Little Jack's diabetes diagnosis broke my heart this season, what can I say. With a background in healthcare, I wanted to write a story as a tribute to all of those who face this challenging condition daily, even hourly.

While insulin is obviously truly a miracle treatment, it is still overwhelming to new patients even now and has its drawbacks and complications.

I only address in this story a few of the many obstacles Nathan and Elizabeth might've waded through as they navigated caring for Little Jack. I hope this story brings added meaning to how this family would rally together to face this life-changing condition together.

Elizabeth held the insulin vial carefully in one hand, the cold glass only adding to her trepidation. With shaky fingers, her other hand tried to awkwardly maneuver the syringe. But, the second she poked the needle through the soft rubber top of the vial, she stopped abruptly.

Faith said something about this important step, but what was it? Elizabeth thought, willing herself to remember. She sighed in frustration at her first solo attempt dosing Little Jack's insulin.

After a pause, Elizabeth suddenly whispered quietly to herself, "The bubble." But she'd forgotten how to prevent that troublesome bit of air in the syringe that could affect giving the right dose. She lightly bit her lower lip to keep from crying. Here she was, the very first step, and she was already forgetting.

Nathan closely watched his sweetheart's face, debating whether or not to intervene in what was clearly an emotional moment for her. With an exasperated sigh, she removed the syringe, set it on the table, and left momentarily to get the copious notes she'd written from Faith's detailed demonstration. Walking back to the table, Elizabeth read through the specific steps carefully.

Pull back syringe to # of insulin units (fill w/ air 1st).

Insert needle in vial. Push air from syringe into vial.

Flip vial & syringe combo upside down.

Make sure needle is in liquid at all times.

Pull plunger by tip to fill syringe with insulin.

Don't touch the inside of the plunger.

After a deep breath, she reached down to try again, only to find that the syringe had rolled slightly. Now the exposed needle tip rested against her vase of flowers, rendering it useless. The needle was no longer sterile.

Elizabeth looked over at Nathan feeling utterly defeated. "I can't do this Nathan," she whispered, erupting into sobs. "I can't."

In a single step, Nathan was by her side, gathering her in his arms. "It'll take time, but we'll figure this out," he assured her, gently stroking her back. "Besides," he added, kissing her temple before daring to tease, "if you can stare down Higgins, this insulin doesn't stand a chance."

As Nathan had hoped, a small smile tugged at Elizabeth's lips, indicating that an effective dose of that Thatcher confidence was quickly returning. Still, feeling completely overwhelmed by the flood of information from this unexpected diagnosis, she admitted humbly, "I feel so blessed to even have this option to try, but will insulin work long term?"

Her teary eyes looked to Nathan in desperation.

But before he could even answer, all of her doubts, one by one, spilled over. "Insulin is from a cow, Nathan! How is that safe?"

"How can they know for sure the right amount to give Jack? He's not even half the size of a cow! What about the side effects? Faith mentioned injection site reactions, weight gain. What's that supposed to mean? How much? And what happens when he's sick? She said his dose may change, but to what? How do I know?"

Elizabeth knew she was spiraling, but how could she not? This was her son! And as far as this miracle medication went, there was still uncertainty in everything—the dose, the success of the treatment, and especially her little boy's prognosis.

A fresh batch of tears filled her eyes. "The consequences are so big," she cried, leaning into the comforting sound of Nathan's heartbeat as her mind whirled.

The massive and impersonal medical terms filled her thoughts. Islets of Langerhaans, ketoacidosis, glucosuria, hypoglycemia.

"Mama, I'm hungry! When can I have breakfast?" Little Jack called out, still resting in bed. His words hung in the air, unanswered, as Elizabeth fought to compose herself enough to reply.

"Not long, Jack," Nathan eventually responded, the rumble in his low voice echoing easily through the row house.

After absorbing some of Nathan's strength through his grounding hug, Elizabeth finally spoke, her eyes pleading. "But it will be a while, Nathan!" she insisted, growing emotional again. "This is taking me forever! And Jack's supposed to have this shot 30 minutes before he even eats!" Helplessly, she looked up at the ceiling, willing her tears not to fall. She was so tired of crying, so weary of diabetes.

At that point, Nathan made an executive decision. "Why don't you tell me what to do sweetheart," he offered, reaching for the syringe.

"Wait!" she shouted, startling him as she pushed his hand away. Then in a more collected voice, she explained. "You have to wash your hands first, to keep everything clean."

Nathan nodded with understanding, and was soon at the sink. By the time he finished, Elizabeth seemed to have calmed, comforted by another pair of helping hands with this new and overwhelming "miracle" medicine.

"And here," Elizabeth piped in quickly. "Here's a new towel. You can't wipe your hands on something used," she informed him matter-of-factly. Despite the gravity of the moment, she couldn't help hinting a smile, realizing how neurotic she sounded. But it was Faith who had been adamant about the importance of sterility.

Nathan held his sweetheart's gaze, smiling in response, as he quickly dried his hands. With a sparkle in his blue eyes, he assessed her lightening mood and risked a playful towel snap, aimed affectionately at the curves below her waist.

Thwack!

Elizabeth gasped, shooting a teasing glare Nathan's way as she giggled for the first time in days. He grinned in response, his heart soaring, somehow feeling hope in the midst of this mess.

After a tender kiss to her cheek, careful to keep his clean hands to himself, Nathan dropped the towel on the table and picked up the syringe and vial.

"So, what's next Mrs. Thornton," he asked, giving her a sly sideways smile. Elizabeth's eyes spoke a silent thank you before instructing her other half on how to first change the needle, careful to avoid the Elizabeth slowly read aloud her notes on dosing insulin.

With his steady hands, Nathan did as instructed and eventually flipped the vial upside down, with the syringe attached, readying for the next steps.

"Okay, now fill the syringe with 8 units," Elizabeth read from the prescription.

"Oh!" she added with increasing intensity, "And make sure the needle stays in the liquid," she warned, remembering that was another way air got in and could affect the accuracy of the insulin dose.

Nathan looked closely at the black lines on the syringe. "Umm, sweetheart," he said with hesitation, hating to bring up another problem. He continued calmly, "There aren't any markings for units. All it says here at the top of the syringe is 1 mL. So I'm guessing these lines are tenths of a milliliter?"

Elizabeth's eyes widened. "Faith didn't say anything about milliliters!" She shook her head and groaned in exasperation. "Why is this so hard, Nathan?" she asked desperately "I've watched Faith do this for two weeks now!"

As Dr. Carter saw the new trial families struggle to make it to the clinic twice a day for insulin, she eventually taught the parents to give the shots at home for the sake of convenience. But, she'd made it look so easy. And it wasn't.

"Maybe check the prescription again?" Nathan suggested with care, trying to be helpful.

Scanning the small slip of paper, Elizabeth came to a confusing conclusion, "No nothing here at all about milliliters, just units," she said with a sigh.

Nathan glanced at the vial in his one hand for more information. With a slight tilt of his head, he read the label upside down. "Ah, here it is. 100 U/mL."

Both their faces scrunched up in thought. "So, eight one hundredths," she began, after which Nathan asked for confirmation. "0.08 mL then?"

Seeing only tenth markings on the syringe, he figured there was no other choice but to eyeball the 0.08 mL dose. So much for accuracy, he thought.

Elizabeth watched first with empathy and then growing amusement as Nathan tried to maneuver the round tip of the syringe with his larger than average hand, all the while holding the vial in his other. She loved this man more than the stars in the sky, who was clearly stepping in to take care of their son. Nathan's tongue poked out and settled between his lips, showing his fierce concentration.

But, soon a deep sigh of frustration led Elizabeth to intervene. "Here, sweetheart," she offered gently, placing her hand softly on his forearm. "Maybe I'll do this part, and you can give Jack the injection?"

Elizabeth's searching blue eyes looked at Nathan in hope, already dreading poking a needle through her son's soft skin. Sensing Elizabeth's discomfort, he agreed, "Yes, of course."

But, this worried and wearied mother immediately second-guessed herself. Thinking aloud, she asked Nathan, "What if he gets used to that, though?" Half-joking at the absurdity, she said, "I mean, are you going to come over twice a day every day?"

Nathan felt his heart pick up pace, a telling smile dancing on his lips. "Well, maybe I won't be needing to 'come over' for much longer," he suggested.

Elizabeth inhaled softly. There'd been so many moments in the last week that she'd longed to be married to this man. Even just from a logistical standpoint, Nathan had already slept through the night here three times since Jack's diagnosis.

But, it was far more than a matter of convenience. Here, together, figuring out Jack's new routine, even this felt like home. She could no longer imagine her life without Nathan.

At his obvious inference, Elizabeth's blue eyes held her sweetheart's gaze as their smiles spoke more than words could alone. Somehow, even steeped in the overwhelming reality of syringes and side effects, Elizabeth's heart helplessly fluttered. And certainly only a man like Nathan Grant could elicit such a response in the midst of daunting turmoil.

"Mama, I'm starving!" Little Jack whimpered, his weakened voice barely carrying down the stairs.

The clear desperation in their son's tone snapped both parents into action. "I'll be up soon," Nathan called out as Elizabeth washed her hands, yet again.

Nathan read Elizabeth's notes out loud to remind her of the details within each step. She methodically drew up the 8U, 0.08 mL dose of insulin, or at least as accurately as she could manage, considering the markings were in tenths and she was fighting with how the rubber plunger jumped erratically along the inside of the syringe.

Proud to see there were no air bubbles, Elizabeth carefully withdrew the sharp needle from the vial, victoriously holding the syringe upright as she passed it into Nathan's capable, caring hands.

She sighed in relief as he shouldered the next step, somehow feeling half the battle was already won even in just dosing one of the two daily injections.

Filled with love for the man Elizabeth instinctively knew would soon be her husband, she nonchalantly picked up the "clean" towel—the one she'd given him earlier when he'd tried his hand at the awkward syringe and vial.

Without warning, she now swatted him playfully on the backside. "Good luck, Constable," she grinned.

But, in truth, it was a shaky grin, since Elizabeth knew she'd just delegated to Nathan the hardest task of all, and that this was just the beginning of their journey with their son and his diabetes. For every year he continued to live, Jack was at the mercy of over a thousand shots, since Faith warned her he'd be shifting to three each day.

As her smile faded, Nathan was at the ready, though, reassuring her with a wink, "We've got this." Holding the insulin dose upright and away from them both, he leaned to the side to gently brush a kiss on Elizabeth's cheek. This attentive father then turned, cautiously walking up the stairs, as he intently eyed the exposed needle.

"Jack! Good news!" Nathan bellowed from the hallway. He pushed the bedroom door open with his foot, and then settled beside the sick little boy.

To ease the appearance of the worrisome needle, Nathan wisely focused first on its purpose. "Your mama is fixing your breakfast downstairs. We just need to get some of this medicine in you first."

"Is it pancakes?" Little Jack asked, his eyes lighting up, already licking his lips in anticipation.

"No I'm so sorry, Jack," Nathan said, breaking the painful news. "They'll hurt your body now."

The young boy's face fell, and Nathan's sweets-loving heart shattered.

"What you're doing is hard, isn't it?" Nathan asked. "Giving up some of the tasty things you love."

Little Jack nodded sadly. Moving the syringe lower and out of sight, Nathan made a startling promise.

"You know how much I love treats, don't you?" Nathan asked, affectionately tickling Jack with his free hand.

"Even more than me!" he giggled.

Exactly," Nathan chuckled, owning the truth. "But from now on, what you can't eat, I won't eat."

Little Jack's jaw silently dropped open in surprise.

The loving dad in Nathan ruffled the boy's messy bedhead and then squeezed his shoulder. Swallowing the lump in his throat, Nathan whispered, "You won't be doing this alone Jack."

"Thanks Mountie Nathan," he answered softly, in complete awe that his longtime hero would give up sweets just for him. Even cookies, Jack thought. "Do I still have to eat my vegetables?" he grumbled, hoping to get something good out of all of this.

"I'm afraid so," Nathan laughed. "But," he added, tweaking Jack's nose with an extra dose of love, "I'll be eating mine, too, right alongside you."

Sensing the inevitable moment had arrived, Nathan began, "Now for this medicine."

He raised the syringe and needle back up within view. "The deal is you get to pick where . . . your stomach, your leg, or your arm . . . and then we'll read a story while we wait for the medicine to kick in."

Choosing to look brave, Nathan asked a simple, but timely, question, "So, where will it be this morning, Jack?"

Little Jack's tiny heart tightened in fear, wondering if these shots would ever get easier or hurt less. But with courage like his Mountie Nathan, he answered boldly, "My stomach!" He wisely reasoned that spot would be less likely to impact his baseball game.

As Jack squeezed his eyes shut, Nathan grabbed the chance to take a deep breath, unnoticed. "Here it comes, son, 3...2...1"

The prick of the needle brought tears to both sets of blue eyes. And then it was done. The first family administered dose accomplished.

Nathan breathed a sigh of relief, and quickly wiped at the tears that had helplessly fallen from his pained, but accepting and grateful eyes.

"Why are you crying, Mountie Nathan?" Jack giggled. "I'm the one who got the shot!"

Nathan chuckled, brushing away the wetness from the little boy's cheeks with his loving thumbs. "I'm just so proud of you, son," he whispered.

At the compliment, Jack beamed, having noticed how Uncle Bill called Nathan, "son," too. He loved being Mountie Nathan's son, and wanted to make him proud. Remembering the reward of storytime, he grabbed Treasure Island from his nightstand.

Nathan snuggled under the covers beside Jack and this father-son duo read for the next thirty minutes.

"All right, honey bear" Elizabeth's voice rang out as she climbed up the stairs, "Breakfast in bed! And I have a surprise for you!"

Jack smiled appreciatively as he saw two eggs on a plate paired with a bacon mouth. Nathan looked up, his Mountie mind reeling. Then from behind the door, Allie popped out. "Hi Jack!" she exclaimed, rushing over to give him a gentle, sisterly hug.

"Allie!" Little Jack grinned, instantly looking far less sick.

"I showed your mama how to make my favorite breakfast," she said happily. "So, even if you can't eat sweets, you can still have fun with what you eat!"

"I love it!" Jack exclaimed, already nibbling on the bacon. "And guess what? Mountie Nathan said he'd give up sweets, too!"

At the astounded looks from his two favorite gals, Nathan shrugged sheepishly, smiling. "What? That's what family's about."

Raising a hand toward their youngest family member, Nathan added confidently, "We've got this, right Jack?"

The little boy grinned, slapping his tiny hand against Nathan's much larger one with a loud, "You betcha!"

Not a second later, Jack was already chewing another bite of bacon, eager to get better so he could use the new mitt and play with his Mountie Nathan.

Author's Notes:

I love historical authenticity when possible, but even with the discovery of insulin, Little Jack being diagnosed with diabetes in the 1920s would've still been a fairly grim situation. So, for his sake, I'm grateful that the show appears to be setting up Little Jack with a more modern scenario in regards to treatment and prognosis.

For anyone interested, here are some basics about the journey of insulin in diabetes management…

Before insulin was discovered as a way to manage diabetes, children only typically lived one to two years after diagnosis, trying to delay its effects by eating a low-carb diet. Insulin use from 1922 to 1926 reduced the number of deaths in young children by six times. While that's a powerful number, insulin wasn't perfect by any means.

It was dosed by trial and error, which caused its own set of problems. For decades, many children were still passing away from getting too much or too little insulin, and those who did live to adulthood also faced some of the longer term complications of diabetes like heart and kidney disease. While average life expectancy isn't a particularly straightforward measure, in the 1950s it was still in the thirties and was only bumping up to forty and then maybe fifty years old around 1980.

Believe it or not, it wasn't until the 1970s and 80s that the right technology became widespread and convenient enough to enable more optimal dosing of insulin. Remarkably, the average lifespan of children diagnosed with Type 1 diabetes increased by FIFTEEN years for those born between 1965 and 1980, compared to those born between 1950 and 1964. Yet, among those same two groups, in those without diabetes, the average life expectancy only changed by less than a year.

So, this dramatic shift in lifespan for those with diabetes came about solely because of medical advancements. In the 80s and 90s, synthetic human insulin and insulin analogs were produced that allowed for safer and more precise dosing. Plus, home monitors enabled individuals to test their own blood and adjust the amount of insulin accordingly. Certainly a drawback, though, was that on top of three to four insulin injections a day, people with diabetes were getting 4 pin pricks a day as well to measure the varying levels of glucose of their blood. These are brave and committed children and adults!

Now, there are even more advanced options with insulin pumps and continuous glucose monitoring devices that thankfully lessen the burden of needle sticks by a significant amount. Improvements in care are continuing to extend not only the lifespan of children diagnosed with diabetes, but just as importantly, improve their quality of life.

Still, this lifelong condition takes diligence, continues to present challenges, and has a massive learning curve, so I wrote this story to give a supportive and admiring hug to any WCTH fans who live in the world of diabetes.

Secrest, A. M., Washington, R. E., & Orchard, T. J. (2018). Mortality in Type 1 Diabetes. In Diabetes in America (3rd ed., Chapter 35). National Institute of Diabetes and Digestive and Kidney Diseases.