after, that cruiser said to me "I've been watching you, I think you have a problem, and I think I know what it is."

John Pearlman on the right.
I believe he saved my life.

It was Type 1 diabetes. I was starving to death. With untreated diabetes, one's body eats itself. The cruiser, John Pearlman, had been a diabetic educator before going cruising 13 years earlier, and he still kept up with it and still had blood-sugar test equipment with him. He and his mate Barbara brought breakfast to our boat on the morning of my 38th birthday and John tested my blood sugar. It was higher than the meter could measure (> 600). Normal is 70-110. One's body eating itself has serious side effects, and John told me that I was lucky I wasn't dead. He said I needed a hospital immediately. We asked around and found the best hospital in the country - Clinica Corominas in Santiago two hours away.

Clinica Corominas, at the time the best in the country

I spoke almost no Spanish at the time, so I couldn't understand much of what the doctor said, but I know he repeatedly said "muy mal!" ("very bad")  and made me lie down every time I tried to stand up. They put me in intensive care. Paula spoke some Spanish, but she was forced to leave. I was left with only a Spanish-English dictionary, which I used to patch together food-related phrases like "please bring me a tasty milkshake." I was very hungry. The staff laughed at me and wouldn't follow my instructions, damn it. 

Regarding that intensive care unit, by the time I left, I had decided I really didn't want to see the normal care unit. They did have primitive-looking electronics including old EKG units, but I woke up the first night having to pee like crazy, another symptom of untreated diabetes. My bedpan was full, there was nobody around, and the EKG monitor was flat-line and beeping. I wasn't dead though; the pads had fallen off of my chest. I pressed the call button - nothing. I looked around further. The nurses were all asleep. I don't mean accidental little naps. All of them had climbed up on the counters, stretched out, pulled blankets over themselves, and slept. One was snoring loudly.

A quick note about diabetes: what is known about Type 1 diabetes is that it is an autoimmune reaction - one's own immune system has killed the insulin-producing beta cells of the pancreas. Other than that, not much is known about the cause. It is thought to have a genetic component (but there is no trace of it in my ancestors). All Type 1 diabetics must inject insulin; it is not possible to manage it completely through diet and exercise, much less some of the other "cures" people have suggested like yoga, Chinese herbs, or homeopathics. The insulin-production just isn't there.  Type 1 was formerly called Juvenile-Onset, but more people are developing it in middle-age and the experts don't really know why. Type 2 diabetes, formerly called Adult-Onset, is the type that's associated with old age, being overweight, eating poorly, and insufficient exercise. In general it can be considered a different disease than Type 1 but with the same symptom - high blood sugar. Most Type 2 diabetics can get by without insulin. 

The diabetic doc who treated me at Clinica Corominas seemed pretty good, and before we returned to Luperon, he communicated to me what insulin I needed, how much, when.

One of the few paved streets in
Luperon in '98. With mule.

He was wrong.   It wasn't long after that, walking down the dirt streets of Luperon, that I had my first hypoglycemic seizure (low blood sugar due to too much insulin). It happened fast. I had no idea what was going on. I could feel myself losing control, losing my grip, going down. Another cruiser we were walking with was a nurse, but she panicked and froze. Paula took charge. (I heard this later, I didn't see it - I was unconscious, jerking around violently, trying to bite off my tongue). Paula finally got John Pearlman into the town from his boat, and they took me to the local Luperon clinic.

Luperon Hospital

Luperon in those days was more primitive than now. The streets were still dirt. Power was off more than half the time (one reason being that anyone who needed it would simply climb up to the lines and hook on). I remember waking up in the clinic in Luperon and seeing a nurse wash her hands in a bloody bowl of water (no plumbing).  The power was off too, of course.

Seizing is like rebooting.  Coming out, the mind is empty. It took me time to reload, piece by piece, who I was, who Paula was, where I was, why I was there. I remember walking back down the main street to the boat and finally understanding what Paula was trying to tell me about the blood-soaked dirt on the street - that it was where I seized and was chomping on my tongue. It was then that we decided I should go back to the states for treatment.

Luperon Hospital

It is hard to say why my left hand stopped working. I did some boxing in college and hurt the radial nerve, and untreated diabetes can exacerbate nerve problems. Or it could have been repeated compression from the auto-blood pressure cuff in the clinic every 15 minutes for a few days on a starved, skinny arm.  Whatever the cause, it wasn't long after we got back to the boat from the states that my left hand mostly stopped working. I had "drop wrist". There was some grip strength in the outer three fingers, but mostly my hand just hung there. The thumb and forefinger didn't work at all. I envisioned trying to handle sail in rough weather with only 1-1/4 hands. Didn't sound good. I had kept a positive attitude throughout all this, but suddenly having only one working hand was the last straw. Paula and I decided that the voyage was over and that we would return to the states.

Our boat NORA tied into the mangroves for hurricane Georges

We enlisted a friend to help us sail the boat back to the states. It was the hurricane season, so we had to wait for the right weather window.  Finally one came. We had spent days preparing the boat and stocking up on supplies. We were sitting in the cockpit the evening before our departure, and the mood was dark. Neither Paula nor I were happy about ending things this way. I moaned something like "I don't know why we're going back; if somebody sawed off my left hand entirely, I'd still find a way to sail." Paula's response was "well, why are we?" We went up to the bow and had a quick conference that went something like this: "Are you serious?"  "Yes, are you?" "Yes." "Yeeha!"

We spent the rest of the hurricane season in Luperon, and that included a hit by hurricane Georges. Parts of the country were hit pretty hard, but Luperon - being the hurricane hole that it is - saw only 55 knots of wind. (Hurricane hole means a good place to shelter from hurricanes).

Continuing the voyage was the right decision, and I am grateful that Paula was willing to risk it. We continued for more than a year and had so many great experiences. We sailed as far as Antigua, raced in the Antigua Classic Yacht Regatta, sailed from Antigua to Bermuda and then from Bermuda to Nova Scotia before coming back down the coast to Annapolis.

I wish I could say that the Luperon seizure was my last, but it wasn't. Tight management of Type 1 diabetes is very challenging, particularly when trying to combine it with voyaging under sail. But it is do-able. And if somebody sawed off my left hand, I'd still find a way do it.