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.

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10 Comments

  1. Hi Sara,
    I am glad to hear you are feeling better. I believe ALL Drs make mistakes (unless they are not human?) It’s just that some of you take responsibility and actually feel for the patient. I’d rather have a Dr who is not cocky personally. Mistakes happen to everyone. I hope the mood keeps up.
    …aqua

  2. Sara, I think you have the makings to be a fine doctor. Don’t give up.

    Don’t.

  3. 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.

    They not only should do what they want, but they will do what they want. Being bossy is necessary for some patients, but mostly counterproductive. Your patients probably ask you questions because they sense that you’re not arrogant, and they feel they can talk to you. That does sometimes feel like they’re challenging you, but it can be an opportunity to find out what’s really going on with people, rather than accepting the story they think you want to hear.

    You have the core of a really amazing doc, if that’s what you want to do, but if it feels like a terrible burden, then maybe it’s not for you. You might also find yourself more satisfied in a field that offers ongoing relationships, like primary care. You’ll find your place, and it will be the right place for you.

  4. Wellbutrin worked almost instantaneous for me. It was very unfortunate when I developed a tolerance for it years later, but it did work immediately, and it’s been the only drug that’s helped me.

  5. I agree with 5150. I’ve been on the drug 0n and off – mostly on since 2004 – love it, it keeps my weight down, keeps the moods mostly even… the thing is that I’m maxed out on my dose and can’t go any higher, but besides that, I love it… doesn’t make me manic at all, but I swing down and not up…

    do you guys have SR & XL?

  6. Sara, your compassion and caring is what makes you, YOU and not the other person who just walked off. that’s the whole point you see…
    please take care, Love, Milo

  7. I wish I could write something that would take your self doubt and insecurity away, but I suppose those are things that will disappear with time and experience, which you maybe have not had enough of yet. Your disorder seems to stand in the way of making your experiences as a doctor mostly positive ones, or am I misunderstanding that? You also have to give yourself a chance to get better and not think that after a few days on a new medication everything is going to be alright immediately. You will find that over time you will start functioning better and you will stop paying so much attention to it. Time is a very important ingredient in all these processes, don’t forget that. When your medication works well, feeling well will become second nature to you and you won’t spend all your time wondering how you are doing, You just get on with life, but you need to feel a little bit more secure about yourself and shed some of that self doubt.

  8. Wow, thanks everyone.

    Irene, you are not misunderstanding, and actually I think that’s one of the best ways of putting the doctoring thing I have heard. When I feel a lot better, I do enjoy at least some parts of doctoring. And the bad stuff rolls off me more easily. The moods are really wrecking everything.

    RAch and 5150 – well, if you like Wellbutrin, you might want to try nortriptyline. Very similar except a little less agitation and it’s GREAT for sleep – you sleep deep and well but wake up willing to face the day.

    But I’m hoping to be ok with it, because last night in the middle of the night I woke up in the middle of a horrific anxiety attack, something that’s never happened to me before. Almost ended up in the damn emergency room except that I managed to diagnose myself. So now I’m supposed to HOLD (medical talk for when you stop a medicine temporarily) for today and preload with valium and then try again…although that sounds to me like a recipe for a seizure, but whatever. I think that actually I’d even learn to live with the panic attacks if it made me stable by moods.

    Jay, I soooooooo appreciate your views as someone more experienced than I. I guess I need a mentor. I am headed to primary care; unfortunately, training and extra jobs until I finish the specialty boards are hospital based. And you are right – when I have a relationship with a patient I don’t have this trouble at all and I love answering their questions. Most of the complaining and challenging that I just can’t cope with right now happens in the ER, which I cover, when random people start yelling at me, or for the nurse (who they assume is me). The ER, as I always say, is like working at McDonald’s – everyone wants what they want RIGHT NOW. And they always, no matter what, feel neglected and ignored and sometimes as a result go postal. And I am small and nonthreatening so they try to bully me into extra CTs and things. Also, a lot of what I have trouble with is working in various systems – the whole mistake happened because of a system that was not good along with a “hurry up” attitude of the department. When left to my own devices, I can sit and THINK about both what I am doing and how to do it with my own little bit of OCD. When trying to please everyone, it all goes to shit.

    Milo, thanks always for the support, and I want to hear more of your story always.

    Susan, thanks for the kind words and I hope you feel better soon.

    And Aqua, thanks always for your blog, and your last post.

  9. Oh, Sara, this must be so hard!

    I, too, am living proof about the possible ineffectiveness of a mood stabilizer alone. I’ve got 2 different mood stabilizers, an antidepressant/sleep aid and Ambien (for REAL emergencies). And I still swing from time to time, but not so much.

    It’s funny …. we are a lot like your ER patients. We want something to make us better RIGHT AWAY. It’s so hard to be patient to find the right drug cocktail for YOUR brain chemistry.

    I’m hoping you’ll feel at peace soon.

    hugs to you…

  10. Heh, not sure if a year is “right away…” – but yeah, I’ve had the “FIX THIS NOW!” moments with the shrink.


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