As I said…

Crazy doctors are better for crazy patients.

Other than that, I’m here, the new med seems to be ok, I mean, at least I function, but has absolutely shot my writing ability and drive. The words don’t fly, I don’t have the motivation, the little voice doesn’t talk. Trade-offs. I’m coasting through picking up odd jobs.

In response to a comment on an older post, I wrote this:

Since last posting, I found a different psychiatrist, and after a few more med attempts, landed on one that works, and I haven’t been back to see him since. And hopefully I won’t. The difference was immediate, the guy was … not great, but PROFESSIONAL. No mind fucks, no innuendo. I don’t really understand what exactly happened with the one before, I think in retrospect a lot of the drama and trouble was not my fault. The perspective of distance from the situation has let me see more clearly and stop blaming myself for someone else’s problems and emotional shit. I have not ever been in any kind of relationship like that before. The best explanation I’ve heard so far is that somehow we crossed in past lives or something. It is just one of those things.

Now that I am reasonably well medicated, all the crazy just falls away. It’s so strange.

Sorry for anyone waiting for me to write or anything. It’s just not there anymore. I’m a little sad about that, but at least I am back among the living.

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“I wept not, so to stone within I grew”

Io non piangea, si` dentro impetrai.
-Inferno, Canto 33

It is 3:40 AM, the witching hour, and my being awake cannot be a good sign.

Of course, I have been awake at this hour every day for quite some time now. Maybe wanting to get up and write is a good sign.

Things here are, well, empty. I suppose it is a depression of sorts, though fortunately like the ones I suffered as a child and teenager, before the “manic” part was added to the title. It is much more bearable, at least on the surface, than the episodes I have suffered in the last few years, because I am just quiet and still and numb. No racing mind or body torturing me with horrible thoughts that come faster than any human was meant to think. If I didn’t have the practicalities of running a life to worry about and could just crawl into bed until it goes away, it wouldn’t be bad at all.

It is strange how it has come full circle, taken me right back to where I started. It does remind me of that time when I was 12 and my mind broke for the first time, for seemingly no reason. It is familiar, if not comfortably so, ha ha. It makes me a little nostalgic for that time, when I thought that the worst that could happen, crazy-wise, was the need to crawl into bed for months. Before I knew what could really happen, all the ways a mind can burn and break that I know now.

It does get better throughout the day, and by evening I am almost normal. Unfortunately, 9 PM is not the best time to apply for jobs or deal with the mundane details of life. Every night I go to bed thinking of what I will do first thing in the morning, the interview I will schedule, the tax papers I have been avoiding (two forms, that’s it, two forms!) for months.

And then morning rolls around at 3:30, and I am numb and frozen and terrified again and nothing gets done.

I have not worked in four months. All solid job offers are shift work, night work, in busy, miserable emergencies for minimal pay. Seeing as that is what made me so crazy over the last few years, I have not accepted any of them. I don’t want the responsibility of not missing a heart attack for $5 of pay. It makes me physically ill to think about going back to medicine.

I wrote before that it wouldn’t be so bad if I weren’t trying to keep up with life, but I am not sure that that is entirely accurate. I woke at this atramental hour, and beyond the dampened terror of my bank balance, the horror at the thought of returning to the repugnant job that is the only one I am qualified for, a little voice dared to run through my head and say the one thing that I have not allowed myself to think: “Your hope is all gone,” the voice intonated. “Your mind will not work again. This is what you are now.”

I miss very much the streams of words that used to race through my mind, needing to be caught on paper before they got away. I miss writing, which used to be an automatic and unconscious activity. Whatever force I used to channel, whatever it was in the universe that fed me the words, has left. I have been alone, without even the words that I could always count on to come, unbidden. I try to force myself now to write, but I sit and try to think of words. I have to choose them, and they are never quite as right as the ones that come from without. I never used to “have to” make myself write. The words used to just come, words and phrases and alliterations and allusions would streak through my head, unannounced and at odd times, often surprising me and making me laugh or smile at their unexpectedness. All I ever had to do was appreciate them, and transcribe them, and be thankful for the electricity that ran through me when they were flowing, the sense of pure purpose, that this is what I had been put on this planet to do.

But whatever consciousness it was in the universe must have moved on, found another emissary or oracle.

Not only the words are gone. The more primal, wordless passions, the pathos and exultations of life, are muted into nonexistence. For months now, I have been walking around on the verge of weeping, with tears in my eyes that obstinately refuse to fall. I think that if I could weep, something might shift, maybe for the better, maybe not, but at least there would be motion.

I don’t understand where those tears are coming from, why they are so firmly fixed behind my eyes. Maybe when my muse left, someone else’s tragedy mistakenly got into the void left in my eyes, and I, having picked up the narrative in the middle, cannot identify the nature of the misfortune, and thus, cannot weep for it. I have no reason to be sad now (unless I think of the countless broken bodies and broken lives that surrounded me and sometimes touched me over the last years). So I am not sad. Just numb.

The lack of hope – another entity that has left me: something in my head keeps whispering, maybe this is it…this is the best you will ever be. Sometimes I wish that the “maybe” would disappear. If I were to be sure, I could figure out how to arrange some kind of half-existence around what is left. But as long as there is still a memory of how I used to be (abstractly, anyway – I cannot channel how I felt when I was alive and ready to do anything and conquer the world, but I can picture my younger self smiling and full of energy, doing things, doing everything), there is that little last bit that keeps me waiting, as the song says,  busco un mejor momento. In some ways, this keeps me from playing the hand I have been dealt. I am always waiting for the next deal.

For my own record, since I do record this shit, I just saw a new shrink. It was horrific and humiliating, as usual, but no worse than most new shrink appointments. The decision was to raise the bupropion, give that two weeks, and if it isn’t enough, add valproate. I have a hard time seeing much logic in this; it seems to me that the last thing I need now is a drug that will slow me down or make me stupider. But I suppose I have nothing to lose (except my hair and my hormonal balance and my lack of diabetes and any potentially normal fetus I may someday conceive), so I’ll try. Mostly because I don’t want to be that patient on the very first meeting with a new shrink.

And things have undoubtedly improved ever since getting out of the miasma that was the previous shrink. I miss him, maybe, as a person, and on some level I think I like him more than this new one, but I cannot ignore the overwhelming experiential evidence that it was bad for me, and there were too many lapses in professionalism to ignore (see “refusing to release records”).

Sometimes, though, in these tenebrous hours, his words still haunt me: accusations he made, (mis)interpretations of things I did or said that nonetheless were hurtful. The insinuations from someone I trusted that something is so wrong with me that it is a miracle I function, and that I will never be “normal” without serious interventions, which apparently have not yet been invented.

For these reasons, even though it is all I think about almost every day, I am trying to avoid anything psychological or mental health related. When I am away from the whole paradigm, I’m just a flawed person, no more or less than anybody else. When I let them near me, I become an amalgam of pathologies and brokenness. Sometimes I wish I never had gone to any doctor. Then, I would have just been eccentric, or emotional, or melancholic, or even just plain crazy.

I have to remind myself that I don’t even believe in their system of belief, that people lived for thousands of years without shrinks, that 99% of the world’s population has never even heard of their concepts. I try to remember who I was before I ended up so entangled with this bullshit system. I was a person. I wasn’t perfect but I was alive and I did things and knew people and sometimes felt something.

Somehow, all of that has disappeared, and all I can think about are all of the words that have been used by the priests of this odd religion to judge my essential being. I do not believe in their religion, yet somehow, their damnation of my many sins, that they delineate in the clinical terminology of their liturgy (affective instability, noncompliance, Melancholia, Mania, narcissism, Cyparissusism, Axis I, II, III, x, y, z, the asymptote of mood-personality-behavior), haunts me.

I don’t know why I cannot break the hold this farcical cult and its practitioners have on me. I suppose it is my version of the person who doesn’t really believe in God anymore, yet somewhere deep down, is too frightened by the spectacle and rhetoric of the fundamentalist hellfire to actually get up and leave the pew.

And so…back to the title quotation. I feel that underneath the conspicous anodynia, there is a well of misery hiding. Hell, it keeps trying to creep out through my eyes. I can’t help suspecting that the underlying pain is for all that I have seen over the last few years and all the people I have lost. I would drain the well, cry profusely and feel deeply, if I only knew how to reach the stygian waters.

But it is too late. So many years of having wept not, I both created and became the adamantine stone.

Still alive, beyond comfort of man or spirit

Thank you to everyone who left me comments or emails or anything. All much appreciated. Sorry I haven’t written back.

I am, indeed, still alive. In fact, the longer days are making some things easier. But I don’t feel better, am not getting better, am just biding time, this version of bardo, laced with apathy and terror. I started Wellbutrin intermittently again. The shrink has pretty much given up on me – tells me to just prescribe for myself and take whatever I want, because that’s what I’m going to do anyway. Not true, but it is very difficult to argue with a shrink.

Except when it isn’t, like the last time I was there, and ended up yelling at him for an hour straight. I feel bad, couldn’t have been very pleasant, but still, throwing psychodynamic interpretation shit at someone in my condition…well, seems like that’s asking for yelling. “Why are you so angry?”

Well, I guess I’m still angry about the borderline comment.

I wish my shrink weren’t so complicit with my self-punishment.

* * *

I woke up after a weekend of physical pain; unfortunately my GP is out until next week. I called the shrink  but then hung up on the answering machine.

Maybe, since I obviously am not going to work today, I should try writing something. I’ve thought of what I need to write, but haven’t been able to care enough, to drag up the energy, to do it. Which, in and of itself, is probably loaded with unconscious meaning that I also can’t quite seem to bring myself to care about.

* * *
Also, I have about 6 more weeks before finishing a certain stage in my training, after which I will have vacation. I have decided to try my hardest to avoid suicide until after that point, so that they can’t say that it was the pressure of the job or that I couldn’t take it or anything like that. Because, God knows, it isn’t that. It is me, all me.

I was so proud of her

I saw a patient the other night with a ton of psych meds in the ER for something unrelated. She was neither young nor old.

(Incidentally – definition of “a ton of psych meds” = more psych meds than me.)

And she was totally normal. If I hadn’t read the list of meds, I never would have known by how she looked, how she presented her pain, how she talked or reacted in conversation, how she was dressed, how she handled the interactions with everyone. No anger, no speech impairment, not slow through a drug haze, not hostile, not overly passive. Nice. Normal. I never would have known.

I always worry that psych patients are always so obvious to doctors after a few minutes, even if they function well or are only mildly ill, that I must be too, that it must be obvious to anyone who treats me. But she wasn’t. She gave me hope. And I was so proud of her.

But of course, I couldn’t say anything.

I did not see this coming

The latest in my escapades – no essays or deep thoughts or medical stuff here, just my personal update.

The anxious racing episode, naturally, crashed into a depression that hit hard and fast. Or maybe not so fast, but I didn’t feel it until it was out of control.

I think I am more and more becoming a burden. I haven’t had many normal conversations with any of my friends lately, it all revolves around my condition. I feel like a burden, and though they’d never say it, we are all doctors in training and under so much pressure that we are very limited in how much we can give to each other. It’s sad, but it is how things are. I also just sort of want everyone to go away and leave me alone, so they won’t see all this, and I can return to my life after I’m better without having done too much damage.

It is very hard for me to accept help, and I just want my partner and everyone else, well, I want them to help me and care for me, but I don’t want them to see me like this.

Since the depression got worse and worse, I went to my GP, who is very sympathetic to these kinds of problems, having had a son commit suicide, so he treats people with mental illness like people, not diseases. Actually, I didn’t want to go, but the psychiatrist wouldn’t treat me further unless I did because he wanted to be sure I wasn’t physically ill. I had attributed a lot of the physical symptoms to medication side effects and the depression effects.

I went to the GP and told him to just sign off, send some basic blood tests etc, and to give the shrink a green light to continue treating me. I told him I was not alright, but I couldn’t tell him about the suicidal thoughts. He knows about the depression, not sure how much about the whole bipolar story. He said I looked bad, and asked if I had ever been this bad before – I had, twice.

He started to do a brief physical exam, like, put a stethoscope on me while I was just sitting in the chair, but once he heard my heart, he told me to get up on the table, and did a full exam. He started yelling at me (well, not “yelling at me” but he got surprised and upset) that I was in horrible physical condition – apparently malnourished and dehydrated almost to the point of shock – racing pulse, minimal blood pressure, gray, the whole textbook version.

I had been feeling dizzy and horrible, but thought it was some central effect of some drug so I didn’t really pay attention. I was surprised because I’d been working as usual. I knew I hadn’t been eating because the depression sort of took away my appetite and one of the medications or another was making me either unable to eat or throw up often. But I didn’t think it was so much. I had been trying to eat a lot of calories in whatever I did eat – adding butter and honey and always juice with lots of sugar. It’s my “depression diet” because I know that sometimes I lose a lot of weight fast when I get like this, so I try to pack as many calories as possible into what I do eat. I guess I didn’t start early enough this time.

He called the psychiatrist from the office right then and there. This felt really bad, like I was this wayward child who needed to be taken care of – all of the sudden I was the ward of these two doctors, playing ping-pong about what to “do with me.” I only heard the GP’s side of the conversation, but he said at the end, “Look, I really think we’re getting to the limits of what can be treated outpatient.” No idea if he was referring to mental or physical state.

He sort of vaguely asked me about suicide, asked if I could or would talk to the psychiatrist about that. I said, “Probably not.” But it got the idea in my mind that maybe I should say something.

I walked out of his office and I remember sitting down at a bus stop just to rest and catch my breath for a few minutes before going to the car. It was freezing. But I was so tired, two hours passed while I sat there, watching people and buses come and go, waiting for the energy to get up and leave.

I did the blood test and the H. pylori test, and then went to meet a close friend (also a doctor), and told him how scary facing hospitalization was (for either the medical or mental stuff, I wasn’t even sure which anymore). He told me, “You look terrible. I’m a friend, not your doctor, so I’m not going to tell you what to do, but maybe you should go to the fucking hospital.”

The next day, I went to the shrink and confessed the suicide stuff, even though it was hard. It seemed like the responsible thing to do. I think I was actually looking a little less depressed by then because going to his office makes me so nervous that it gives me a little energy. He basically didn’t react. Nothing. I asked what to do. Nothing. I felt ridiculous, like some drama queen. He didn’t ask any of the suicide questions that even I know to ask (Do you have a method? Plans? What do you think will happen if you do? What stops you?).

Finally I asked, “Do you think this is some sort of manipulative thing, just to get attention, or something?”

His answer was, “It would only be manipulative if you were doing it consciously.” (I guess that qualifies as a Shrink’s Line of the Day.)

Then he said he wanted to give me Zyprexa “as it recently got approval as a mood stabilizer.” He sounded like a fucking Lilly commercial. I absolutely refused. Then he got angry at me. “You just can’t work with you! You say you want help, but then you refuse the help anyone offers!”

I asked him if he would take a pill of that. He said that that wasn’t a fair question. I said I ask myself that every time I prescribe something for someone (true). At the same time, he told me to stop the antidepressant that he started a week ago – just as I had started to get over the nausea from it, way before anyone has any idea as to if it will work or not.

As usual, I left there feeling worse than when I went in. Maybe he was right, who knows? Maybe not reacting will discourage me from threatening suicide again. He’s a nice guy. He did call today to suggest maybe somehow finding some derm specialist who can solve the side effect problem of the old drug (or possibly that was the subtext for calling to make sure that he didn’t kill me after all), that he had searched around the area and there was some guy a few towns away who specializes in drug reactions in the skin.

I said I was sorry for being such a horrible patient.

The next morning I went back to the GP for the test results and because he had said he wanted to see me again the next day. To make sure I was still alive, I guess. I told him what happened. I asked him if he thought I was being unreasonable to refuse the Zyprexa. He did the screening for psychosis (of which I have never had any symptoms). Then he said that Zyprexa seemed a little excessive (“an atomic bomb drug”), but that he didn’t know why a psychiatrist would suggest that or what psychiatrists consider.

You see so many psych patients who come in with lists of maybe 5 or 7 psych meds, from all different categories, and they look horrible, like zombies, and you have to think that whatever their illness, it can’t be as bad as that, and that there is no rhyme or reason to treatment, they just keep throwing more drugs at them, one on top of the other. That poor girl I wrote about was on something like two antidepressants, and old and a new antipsychotic, a benzo, valproate, and a sleep aid. No wonder she could hardly speak.

I felt like I was slowly turning into that. I was on a lot of peripheral shit at the time. The psychiatrists, including mine, mean well, but it’s such a strange field, no one knows anything, and they just keep throwing more and more drugs on people until they are just shells. I feel bad, so he gives me a med, and I still feel bad, so he gives me another – it’s all well-intentioned, trying to relieve my misery. But I got the feeling that that was what was happening to me – I was being made sicker.

So a few days before, I had also stopped taking all kinds of benzos and sedatives and phenergan and shit that the shrink had put me on, and only left the antidepressants, so I think I had a little more affect when I walked in to the GP, looked a little better, even if I didn’t feel better. I wasn’t like the walking dead.

The clinic was very busy so I didn’t want to take up a lot of his time. But it took me a minute or two while I asked him to wait so I could get up the courage to tell him that I had been checking my life insurances, making sure everything was in order. I didn’t tell him the rest. But he took me seriously, told me to go home, go to sleep, and come back in the morning again.

I was supposed to go with my partner to his parents’ for a few days, but when he got home from work it was late, and I had showered for hours and gotten minimally dressed to leave. But I was so weak and lying in bed, thirsty, sort of hungry. I couldn’t move (as had happened most of the week, lying down with no willpower to physically move my muscles). I just couldn’t get up and pack a bag and get in the car. The wind was howling outside, and the bed was warm and soft, and I was so tired, and thought of the uncomfortable bed at his parents’, and their yapping dog and the noise there…when I finally felt sleepy and warm and safe at home. I just told him to leave me a glass of water and go without me.

The prospect of a silent weekend alone was so tempting. I slept. Woke at 3 AM again, but not as restless as usual. Just relaxed in bed and listened to the wind until I fell asleep again at dawn. I got up in the morning at 9. I wanted to go back to sleep, but I figured that since the GP had been so decent, the least I could do was show up. (Friday is a half day for him at that clinic.) So I went in there, and sat down to wait, and started to feel faint so I went and bought some juice. I didn’t want to pass out and make a scene, or worse, be sent to the emergency room of my own hospital.

I told him that I thought all the drugs had really knocked me down and out, taken away the last bit of energy I had to cope with anything, including the depression, that they were slowly working their way out of my system. I kept taking the antidepressants but stopped all the heavy shit. And suddenly I could move again.

He asked me about my plans for the weekend, and I told him honestly…that I just really wanted to be alone at home. He said I deserved some rest. I was glad he didn’t try to insist I be around someone, that my partner be home or that I go with him. I thanked him and apologized for making such a mess and scaring him, and he hugged me and told me to come back sometime next week.

Then I went across the street and bought a newspaper and some bread and light food and went home and, for once, instead of dropping it all on the floor to deal with later, put the things away. I took out the garbage and minimally cleaned the floor. I drank and ate a little bit, then went back to sleep until the afternoon. Then I moved to the sofa and watched bad 80s movies. The quiet day, no one at home but me, the big bed all to myself…the sleep, for God’s sake. It was all so sweet.

I hate to say I’m getting better because every time I say that something horrible happens, but I wish this quiet could never end. I am just going to try to enjoy the rest of the evening, watch bad sitcoms. Try to sleep off the rest of these drugs. Not to worry about all the things that got me to this point or when I will go down again. Not to fantasize about suicide. To eat long enough before taking the meds that I will gain some calories from it. To drink. To try to orally fix the electrolyte mess that came back in the bloodwork.

* * *

I’m not sure if I learned anything from all of this or what the point of writing it down was. No profound insights. I didn’t suddenly find purpose in life, and I don’t know how long I will remain ok. I have to go back to the race shortly and I am terrified and still exhausted. It’s not a big happy ending. I don’t “know that I have more of a safety net than I thought” or that “people really care about me” (they do, but I already knew that and it doesn’t really matter when I’m in that place). And it seems like I have made a real mess of my body that will need some straightening out. I guess that there are probably some readers who read for the personal stuff, the same kind of stories as they go through. So that is why I am trying to be honest here for you.

I may go back and remove or edit this. It feels very raw and exposed. But for now, this is my story.

Here we go again

New appointment.

New level of truth telling by me.

New drug.

One (low) dose of fluvoxamine down.

Hours later: paralytic sleep, the kind where you know you are asleep but can’t move and can’t wake up.

Woken up by nausea. At the same time, phone call from work.

Vomit for 15 minutes, not very successfully. Do not feel better. (It’s central nausea, of course not.) Wonder vaguely how the eating disordered do it.

God, will this ever stop? I just don’t know how much longer I can do it.

Don’t let me slip away

I want to write a post about a self-harm patient I saw last night. (Seriously – I guess the message for what I should be doing with my life is clear, medical treatment for crazies. I went maybe 9 months without seeing any psych patients and then this stretch of them just when I’m ready to quit medicine…) Especially since the topic of scars and regret has been going around on a few blogs lately (for example, here and here). I think as far as damage goes, it was a fairly severe case, though, as I said, I haven’t seen many.

My point is – if anyone wants to hear about that, remind me, sit on my ass to do it, because so much material gets lost by my laziness and losing interest or having moved on to the next thing and forgotten the incident that I wanted to write about in the first place. I write only a fraction of what I want to, and if I don’t write, I forget.

But I need to get some sleep before the all-nighter sets me off; I think this bupropion seems to be pushing me toward the manic side (that’s a good thing for me) – it’s ok as long as I am super careful about light and sleep and caffeine and exercise, but last night I worked until 2 AM or so, and then we split to sleep, and I couldn’t – because I was full of racing thoughts that jumped from one topic to another. Not worries or anything like that – the real true racing thoughts. And then the panic of realizing what that meant. I was in the stupid on-call room bouncing off the walls. Usually you PRAY for your phone not to ring at night. I think my most sincere prayers, considering I’m pretty much an atheist, have been those ones.

But last night, they called me at 3 AM and I was glad for something to do, another patient to see instead of lying there crawling out of my skin. I think I joked with them a lot more than I have been doing lately. In the morning, right before going home, I actually made a cup of coffee, because even though I was all over the place, I wanted to keep feeling good.

And now I came home, and instead of going straight to shower and bed, I made breakfast, and wanted to come see if I got comments, and now I’m writing this! And I could easily keep going all day. That’s exactly how my last manic episode started – a long night and then I should have gone to bed, but at 5 AM the sunlight was so tempting,  and I spent the day shopping on foot in the city, meaning I was most of the day in that sun. And boom.

Which means it is time for some heavy benzos. I got the shrink to agree to leave the Wellbutrin and no mood stabilizer if I’d take zolpidem or something similar when I start to not sleep. So I guess I better.

I went and pulled a lot more of the “cyclothymia” references at the medical library last night. Some were in the actual paper stacks, they were so old. I love going up there to the fourth floor where there are medical journals from the 1930s and back, in all kinds of languages. The material is interesting; I read some of it while I was bouncing around and not sleeping. If anyone wants, let me know – most of the files are PDFs. All kinds of funny little tips in there, as in, “They are the patients who like both uppers and downers.” Meaning, purely depressed patients like stimulant drugs, anxious patients like relaxants – benzos and so on. Cyclothymes are the few who enjoy both. Actually, you can tell a lot about a person’s psychiatric makeup by their favorite drug.

They are the ones most likely to refuse mood stabilizers because it flattens them (because their personality is greatly shaped by the mood states, that is the way they know themselves and not having that will make them feel weird).

Or, from way back, something like, “the job of the psychiatrist is not to try to change the person’s temperament, which cannot be done as it is almost certainly a biological substrate, but rather to be supportive through the numerous crises in which the cyclothyme will inevitably become entangled.” I seriously thought of copying that and passing it on to my psychiatrist. I think there was something in there about medications also not being great because we quit because of feeling flat; though when I feel good and not flat (which means that I am fairly unstable, with bad times too, just with also good times), I am incredibly med-compliant.

I answered some comments on the last post as well. I notice that the comments are getting longer, more philosophical.

So write me and tell me to write the damn post! (Oh no, is this the “uninhibited people-seeking” phase? Does my writing sound manic?)