Shrink’s Line of the Day (edited)

Me: I don’t want to do any med changing until after I take the boards next week. At least my mind is okay right now.

Shrink: What happens if you move the date?

Me: I don’t think I can at this late notice. (Note: I never said anything about moving any boards. I had no such thoughts.)

Shrink: And if you don’t go?

Me: I guess it’s noted, and I’m out a couple thou.

(Pause)

Shrink: What happens if you fail it?

Me: I don’t know. The same. I have to redo it, it’s noted that I failed once, I’m out a couple thou.

At the time, I just moved on to the next thing. But now I’m thinking, what the fuck? I have never failed or screwed up any professional or other obligation in my entire life. If anything, I’m too perfect all the time. And right now, I actually feel sort of okay about going into the test. So what the fuck was that? Why would he hint that I might fail? How could that possibly be helpful?

The other great thing is I think he left with the impression that I am paranoid. I mentioned something about how during these last three months, I hardly answered phone calls. I mentioned that lately many friends have been leaving messages asking if I’m ok, that I don’t know why they all the sudden started calling. He asked, “So, are you worried there are rumors flying around?” I said no, it isn’t that, it’s that I hate people worrying about me and I honestly have no idea how to answer them. I don’t want to lie and say everything’s fine, but also am not interested in sharing my insanity with everyone.

Other things touched on: the upcoming personnel physical and drug test, which he didn’t believe they did (the drug test part), so that made me sound paranoid, and that I had used a fake name to do the levels test.

Suddenly, now I realize why he said he wanted me to come back in in the next couple of days, before the exam. He thinks I am totally paranoid, and also, in discussing the exam, I mentioned how my mind is working better now (as opposed to when he had me stoned out on lithium), and phrased it as something like, “Yeah, now I can just see the question and the right answer.” So that’s probably some magical thinking in there too…and why he asked me what happens if I fail.

I feel stupid for realizing this only now. I hate that I can’t really get a doctor who shares a native language with me, because I’m sure that contributes to this.

Anyway, he said he would call tomorrow – which I also couldn’t figure out until I just realized all this – because he certainly didn’t make such a big deal when I was actively suicidal. But now I get it.

Question now: how to confront the issue without sounding more paranoid? After a certain point, anything you do sounds worse, incriminating. What I’m most angry about is that he wasn’t just honest with me, and didn’t ask further questions. Just took a (mistaken) clinical impression and ran with it. I figure that unless I get some brilliant suggestion, I’m just going to ask straight out why all the sudden he jumped on me so much, and if that isn’t clear enough, I guess I’ll ask directly if he was thinking that I’m sliding into psychosis.

And maybe that’s why he encouraged me to go into writing and get out of medicine. Assumes I am shortly to be too mentally ill to practice.

See? Anything I can say or think now always sounds paranoid.

On the other hand, it is very tempting just to never go back. Again.

Crappy Birthday to Me

Yesterday was my birthday. No, I didn’t do anything special. The boyfriend made me a nice cake and was warm. But I can’t seem to control this rage, this inquietude, this undermedicated-ness that is casting a dark shadow over everything.

I am not taking enough medication. Obviously. But the doc won’t let me take more, because he thinks I am going manic, and you aren’t supposed to take this shit when you are. But every time I have gone manic, it has been from not having enough of this shit, fuck whatever the textbook says.

It is enough to make me feel more energetic. I no longer sleep 22 hours a day. But all I can do is panic about how I have to take care of everything that I haven’t been able to for the last three months. In a way, it was better to be so depressed I couldn’t move.

And once again, I have to put my entire life back together. I don’t know how many more times I can do this. Doesn’t a phoenix even have a limited number of lives? I spent three of the last 7 days dealing with doctors and labs and this stupid disease. All I can think about between appointments is this.

I just want my life back.

Right now, I’m apologizing to the universe profusely for ever thinking that sunburn was a bad enough side effect to stop taking the good drugs. I would gladly go back to living at night after this three month hell tour. I want to go back to being me, to being warm, and giving, and competent. To contributing something to the world. To being a person, not just a mass of symptoms and misery. Not this half-life, in which every moment, I’m trying to figure out how to get through the next one with a singularity of purpose that precludes anything else meaningful coexisting in my life.

I wish I had a real parental figure in my life. Someone I could talk to honestly, who wouldn’t judge me and who would stroke my head and help me and comfort me and tell me that everything will be ok, somehow. When I feel better, I can comfort myself (and everyone around me, too), which I guess is the mark of adulthood. Do we ever stop needing, stop hoping, for a little love and care? Immature, I know. If there is one thing I have learned from this sorry world, it is that we are born alone, die alone, can only save ourselves. Can we be blamed if sometimes saving ourselves becomes exhausting, starts to look like too much work? That we’d rather save everyone else?

More search engine terms

Even though I just did this, there have been a few that popped up in the past few days that are so worth posting:

i lost my ego

why i hate psychiatry

even my shadow is jealous my skin is mad

feelingless bipolar 

escape life seclude depression

The runner-up for best search term:

are psychiatrists strange

And my favorite:

what asshole i am

More shame, at the end of which my heart just breaks

Today I had to check drug levels. This involved a tremendous amount of humiliation. All morning I was angry. Now I am just heartsick.

The doctor tried to do me a favor by talking to the clinical lab director about if they could order the test through the clinic and send it over, saving me from the trip to the hospital with the only lab that does it, as well as it being the hospital where I work. Besides the humiliation, it is damn near impossible to catch both the bloods office and the pharmacology lab open to the public at the same time. You need a fucking Aztec calendar and pyramid to figure it out.

The lab lady said, “No problem. Tuesdays and Thursdays, we send all the stuff that they only do at the hospital over there with all the paperwork.”

I went to the clinic this morning for the blood draw. The male nurse who did it did not speak the language very well, and my idiot of a GP who had sent the official insurance order for the test sort of misspelled the name of the drug. They could not figure out how to draw and transport it. So the nurse gets on the phone to the head of the lab, mispronounces the drug name so badly that she has no idea what he is talking about, and she says to fax him the (misspelled) order so that she can try to figure it out. At no time does anyone think to ask me.

As far as confidentiality, it’s shot. The nurse is yelling on the phone in front of a full clinic. Another nurse there tells me, “You know, you’re just wasting your time. Just go straight to the hospital yourself and do it there. They will probably lose it on the way if you do it here.”

Meanwhile, we’re waiting for the lab lady to get back to them. She doesn’t. Finally, genius that I am, I think, what the fuck? They are sending it to the hospital lab anyway. I bust out my cell phone, call the hospital, get the lab, and ask them, “Hey, what kind of vial do I use for a drug level of xxx?” They tell me. I tell the nurse. They draw the blood. I leave.

I get home, and my phone rings. It’s the nurse, saying that the lab lady can’t figure out what drug it is either. She left me a number to call her and clarify.

I call. She has no idea who I am or what I am talking about, despite the fact that she left the message for me five minutes before. Finally, after many failed attempts at communication, I start at the absolute beginning. I manage to explain that my doctor spoke to her yesterday about sending a blood sample to the hospital. She has no idea what I am talking about, though she has the exact same name as the person the doctor said he spoke with. She also, beyond that, has no idea what drug I mean, even when I spell it out for her in both local and Latin letters, generic and brand name. “It’s not even in the formulary!” (It is.) Then she says, “Oh, well Dr. Shrink didn’t tell me the name of the drug. We don’t send that over. You need to take it yourself. Go back to the clinic, get the blood, and I’ll fax the form for insurance that we’ll pay for it to the clinic. Take them both to the hospital. ”

I go back to the clinic, retrieve the blood from the ice chest. Then I go to ask the secretary if the paperwork got there by fax or email. In the middle of a huge office full of people, including doctors I have worked with, of course. It is not there. I call the woman back. Someone else answers her phone, so I have to launch into the whole story again, in public, until she cuts me off and says, “Stop, I’ll go find the lab lady.” Finally, she sends the referral.

I take the blood, the insurance paper, and the referral and head to the hospital. By this time, it is 11 AM and there is nowhere to park. I drive around in the heat for half an hour looking for parking, watching my watch as the day gets eaten up.

By the time I make it to the hospital’s doors, I am sweating through my shirt from the heat and rage, and I run into a colleague. He tells me, “Hey, you know, we have to go renew our personnel stuff this month.” That stops me dead. Now I am interested. I ask him what that will entail.

“A lot of errands. Oh, and you have to go see a doctor at employee health. They do a bunch of tests and stuff.”

This stops me cold. Tests mean that things go to the lab, which means that when they pull up the results on the hospital computer, the results for blood levels of the oh-you-are-so-fucking-crazy meds will show up.

I don’t think I could face that.

So I get to the main office, and sign in and get called up in front of a bitchy secretary. I tell her what I need, reading off the test billing code number from the insurance form. She starts taking down my details. I give my post office box address, because I live in a rural area where if they send the mail to the house, it never arrives, and even if I give the post office address as a mailing address in addition, they always send shit to the house and I never get it.¬† She starts screaming at me that I can’t give her a post office box. “Where do you live?” she shrieks. I start to try to explain the intricacies of the rural postal system, but she keeps screaming at me. I realize that no amount of actual, truthful explanation is going to work.

Finally, I just lie, say that I am staying in a local neighborhood with friends and don’t know the address or the street name. She looks at me like I am a small, retarded child, or possibly a criminal trying to steal a blood test. She registers my post office box, but in the local neighborhood and zip code I gave her, thus ensuring that the results will never get to me that way either. She will not accept any attempt to correct this.

I decide that I just can’t, just cannot do this. Cannot be humiliated like this any more. No more yelling. No more explaining. No more apologizing that I am so crazy I need to take medication that requires its levels to be measured. I give her my grandmother’s name, and pay in cash.

Yes, I pay cash, which means that I could have skipped the entire morning fuckaround with the clinic altogether and not have been dragged through the the repeated humiliation, and not had it written on my file at the clinic and with insurance.

Total cost: around $40 USD. I could have made one phone call and asked before going through all of this.

I am such a fucking idiot.

The shrink and the GP have both continually tried to tell me that it isn’t that big a deal. That no one will deny me a license or cause me trouble over this. “Don’t worry,” says the shrink. “I’ll sign that you are fine,” says the GP.

Of course, these are the same two who promised me I could take the bloods at the clinic and sent the unintelligible form, respectively.

And even if no one will make a big deal, I think that the moment they call on me to explain, ask, in that fake-non-judgmental doctor way, “So, what are you taking that for?” I might just fade into another dimension. I might cry. I might just turn around, walk out the door and keep walking miles and miles into some woods lovely, dark and deep and right out onto the frozen fucking lake.

Why can’t I be like this guy? Walk proudly into the emergency room, and explain cheerfully to the staff the exact pharmacology of the overdose that caused his EKG findings? Why can’t I just walk in and ask for what I need, and if it makes them uncomfortable, well, fuck them. This illness is not my fault.

Of course, the problem with this approach is, 1. I don’t think most people care that I am not to blame, and 2. I’m pretty sure that somehow, somewhere, this is my fault.

* * *

I got some positive feedback on the Shrink’s Line of the Day feature. So I’ll add this one, which came up a little bit ago, when I was debating whether or not to bring up crazy behavior #336.

Me: (Friendly, hesitant.) Um, you know, I don’t want this to come back and bite me on the ass when someone sues me for malpractice ten years from now and they pull, oh, everything for the trial. (Pause. Nice, and as nonthreatening as I can be.) Can I ask, what kind of records do you keep? Do you even keep paper records?

Shrink: Don’t worry about it.

Inspired by BPLC

As always, brilliant describes BipolarLawyerCook. Inspired by that, here are my old friends. It isn’t that they are necessarily my absolute favorite books ever, but when you move countries often, most of your stuff gets left behind and you are constantly starting over. If I really need a book, I usually have to replace it. These are some that have made the journey with me at least a little bit.

My camera is kind of broken, so I can’t get it to really focus, but still, I love them. I think the fuzzy picture sort of captures it anyway.

dscf1851sm.jpg

This copy of The Princess Bride is my father’s. I think it is the only gift I have from him. I don’t think it was really a gift. I just took it. I always return to ee cummings after a bad episode, when I start to come back to life. Sometimes when I am down as well, being answered only with spring is fair enough for death. I even opened it today. It was sunny and I woke up better than I have been since this whole med debacle and that is my little prayer:

i thank You God for most this amazing
day
:for the leaping greenly spirits of trees
and a blue true dream of sky;and for everything
which is natural which is infinite which is yes

(i who have died am alive again today,
and this is the sun’s birthday:this is the birth
day of life and of love and wings:and of the gay
great happening illimitably earth)

Lolita is on its side because the front cover is missing, but it is my original copy from some dingy used bookstore. It also has been with me since college in that kingdom by the sea.

Fanny, however, is not my original copy, which was black and had a prettier cover. It reminds me about adventure, bravery, that life should be at least a little picaresque, that every woman needs to be a little bit of a witch. This copy came from a tiny used bookstore somewhere in the Middle East.

dscf1854sm.jpg

The Carl Sagan, I’ve had since high school. It only recently made the move from my mother’s garage to here with me. My original library had all of his books, but being a biology type, that’s the one that made it with me, though I also found Demon-Haunted World very comforting. Variety of Life lived with me during my pre-med days. I probably should have stayed a field biologist. I just love Wicked for the story. It is a recent acquisition, relatively speaking. So is Maiden Voyage, but rereading it has taken me through many a hard night.

More psychiatrist fun

I haven’t updated because I’ve been sunken into the worst depression I’ve had in years. It is so hard to remember that just three months ago I was fine. I am sorry I ever thought to change meds, even with the side effects.

But I’m also tortured by the sneaking idea that those 4 years I had that were ok, when I was just like a normal person, were borrowed time. During that whole time, I knew that sooner or later I would have to pay. And now I am.

It’s funny, this depression is so different than my usual ones. In some ways, I’m suffering less. Usually I have some fairly mixed features – I’m anxious and my thoughts race and I’m hypersensitive. Now, I’m just washed out.

They always say that people deal with their first episode of depression the worst. Something about the experience being new, and in later episodes, knowing what to expect and also knowing that it will pass. This is grinding me down like a first episode because it is so different than before. I can’t get out of bed. Everything hurts. My mind is blank. I constantly want to throw up.

Outside Over There
So the goblins came. / They pushed their way in / and pulled baby out, / leaving another all made of ice.

The thing is, my other depressions, my natural ones, not the ones from some weird drug reaction or withdrawal or whatever the fuck this is, are rich experiences. They can be miserable, but there is also a heightened sensitivity in them. Sensitivity to what is ugly, dark, yes, but they are a complement to my normal sunny, conquer-the-world self. I used to always be able to crawl into bed with the a beloved book, watch a dark film, and cry in a deeper way than most people ever get to. I don’t even want to feel good again right now. I would be happy to have my tears back.

As to the shrink, I’d like some audience feedback.

I’m lucky, here, most psychiatrists still do therapy. I understand this is a huge problem for a lot of people – they can’t have the same person manage their meds and talk to them.

This guy always wants to do more therapy and spend less time fixing meds. But I hate therapy. I feel way too exposed. And I don’t think it really helps, and in this country they are still doing a lot of psychodynamic therapy which I find particularly useless. I am a very rational person, and psychodynamic stuff seems like voodoo to me. A non-predictive system. And I don’t buy the basic premise – that insight does one damn thing to make you stop doing the same shit you always do. So you know why you are fucked up? So what? CBT is the way to go in my eyes. Address thoughts, address behavior. Simple learning theory. It was incredibly helpful in my past. Even supportive therapy is probably ok. Someone to tell you it’s going to be better, that you can hang on, is valuable. But I’m just not into that whole childhood trauma shit. I mean, there’s got to be a statute of limitations somewhere. And I function well and when I’m well-medicated I’m reasonably happy – so why fuck with things?

Here’s the other issue. Despite that I know the guy for maybe 6 years or so, we’ve never really clicked. I’m not sure why. I like him well enough, well enough to keep coming back even after all the shit like this. I think he is good at what he does, and also a decent person.

I know a lot of it is my fault. I don’t trust anyone and all kinds of things like that. But I think that there is more.

Despite that he’s nice and respectful and really ok and not stupid (all of which are problems with many, many shrinks), I just don’t seem to trust him for some reason. But I have a very bad record of deciding who I should and shouldn’t trust. The fact that I don’t trust him should, based on the evidence, almost certainly mean that he is trustworthy. And I don’t know why I don’t trust him. He does all the right shrink stuff, is warm and empathetic in all the right places, is professional.

I just can’t put my finger on it. I think that secretly he thinks I should be more boring, which is no good for me. I always get the sneaking feeling he thinks I should be married with three kids and a mortgage, that doing much else with my life is a sign of immaturity or something. He uses too much shrink silence, which I hate. He never tells me what he’s thinking, just drops his profound statement at the end.

I think that really flipped me out when he first diagnosed me, was why I never went back all those years ago. He just said, “I want you on a mood stabilizer,” with all that that implied, without explaining why. That was brutal when I was so sure I was unipolar only. He asked me a million times back then if I was sure I’d never had a manic episode, in a million different ways. I always said no, because when I was so low, I couldn’t remember having had them. If he had said, “Look, I’m saying that because even though you feel depressed, you are talking at 100 miles an hour, and seem a little too confident in your abilities, and you can’t sit still for even 10 minutes,” I might have been forced to agree. But he didn’t. He just sat there in shrinky silence, waiting for the proclamation to sink in, which it didn’t for years.

A couple of times though, he has surprised me in a good way. One was this last suicidal week, where he promised not to call the cops on me no matter what. I’m not sure I believe it, but at least he was perceptive enough to see that that was the right thing to say. The other time was when he actually, contrary to what I expected, didn’t tell me to just go be a good doctor and give up writing, but rather encouraged me to do the opposite. That shows at least a minimum of non-bourgeois sensibility.

So – did anyone ever get anything out of that kind of therapy? And should I try to salvage the relationship with this guy or just use him for meds? Would it be reasonable to just tell him all this and see what happens? Or is that just going to lead to me not getting anywhere and wrecking my comfort level for going to him for meds?

Since I am far, far too fried to write

I thought I’d put up a list of some of the search terms people used to get here. I always enjoy it when people do that:

how make appointment psychiatrist (and many similar ones ie “what happens at a psychiatrist appointment” – believe me, not all are like mine)

lithium suicidal thoughts (yep)

does lithium take away joy (ditto)

words of comfort, cycle of life (sorry, can’t help)

i’m lose my mind (also, sorry)

artist ego depression

and one of the most popular ones: aaaaaaaaaaaaahhhhhhhh