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Seated by the receptionist’s desk, the representative from the Silent Generation has spotted skin thinner than his papyrus lungs, which rustles each time he snatches a breath. Across from him, a silver-haired woman abandons the three seats she claimed outside the bathroom with her sprawled possessions. She has rushed in and locked the door three times since I’ve arrived. By the exit, the guy in his mid-fifties rests his phone on his paunch. He limps when he steps outside for a few quick puffs on his e-cigarette.

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If they were to make eye contact with me—the only thirty-something in the endocrinologist’s waiting room—I’d probably ignore them. Though we share the same disease and though they have committed no wrong against me, I have—in a selfish and abstract way—contemplated their deaths. We with chronic diseases and frequent co-pays arrive early to appointments, harboring a fungal hope that, perhaps, a patient’s death has opened a slot in the doc’s schedule. Competition for his undivided attention is silent, selfish, and ugly. So we’re willing to sit and flip through magazines or scroll through phones or scribble in notebooks or read the ticker on the local news station for the seventh time and help the waiting room realize the fullest capacity of its name.

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And while we wait, I think: If we’re cast into survival mode and the doc had in his possession one vial of insulin, what would we do? If their pneumonia or colon cancer or heart disease didn’t kill them, would I?

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Even on Friday afternoons, as I wait in line at the grocery store, I commit hypothetical murders. I satiate my voyeuristic appetite and peek in shopping carts or evaluate the black conveyor belt’s contents with a coroner’s eye.

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Avoid salmonella and don’t place the organic blueberries on that wet spot left by thawing chicken thighs.

Those mini cans of Coke will eat his teeth and corrode his organs.

Dented can of Chef Boyardee. Mrs. P., the home-economics teacher, warned us to beware of botulism.

That yellow sticker on the manager special sushi is a cautionary flag, not a discounted price.

Cause of death: a lifetime of poor choices.

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But every three months, when I’m rocking back and forth in line at the pharmacy, I don’t note who’s buying Vaseline for what purpose. I respect—to a degree—my fellow patrons’ privacy and focus instead on where the pharmacist wanders to retrieve the prescription. If she searches the shelves behind her or disappears to the back, I can dismiss the customer before me—threat level, minimal. If she sidles to the far side of the counter and ducks below to the mini-fridge, I measure the customer.

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Age?

Weight?

Upper body strength?

Potential for carrying a weapon?

Will to live?

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If the pharmacist lays that familiar stack on the counter, be it pen needles or vials, I mark that customer as an imminent threat to my life. Come devastating flood or nuclear attack or arctic blast that freezes for centuries the entire northeast, push come to shove may lead to me knifing this fellow diabetic in the kidney or pancreas or appendix or whatever piece of him interlopes between me and the medicine that will grant me a few more weeks of life.

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No one out waits death. In this game of hide-and-seek that ends only when we lose the whole human race, a cluster of kids giggles in the shade behind a willow tree—waiting for that one bony kid to find them, but when he does, instead of shouting Gotya! he lets rip with a sickle and cuts them down. 

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Remaining conscious of the game’s stakes while playing may prod one toward lunacy. Play, then forget you’re playing.

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I forget to forget, so I’ve gone slightly mad for survival. I lack that luxury, that primitive privilege Robert Burns cherishes in the mouse: “The present only toucheth thee . . . An’ forward tho’ I canna see, I guess an’ fear!”

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For the floods that might sweep over Long Island, I bought life vests. One for everyone in the house. Tethered together, we could swim to one of the tall oaks, shelter in a treetop until helicopters arrive. I’ve also noted from which neighbors I could steal boats from their driveways or kayaks from their garages.

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For the looters who might kick in our basement windows or hammer through our doors, I have baseball bats, axes, knives, swords, and slingshot pellets. How many nights have I fallen asleep with visions of the massacre I’ll commit on the stairwell? Bloodied corpses stacked nearly as high as the baby gate obstructing the landing. Once I became a father and was invited into local parents’ houses for playdates and parties, I started casually asking during conversations about school plays and Netflix shows where our new friends stored their guns, if they had any.

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For that get-the-fuck-out call that might come any time of day, that screeching beep from the phone signaling your current location is not safe, I’ve prepared in the basement emergency bags stocked with granola bars, flashlights, bottled water, and some peanut butter pouches.

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A month prior to the 2016 presidential election, anyone with eyes on my supermarket conveyor belt probably thought me the worst of the do-gooders, the guy who donates to local food pantries all the generic canned goods families who cannot afford a choice must accept: beans of many names (black, pink, pinto, refried, garbanzo, cannellini), soups, tuna fish, corn, peas, mixed vegetables, diced tomatoes, peaches, pears, fruit cocktail (lest scurvy carry us on bowed legs to the reaper). They’re mine. All mine. Shelves of “non-perishables” just in case this little experiment in democracy of ours does perish.

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I read Cormac McCarthy’s The Road and squeaked audibly when the protagonists came across a cache of preserved goods. If I can’t eat it myself, may my preparations benefit some fellow keeper of the light, fortify some scraggly survivor’s malnourished hope.

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Undoubtedly some in this great American expanse welcome the fall of government and civilization. They anticipate the final freedom to eat, drive, fight, fuck, and shit as they wish. Finally, their stockpile of ammo has a purpose! They must not be diabetics.

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My wife has already said if this world of ours devolves to the point of habitual rape and occasional cannibalism, she will call for the check and leave no tip. When the sun goes down on civilization, how many others in our species will yield to suicidal lullabies? Not me. The urge to survive is so strong I’ll ride this cold dead rock as it drops out of orbit.

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Back when I waited tables in my late teens, I didn’t think these thoughts. My parents’ health insurance shielded me from the scenarios you read about today: stories of young diabetics rationing their insulin and dying a paycheck short of salvation. I didn’t know such vulnerability existed. Then a fellow waiter wandered onto the train tracks one evening and never left. Could’ve been suicide. Could’ve also been the disorientation caused by low sugars that led him to cross where flashing red lights and the wobbly striped arms cautioned him to stop.

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“We’ve been cleaning out his apartment,” a friend and colleague said to me the week following the funeral. “No one was ready for this. He had a stash of monolets, alcohol pads, and syringes. Would you want any of that?”

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Why would he stock his apartment with the means to live if he intended to die? Those supplies suggested a bent toward life, a cardboard fort to obstruct death’s Sauron glare for a while.

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“No, thanks. I’m good.”

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I was good in the sense that ignorance blinded me to my poor diabetic ways. The Humulin insulin I injected chilled beneath the butter in my mother’s refrigerator. My blood test strips, needles, and alcohol pads arrived like air in my home, ostensibly free because I never asked my mother how much they cost. My A1C, my average blood glucose level over a three-month span, supposed to range between 6.5 and 7.5, never dropped below 8 and frequently exceeded 9. And though his supplies were boxed, unused, unopened, I regarded them as unclean, unusable, unfit for my body.

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At nineteen I wasn’t much concerned with a prolonged life. I abided by the bug zapper’s assessment of life in Kimberly Johnson’s poem: “We firework, we meteor in streaks lit up like a house aflame.” That’s all I expected—live fast, hard, full, and once you’re at the brim, you burst and dissipate, and a few fairly sober friends will remember you occasionally as they age.

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After that you’ll slip without a peep into the realm of forgotten souls.

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Many in my friend group lacked the imagination to envision themselves living three decades on this planet. They anticipated a tremendous glory in their teens or twenties, their highest point of life, their aristeia. But they had no battles to fight, no enemies to subdue, no means to propel their names into future histories where truth and myth would blend. How many young men would welcome Atropos’s shears if it meant they could keel over with their joysticks in their hands, a flawless victory flashing on the screen, a chorus of worshipers singing praises in their headphones and ushering them into the immortality of YouTube sensation?

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A life’s purpose, achieved.

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What a load of shit. There is no God-assigned purpose. No divine reason why some civilians survive mass shootings and others don’t, why some tornadoes gut small towns and others don’t, why some people’s immune systems set forth an army of Tyler Durdens to slug the pancreas or clap the kidneys.

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I’m no diabetic because God wanted me to learn restraint through suffering at seven years old. I have no intention of curing my disease, no calendar event penciled in to achieve world peace. Even as I write this sentence, I’m hoping someday these words will afford me the life to which I cling with uncut fingernails and muscles weakened by myasthenia gravis.

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And when I die, that will be human error, a fault of the human form, a mortal response to the immortal question: Why are we here?

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Ask the squirrels pawing up mounds of dirt on the front lawn; they’ll tell you—Survive as long as possible!

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Every morning I survey our suburban lot. The oak trees drop acorns we sweep off the patio, and the dirt pumps up dandelions we break our backs uprooting. In dire times those nuisances become dinner. I’m slingshot-shooting squirrels, rolling them in acorn flour and serving them over dandelion greens, and I’m smiling because I’m living, at least for a while.

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Some can live on squirrel and acorn and dandelion alone. Not I.

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I’ve constructed my own cardboard fort in the basement. On the pressboard shelving with the out-of-season wardrobes and plastic totes of holiday decorations, I cram square and rectangular brown cardboard boxes, the kind of yummy stuff that camel crickets can feast on for months. The shipping labels narrate my shifting definitions of home over the last fifteen years.

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As a terrible diabetic, I occasionally never wiped my fingers or limbs with alcohol swabs prior to a blood test or injection. I would also reuse those single-use finger-prickers, just leave them in the plastic device, a dab of blood hardened on the metal tip dulling with each use. What is the worst that could happen? asked the man who will probably die stupidly from cellulitis. Each unopened box of monolets and alcohol swabs joined the emergency supply. When older relatives stopped aging and started decomposing, we sifted through their life’s accumulations. If they, too, built a fortress of syringes for their then medical needs, I inherited the stash and thickened the walls of my own fort.

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Not everything from those deliveries could be salvaged—test strips for glucose monitoring have their expiration date printed along the bottom. The enzymes in the sticks break down over time, rendering the readings inaccurate. If only we diabetics could divine our numbers by meditative reflection (Envision your blood. Envision your blood cells. Envision a number riding those blood cells like a miniature rodeo champion. What number do you see?). Or if we could swig a few drops of our copper crimson and work it around our palate like a vampiric sommelier, then we could determine our current sugar status, detail our previous meal and detect any vitamin deficiencies. A precise blood glucose level leads to an exact insulin injection and better planned meal. Ultimately, knowing your sugars means taking control.

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But we diabetics, though we listen to and know our bodies, know that the longer we and diabetes tussle over these bodies, the less we are aware of what diabetes is doing to us. Our nerves lose their receptive sensitivity, and our bodies fail to notify us with those involuntary convulsions of hypoglycemia. No more trembling hands. No more jerky knees. No more twitching muscles. We tickle our toes, not because we’re podophiliacs, but because we anticipate a causal chain: poor circulation leads to numbness leads to amputation leads to complications leads to death.

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If current projections are accurate, I won’t have to worry about having low sugars in the future. Just those fatal highs. Prior to the 1920s, diabetes was a death sentence. Without our insulin, we diabetics have a shelf life of approximately two to seven days. Doctors tried treating the disease with diet, but the restrictions grew more extreme since the recently diagnosed goner was burning through his body’s final store of insulin. You could eat normally and die quickly, or you could starve yourself, drink water, and die within a month. The body, incapable of transforming glucose into energy, would pass out all sugar in the urine—hence the diabetes mellitus, the honeyed piss, that sweet scent of doom.

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I now have a vision of apocalypse: me, gaunt, bones sharp and angry, fat and muscle eaten by my disease, breath sweet and sick like rotting fruit. Blades in hand, I, desperate to find a safe place for my wife and child, slash like a fever through marauders and land pirates. I burn my energy until I drop, the final victim of my murderous frenzy.

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But my apocalypse may come sooner than the general one. Increased obesity rates hold sweaty hands with increased diabetes rates. We’re slated to suffer an insulin shortage when I round the mid-century mark. At fifty years old, how will I justify receiving my medication when some juvenile diabetic may hold the potential answers to future plagues and diseases? What if this young blood could cure the very disease killing both of us?

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Those existential quandaries haven’t stopped me from memorizing locations of every pharmacy within a ten-mile radius. I’ve also considered what kind of arsenal I would need to siege an Eli Lily distribution factory. We have no pork farms in our area, so pork insulin won’t work. I can possibly puree squirrel pancreases—perhaps grab a mortar and pestle, process their organ into a dry chew to absorb through the cheek.

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There are the Armageddon criminals, too. Inform the captured looters, raiders, and lawbreakers that first they’ll be hanged and then they’ll be harvested.

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And what about you, dear healthy reader? How many nights have you spent researching the best methods to extract a human pancreas?

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Necessity is the father of incriminating Google searches.

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Here’s the shit deal that keeps my lips chapped with bite marks and my eyes weighted with sleeplessness: I can stack syringes in my basement, concrete floor to wood-stud ceiling, but without the medication I will die behind my fort. The garbanzo beans I spoon out of the can during those end times will save me as they kill me unless I have insulin, and every day a new competitor wanders into the crowded field of women, men, and children desperate to live.

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At the pharmacy one afternoon, I glanced back and saw a mother and her daughter. The girl, no older than eight, donned the bright colors of youth—all purples and pinks and splashes of green. On her arm stuck a single gray splotch: the recognizable constant glucose monitor, a technological wonder that allows diabetics and their relations to monitor their sugars via Bluetooth and downloaded apps. When the power supply systems fail, all our life-saving technologies will fail with them.

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“Excuse me,” I nodded to the mother. “I just started on the Dexcom, and I didn’t know they could be placed there, on the arm.”

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Her distrust gave way to camaraderie. Something about seeing an adult diabetic living unimpaired inspired hope for her own child whose future was uncertain.

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“It is such a blessing,” she said, and there in line we performed an unscripted infomercial for Dexcom (ask your endocrinologist if Dexcom is right for you).

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I wiggled my finger to sign the electronic screen, gripped my prescription, wished pharmacist and mother and daughter a good day, and walked away. But I departed knowing I made another potential enemy. That mother, while finding me pleasant, also marked me as a future threat. She would, without waiting to hear my pleas, pepper spray me and club me with her glass water bottle and open my jugular with her RAV4 keys if it meant saving her daughter with my insulin.