“My cotton-wool-spotted coat” 

“My cotton-wool-spotted coat” 

My cotton-wool-spotted coat keeps me warm
Pockets brimmed with sugar treats
I feel shielded for a fleeting moment from the judging world
With this indulgence
The wool is thick, blurring my vision 

But the wool is heavy to run in
Laden for a swim or marathon win
I think of changing it for a sterile white coat
My toes are starting to freeze
But my cotton-wool keeps my soul warm 

I was warned this coat is expensive
It hugs my heart, almost too tight at times
I can’t feel my toes anymore
But my cotton-wool gives me comfort
It has been my companion in crisis
my callous source of coping 

I could try those white coats out
They keep encouraging me to abandon my cotton-wool
but I cannot recognize my skin without it
Passed down from my parents, a leisurely lethal heirloom
Do I have the capability to know life in a different suit? 

Normally, cotton-wool spots is a fundoscopic eye exam finding that’s suggestive of progressive type 2 diabetes. I found the adjectives “cotton-wool-spots” to be very visual, and I wanted to symbolize diabetes in a person by wearing a “cotton-wool” coat. Diabetes can cause vision loss from neuropathy. Diabetic neuropathy also affects the feet (peripheral neuropathy). Since diabetes is caused by high glucose levels, the coat is filled with sugar treats.  

Diabetes has genetic components, so I tried to highlight that by saying the coat is an heirloom. Many diabetics have a hard time changing their lifestyles to be healthier (symbolized by a white coat of medicine). The poem overall demonstrates the struggle patients with diabetes have to change lifestyle, reflecting the human condition. 

Hearing the stories of many diabetic patients at our local free clinic inspired me to write this poem from their perspectives. The speaker’s feelings while wearing this coat symbolize the struggles and effects of living with diabetes mellitus. Many patients find it difficult to change their lifestyles, even when facing severe consequences like the risk of foot amputations due to peripheral neuropathy.  

I learned that showing compassion to patients is just as crucial as providing clinical care. These experiences motivated me to develop resources, like educational pamphlets on type 2 diabetes for patients, and to teach classmates how to perform peripheral neuropathy foot exams with empathy, with the aim of making this a routine screening practice at our free clinic. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.