What Tarot Card Are You Quiz

First of all – a quick note – for some reason, suddenly I’m getting hundreds of hits from closed weight loss forum sites, especially to a post called Facing the Weekend. I can’t see who put my site on there. Does anyone have any idea what is going on? Did anyone come from one of those sites? If so, can you just let me know what the deal is? I have no personal connection to any weight loss programs or surgeries.

As for this quiz, this is insane. Do they personally know me?

You are The Moon

Hope, expectation, Bright promises.

The Moon is a card of magic and mystery – when prominent you know that nothing is as it seems, particularly when it concerns relationships. All logic is thrown out the window.

The Moon is all about visions and illusions, madness, genius and poetry. This is a card that has to do with sleep, and so with both dreams and nightmares. It is a scary card in that it warns that there might be hidden enemies, tricks and falsehoods. But it should also be remembered that this is a card of great creativity, of powerful magic, primal feelings and intuition. You may be going through a time of emotional and mental trial; if you have any past mental problems, you must be vigilant in taking your medication but avoid drugs or alcohol, as abuse of either will cause them irreparable damage. This time however, can also result in great creativity, psychic powers, visions and insight. You can and should trust your intuition.

What Tarot Card are You?
Take the Test to Find Out.

Not a post, article link

Too busy to post, hanging together mood-wise, not great but ok. But I came across this NYT article, and, hmm, sound familiar?

In which I fall back into my life

I know, I know, terrible to tempt fate. But it seems that the lithium + Wellbutrin combo is working. I’m not 100%, not even 50%. But I am not bat-shit crazy right now, and that brings both tremendous relief and tremendous horror at how I have acted over the past year. All the flying into rages, the inability to sit still, the impatience, the hating everything and everyone – all the stuff the shrink blamed on personality flaws and not mood – it has all just faded away. Now that I am not in the middle of it, I can fully appreciate how awful it was. How awful I was.

And now I have to put my life back together. I missed almost every opportunity this last year to learn something, to enjoy my work, to live my life. I’ve been horrible to everyone who cares about me, either from the irritability or being so sunk in my own misery that I couldn’t extend myself to them at all. By being so irritable and angry and short-fused, I’ve ruined my reputation in almost every department I’ve dealt with. Not the brilliance reputation, which might have even been enhanced (I aced the medical boards while in a similar manic-irritable state – in half the alloted test time), but the idea of being someone that anyone would ever want to work with.

I haven’t been to the shrink in about 3 weeks and honestly, that feels good too. I have a lot of work ahead of me, mending fences or bridges or however that expression goes. I am not sure if I owe him an apology for being so crazy and difficult and aggressive, or if he owes me one for not identifying that more clearly as a fairly severe mood state. Maybe both of us do.

I think I might need slightly more Wellbutrin and soon I need prescriptions for both things (I am still trying to hold fast to the principle of not messing with this stuff myself, getting prescriptions from a treating doc). And the Wellbutrin seems to be making me something of a worrier – every wound I close, I can’t sleep at night wondering if it will open, if it is bleeding inside. This is causing me considerable distress, and maybe I need a whiff of serotonin to tone that down.

I left a message with him last week, never got a call back (he is usually good about calling on the same day) and I’m hesitant to call again because, well, I’m always so ambivalent about dealing with him. In the meantime, I’m assuming he’s out of the country or something, though there is that nagging question about whether he possibly snapped himself and jumped off a roof somewhere. Occupational hazard.

But I don’t really want to go back to any kind of therapy. Not now. Not with him. It has felt good to have that weight and dread of appointments off me during these three weeks. Right now, I need to work on rebuilding my life, making amends, starting to function again. I know how to do that, more or less. Unfortunately, I’ve had to do it many times. A few of them, I’ve picked up and moved and started my life all over, so hard it was to face what I was during the episode, to face the people who saw it.  Sometimes, it’s easier to just start over than to try to fix what is broken.

I think a comment I left over at Secret Life of a Manic Depressive was sort of hurtful, though I didn’t mean it to be. It’s so strange, you learn as a doctor, how sometimes something that you say and mean in a totally different way is interpreted as insulting or hurtful. It’s happened to me. I guess the lesson is, once again, be gentle, for everyone around you is engaged in a great struggle. I’m sorry.

Psychiatrists’ Offices

Over at Tony White, there are two posts (1, 2) about home visits. It was a fascinating series and got a lot of reactions. Go read them first.

I used to make a lot more home visits, especially with the palliative care service. I never ever was sorry. I found so many things I’d never know about people. An elderly, extremely poor woman had a huge aquarium of tropical fish in a beautiful apartment with furniture that was highly stylish and I’m sure expensive in the 1950s. Once I saw a mildly retarded woman and discovered that she desperately needed social services to help clean the miserable bathroom, but also that she had an easel and painted these quirky primary-colored landscapes that I knew nothing about before. And though she couldn’t read them, she kept a huge bookcase of her dead parents’ books.

Of course, I live in a small community and also a culture where the distinction between a professional and personal relationship is hard to keep. Most shrinks keep  their offices as a front room in their homes – in fact, I don’t think I’ve ever been to one elsewhere. You can’t keep total neutrality anyway, because you’ll always have acquaintances in common, or at least I will because we both are in the medical community.

With my current shrink, there’s no real waiting room and a few times, when the client before me has run over, the shrink sits me down in his living room.

The last time that happened was WEIRD. The lights weren’t on because it was the middle of the day and the curtains were closed, so I just sort of stood there awkwardly in this semi-dark room. Then, all of the sudden, I realized his father was napping in an armchair in his underwear! I hadn’t even realized there was anyone in there until he said, “Please…sit down.” Scared the hell out of me. And now I know he’s disorderly, which is good – the newspaper is all over the place, etc. I wouldn’t like one of those sterile types.

And the shrinks’ offices I’ve been in are never very sterile. Well, my first counselor’s was because she was at the time working in an organization and it wasn’t really her office. But usually, their kids’ crap is strewn around, paintings by their kids and pictures on the wall. The bookshelves are filled with their personal books, not just the shrink journals. The current shrink’s couch always has these old, well-loved stuffed animals on it. I always wonder whose they are/were, or if they are there for patients to hug or something (he doesn’t see kids). There’s this old burlap stuffed dog that I want to pick one and hold sometimes, but I never would. I could never admit I want that simple childish comfort.

It’s not formal there at all – and in the summer I usually kick off my sandals and curl my feet under me, especially if I’m wearing a long dress. I always wonder always if this is weird, if it is going to be interpreted as some kind of behavior or other – possibly seductive, or dismissive of the seriousness of his profession. The truth is, I’m really short and most normal adult furniture leaves my legs hanging a little uncomfortably, so I always pull them up, even at the dinner table my knees curl up and I put my heels on the chair and eat over my knees.

There IS an element of hosting, or guest-host dynamics, like someone said on the original posts, but I think that’s ok. I always thought my ideal practice would be solo, out of my home…where I stop feeling like I have something to hide and people know that the doctor lives here. (Yes, that’s really me talking.)

On the other hand, I think that my shrink seeing me in my home would be an INCREDIBLY stressful experience. Not that there’s anything out of the ordinary about my home or anything that I want to hide (other than the lithium boxes, ha ha, which I leave out so I don’t forget to take it, but also panic that someone will drop in unexpectedly and see them). It’s always a mess, but a comfortable mess for me; there’s not filth everywhere or anything like that. It looks like the average apartment in this area, slightly messier. It’s warm and safe-feeling, I think. But I’m so guarded around him in general that it seems like that would be too revealing. My home is always my fortress and my retreat. I rarely invite people over, just because it’s my sanctuary. It’s where my books, my true lovers are, and I want to protect them, keep them private.

Also, I hate how the living room walls are adorned. There is one big picture hung in the wrong spot on the wall. It always bugs me as out of proportion. My partner does not know how to hang a picture.

But I digress. What I wanted to do with this post is ask everyone about their shrink’s office, or, for the few shrinks that read, about your office. What do you think about it all? Do you want the professional look or something personal? Ever been in a really weird office? Describe your shrink’s office in the comments, or on your site and leave a link to the post – all the bloody details and what you interpret from them. Maybe we’ll round them up and get a Shrink Rap post out of one of them on the subject too.

Fear and Hope and Wellbutrin

For a day or two, I thought it was working well – not well, but it seemed like suddenly I fell back into myself, which is a strange expression, but only by becoming me again, I realized how swallowed up by this monster I had been, how lost I was. I speculate: where was I during this last year? Someone else, someone horrible, took over my body and life, torturing me, making a monster of me. Then I thought, maybe I was wandering around in another dimension, or inhabiting someone else’s life and body. I’ll have to think of this idea a little further, there might be a story in it, though I suspect it has been done this year with that book Atmospheric Disturbances that everyone is talking about. But maybe there is a good fantasy alter-life in it. Maybe I can write myself, or my alter self, a better year.

I did get a little manic buzz, joking, punning, quick and enthusiastic again. It was a little frightening to just pop back into my old self almost overnight, disorienting, like someone getting tossed through river rapids and rocks who suddenly finds herself washed up, and not only that, but that the river has turned mysteriously calm behind her, and she can’t quite figure out what all the bruises and breathlessness came from.

I pray this isn’t a fluke, that this drug will keep working. I’m thinking it’s similar to the nortriptyline by how I feel, right down to the little twitch in my right eyelid. So similar, in fact, that I managed to already make my way to the medical library for a big specialist book on psychopharmacology and discover that nortriptyline does have some downstream dopaminergic activity. I guess that probably is why it works like Zyban on the smoking too. And that idea that a mood stabilizer alone is enough for bipolar is bullshit – I’m proof.

I almost even wanted to forgive the shrink. I certainly can’t have been easy to deal with, and he’s been doing it for a year.

I’m not fine yet, that’s for sure, even though the improvement was so fast and so sudden that I almost felt forgiven by God. It doesn’t fix my sleep like nortriptyline, and I’m rather jittery. But I’m me. My thoughts are back, the rage has calmed, and I don’t just want to crawl into a ball and die. And little things which I only noticed afterwards. I spent the evening looking at volunteering in Ethiopia at an AIDS orphanage for when my contract is up. This doesn’t seem like much, but it is the first time in a long, long time that I looked toward the future, thought of something – anything – that I might want to someday do.

Today a bad thing happened, which set me back quite a bit. I made a mistake at work and a patient did suffer some damage from it. I probably shouldn’t write about it in this kind of public forum, for all kinds of reasons, not the least of which is legal. It was a dumb, procedural mistake/orders mix-up, something rather similar to this but without the happy, not-my-fault ending. One of those things that a safety systems investigation would shit over; I was in a new-to-me department and I’ve never in my life seen such a lack of a consistent system for orders. And there are some dumb-ass nurses who today came to pest me about ten times because I’d written an order for omeprazole 20 mg once a day, when for some reason they wanted it 10 mg twice a day (“once a day dosing,” ya idiot, if you don’t study pharmacology, don’t you at least watch the commercials? It actually has some interesting pharmacokinetics, by the way, if you’re into that). Yet a massive mistake like this, which was obviously NOT correct and they say nothing.

It wasn’t only my fault – the mistake actually was written a few days ago, but I certainly continued it. And saw it – it wasn’t like I didn’t see the previous order.

I felt so horrible. It is a fragile patient anyway. I don’t think any long term harm will come of it. I hope not. The guilt, however, is killing me. The other doc involved in the original order seemed to be able to walk out of there worry-free. But I was so upset I wanted to cry – of course, I’m still too depressed to really cry. I also, a bit, wanted to hang myself. So I guess I’m not better yet.

The other thing I wanted to say is thank you again to everyone who took the time to respond, to comment, to reassure me that I wasn’t as crazy as I thought during all this time.

And then I thought of how unequipped I am to be a doctor, how I want out of this responsibility with all my heart, how, while I might be an academic freak genius, I’m not meant to carry this burden. I don’t want this kind of responsibility, and authority over other people, telling them what to do, doesn’t suit me at all. The doc who initiated the mistake is great at bossing people around nicely. I just can’t do it. Even if I think it’s best for them, when people challenge me, which happens often because I utterly lack the self-assurance and cockiness of so many docs, I’m no good at answering, because I just ultimately believe they should do whatever they want. I offer an opinion and that’s it, take it or leave it. But that’s not really what practicing medicine is about. And that’s something they never tell you in medical school.

Thank you

To everyone who left a comment and emailed – it means a lot to me, and your generosity of spirit and perspicacity are so much deeper than the supposed professional. I hope that all of this medical training hasn’t beaten out of me the common-sense wisdom and gentleness with which you have responded to me and that I can offer the same to someone else someday. Thank you so much for the reality check, the “you’re crazy, but not that crazy” that I so badly needed to hear.

Why oh why can I not fire this shrink?

Thanks so much to everyone who commented supportively. It means a lot.

I was going to cancel the shrink, having hit such a low that I knew that I’m beyond help by anything human. But then I thought, “That’s ridiculous, to not go to the doctor because you feel too bad.”

I went today and laid out how I just can’t take much anymore and to please help me. That I am terribly independent and stubborn and all that, but I’m really reaching my breaking point, that a year of mood episodes almost non-stop is breaking me down. I had no idea how hard it would be to admit this.

His answer: “You can’t be that bad off. You’re wearing makeup.”

Never mind that I had just come from work at a new site rather than coming in after a call night, or that makeup is often my last defense. I subscribe to the “at least you looked good” school, which says that when everything else goes to shit, at least try to look professional.

This provoked a moderately angry response, which earned me a lecture on how bad a person I am, how if only I weren’t so angry all the time I wouldn’t have a mood disorder, how I’m too negative, that I need to just grow up. I’m an adult and a doctor now, I can’t allow myself to slip into manic episodes because they are fun (this was in response to the complaint that lithium is making me an idiot).

I have a  bad temper, but I don’t think I have anger issues – I never have exploded at someone in an inappropriate way. Yes, I am angry at this guy, but fucking up a year of my life and then blaming me for not wanting to help myself – when I have not taken ONE sick day or anything – seems like I have a right to be a little angry.

Anyway. I don’t know why I can’t quit. Part of it is that he’s convenient – conveniently located, flexible about seeing me at the freak hours I can actually make it, and not affiliated with any hospital or clinic I work at. And at least he’s seen my actual episodes. And honestly, most shrinks are idiots – incidentally today I had to call for a consult from the psychopharmacologist he wanted to refer me to and that guy was a complete idiot as well.

It seems I need to just stop going. That’s the odd thing about it all; when I actually seek help, I seem to get worse fast. (One of my complaints today was that over the past year, I’ve turned into a full blown psych patient.) When I am forced to get by on my own, as hard and lonely and scary as it may be, I do.

I guess I need to remember that psychiatry isn’t the answer, isn’t even much of an answer.

It’s the time of year to be thinking about repentance, being better, making amends. I think that might be contributing to my guilt-drenched nightmares. If I am that horrible of a person, which I certainly might be, though not for the reasons he thinks, then I pray for forgiveness from everyone who has ever had to deal with me. I’m sorry. I didn’t mean it. This is all I can think of lately, when my brain manages to function at all: how very very sorry I am for everything, for poisoning this sorry world further, for all the people I have hurt and will hurt. I am so sorry.

Soon it will be signed. I’ll do the best I can in these seven days that are left. I wish it would just be signed and sealed, come what may. I hope for a better year, though I don’t think I deserve one.  And I’m too drugged to even have enough feeling to repent. Still, may the God that lithium erased have mercy on my soul.