back from a zigzaggy day of hospital, work, hospital, pharmacy

Today started early for me: I was up at 7:30 a.m. so I could get ready for my 9 a.m.-ish arrival time at Samsung Seoul Hospital. My first appointment of the day, with the diabetes clinic, was at a little after 11. I had fasted the day before (you may recall me noting somewhat incredulously that fasting all day may have been connected with no chest pain during my nighttime walk last night), but despite taking medicine Thursday night, I wasn't woozy.

At a few minutes after 9, I used the QR code stored on my phone to get in the hospital's front door. I then went to the phlebotomy department, got my waiting number through the automated ticketing machine (you have to check in to every department you visit), gave a blood and urine sample, then moved on to radiology. There, I took off my shirt, donned a ridiculous and ill-fitting gown top, took exactly one second to have the x-ray done, and moved on to cardiology. An assertive staffer immediately found me and walked me step by step through getting my ticket for my 5:20 p.m. appointment, then she helped me figure out how to get my EKG, my blood pressure, my weight, and my height.

All of that was done by 10 a.m. Samsung Hospital requires you to come early and do those tests so that, when you sit down with your doc or docs, they have your data in front of them. My first appointment, with the diabetes clinic, was at 11 a.m., so I had time to wait, and I decided the moment had come to break my fast. I went to the small concession stand on the first floor, bought myself two modest sandwiches and some sort of frou-frou "natural" drink made of fruits and vegetables and the souls of young rabbits (it wasn't as bad as I'd thought it would be), found a set of chairs where no one else was sitting, and had breakfast. It was a relief to eat and drink something of substance after over a day of not consuming anything other than water (and meds and vitamins, which might technically break a fast).

That first appointment was with the same doc who had treated me years before... I think her name is Kim Gyuri. She was just as brisk and brusque as she had been three years earlier. She seemed disappointed that my A1c hadn't dropped very much, which I found frustrating: your HbA1c score is a three-month average. I started recording mine on April 15; there's a formula you can use to convert your daily fasting blood-sugar numbers into an A1c score, and I've been averaging in the 7s, a significant drop from the 10.2 from when I'd been hospitalized. So if I had spent the past month at 7-ish, and the two previous months had averaged 10-ish, you'd expect my A1c to be 9-ish, which it was: 9.1. Far from being disappointing, this meant that, if I merely held steady on my current path, I'd be at a full 7-ish in only two months. This was good news! But Dr. Kim was like, "I see your A1c hasn't gone down very much" in a disappointed tone. I was so flustered that I forgot to ask her the several questions I had planned to ask about things like chest pain and what my triglyceride score had been in April, and what it was now. Dr. Kim went on to grill me on whether I had taken this or that other test (for my eyes, to check for deterioration in vision; and for the nervous and vascular condition of my legs); I said no, and she said I'd have to undergo even more testing the next time I came to the hospital. (This sort of unnecessary hamster-wheeling is why I'd quit going to Samsung in the first place.) With that, the session was over; I went outside, and a nurse printed up the summary of what tests I'd be doing during my next visit.

My appointment had been for 11:10 a.m., but the line of patients had been moving slowly, and I didn't see Dr. Kim until 11:35. I was out by 11:45, and I then had a more than five-hour wait ahead of me. I'd already told the boss that I would come into the office and do some work; I had no intention of sitting inside the hospital all day. I confirmed with Samsung's information desk that my QR code was good for the entire day, and I left by cab for the Daechi district.

Work was quiet. I got in earlier than I usually do (I normally arrive around late lunch and stay late into the evening); my Korean coworker was there, but the boss wasn't. He showed up today around 2:45 p.m., having had to take care of some personal business. A certain executive popped into our office and beckoned my boss out so they could have a little chat; whenever this exec comes around, it's never good news. Sure enough, when the boss came back, he said our R&D team was now on the chopping block thanks to budgetary concerns, and in all likelihood, we'd be dissolved by the end of the calendar year. The boss told me and my Korean coworker not to sweat it; we've been through shit like this before. At this point, I've got a good bit of money in the bank, and if I were to leave Korea to return to the States, the Korean national pension fund would pay me whatever I've been paying into the system all these years—not just for the work at my current job, but also the work I've done at various universities. I'd have options. Anyway, working at my current company means you always have to be ready for the bottom to fall out; our CEO (from whom the current crop of bad news ultimately comes) is a mercurial fellow who has structured the company as a sort of cult of personality; my boss says his true focus, these days, is on diversification: land purchases in the States and whatnot. The boss also thinks that, were the CEO ever to leave this company, the company would die without him because it's essentially a cult of personality. I told the boss I found it ironic that the CEO wants to pass the company off to his daughter, who had lived and studied in the States. She's going to inherit an empire of sand.

With this new bit of news to ponder, I finished what I could of the project our team is currently working on, then headed out the door a little after 4 p.m. to return to Samsung Hospital for my 5:20 appointment. I already had the ticket (called a jeopsu-jeung/접수증 in Korean—a "reception voucher," I guess), so it was just a matter of heading over to the cardiac clinic and awaiting my turn. My name got called way earlier than 5:20, and I was in the doctor's office before 5 p.m. I told her about my chest pains and asked her why I might be feeling pain at the beginning of a walk but not after I'd rested for ten minutes. She offered some explanation in Korean—something about blood vessels and "three years ago," but I didn't understand everything she said. I did catch that she was going to prescribe extra meds for the pain; I think she ended up prescribing me nitroglycerine pills, sort of the modern version of digitalis: the meds' instructions say to place one pill under the tongue in case of pain. I think there are only seven pills, though, and I'm not sure I even want to use this medicine (whose label says to use it only in time of need). I had tried to explain that the exercise I'm doing is a routine, so this was a routine pain. Ultimately, I think (1) seven pills isn't enough, and (2) she didn't understand that I wasn't worried about having a heart attack. I think I'm going to ignore these pills in favor of resting every time the chest pain appears. Although I asked the doc about my chest pain, I once again forgot to ask about numbers like my fasting glucose and my triglycerides. That'll have to wait until July, which is when I next go back to the hospital for the same two appointments plus even more tests.

I did try to get some numbers before I went to the hospital, but I didn't get a fasting-glucose reading because, as it turned out, the new test strips that I'd gotten for my glucose reader were incompatible with the reader. I'd simply bought the strips willy-nilly via Coupang, thinking they were all the same. That proved to be a waste of thirty bucks (I'm not bothering to return an already-opened package—one of the perks of being filthy rich). The stats I got:

blood sugar: N/A (at a guess, around 120-140)
blood pressure: 101/65 (low!)
weight: 114 kg (water-weight fluctuations)
pulse-ox: 98%
pulse: 57
estimated A1c since 4/15: 7.73 (up somewhat because of... indiscretions)

It's possible my A1c since April 15 is actually lower than 7.73 if the hospital is saying I'm at 9.1 a month after being 10.2.

No dice on getting off the insulin pen. That might happen later this year. We'll see.

Anyway, the afternoon appointment finished early enough for me to go to another automated kiosk, pay my bill for the day, send a request for meds to the local pharmacy that I always use, then walk over to that pharmacy before it closed. After that, it was just a matter of walking home. While I'd been at work earlier in the day, I'd continued my off-the-chain behavior and sat down to eat fried pork cutlet (donggaseu, the Korean rendering of the Japanese donkatsu). When I got to my apartment building, I grabbed some bad-for-you items from the Paris Baguette bakery (desperate times, desperate measures), then spent the rest of my evening banging out this entry and pondering my weekend. I can only imagine that I'll be paying for this misbehavior tomorrow. I won't be distance walking until I've fasted again.

And there's the thing: if my theory is correct that food (especially carbs) is a trigger for chest pain, I think I can craft a dietary strategy that will have me fasting four days a week on (mostly) alternate days, then eating the same nights I exercise. So let's say that my three days of walking are Monday, Wednesday, and Friday. I can then fast all day Sunday (to be ready to walk on Monday), Tuesday (as prep for Wednesday, etc.), Thursday, and Saturday. My Monday walk might be a bit of a stretch if I'm fasting all weekend, but a two-day fast isn't the end of the world; it's certainly nothing like fasting for five or seven days. Making a routine out of eating only three days a week might be a very good thing. And on my non-walking days, I can concentrate on alternate exercise: heavy club, kettlebell, dumbbell, animal flow, exercise bands, and calisthenics. I don't think strength exercises will have the same angina effect as walking, but I admit I haven't tried them yet. Where would stairs training fit in all of this? I have no idea. I'll get back to you when I know.

seen on the walk back to my place