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?)

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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.

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.

In somnium veritas

I thought this blog was getting too self-centered, but it seems like people are likely to visit any blog that is regularly updated. So here’s a dream update. Why can’t I listen to my gut, my dreams? Especially when they tell me something I already know.

It’s the end of an appointment with the shitty shrink. I get up, head for the door as usual. As I get there, he stands next to me at his work table and I look over as I’m on the threshold, and see that he is doing something so unprofessional, so inappropriate, some total violation of medical ethics, something illegal. I’m not sure what it is – maybe something I see written on something on the desk, but I know that it means that unequivocally there is no way I’m coming back. And I’m glad. The decision has been made for me, that I have proof of what I suspected all along – that I should not be there.

So much pathology in this that I don’t even know where to start. One, if I know this, what the fuck keeps me from acting on it? Why does a situation have to get to full-on abuse before I say enough? This echoes so many situations in my life, such as my partner. How bad does our relationship have to be before I say “enough” if even now I know it isn’t right? Or being a doctor?

I also wanted to thank everyone who has commented. I am always happy to hear that someone else can relate, might have found a bit of comfort or sympathy or feeling like they aren’t the only one in the world to live through this shit. I guess the way to get more readers is to write regularly. I will try to be better. I had a mild hypomanic blip (let’s hope for that to continue) as I dropped the lithium dose after the accidents started again. Most of the writing inspiration during that will not be for writing here, I don’t think. But thank you nonetheless for reading and commenting. Believe me, I have been helped by this blog far more than I have given help. And I’ve learned a tremendous amount about psych medications…I suppose the internet is a good counter to the drug company propaganda. Maybe I should open a site: “Where to Go When Your Wonder Drug Isn’t.”

Off All Meds, Cymbalta Withdrawal, and Waiting for Disaster

The shrink took a vacation (oh, August, the shrink vacation month…could anything be more irritatingly stereotypical?), thus leaving me with the worst physical withdrawal I could imagine. Seriously, could heroin be worse than this? The lesson out of all of this: never, ever quit Cymbalta! For the past few days, I have been having complete autonomic failure. The idea is to go back on my good cocktail, sunburn be damned. Then maybe try lamotrigine. So my skin can all fall off, you know.

The first morning that the withdrawal started, I got the day off on the right foot by arising at my usual crack of dawn hour and promptly passing out. Due to this, I was two hours late to work, which resulted in my being yelled at for another hour and a half.

Follow that with random attacks of true vertigo (walking down halls of hospital – suddenly I’m totally off balance and everything spins), vomiting, shivering, diarrhea, and sweat flashes, and that is quitting Cymbalta in a nutshell. Every time it starts back up, I take a little bit, just so I can function. I have to open the capsules, use the little pellets inside. It is like cutting lines, but a lot less fun, and, I suspect, much more ridiculous.

But – I can sleep, god, sleep after weeks of no sleep, nightmares, and waking up sobbing and suicidal at 3 AM every single night. No more scrounging through Lear and Pale Fire for consolation. This is what the shrink called improvement. Because I was nice. Last time I was in his office, he kept going on about the nice pleasant conversation I was making. I was chatting about nothing because honestly, I was too depressed and suicidal and sick of myself and my misery to even carry on about it. I did what I always do – faked a happy face. But do I really need a shrink for that?

Although the drug did take a certain edge off. Last night I yelled at the partner for overwatering a plant. All of that kind of rage had disappeared. I suspect, though, that that was due to the massive amounts of Valium he had pumped into me to try to fix the sleep problem.

I also totally lost it on a patient the other day. True, the patient was particularly nasty, but on the other hand, was also terminal (I did not know this at the time). After this, I called the shrink (before he left) and told him I was not fit to practice, that he would need to write me some sick days. Mostly wanting to get off to his holiday, he said fine.

But I didn’t call in sick. Arbeit Macht Frei and all that. And I would feel damaged and broken forever and never forgive myself if I ever called in sick over mental illness, no matter how severe.

Everyone around keeps asking me what the hell is wrong, at work, that is. Today I finally made some vague allusions to health problems and let it go at that. It always makes me uncomfortable when people show a personal interest in me, are nice to me. Somehow, I feel better keeping things cold and bastardly.

Despite the horrible physical withdrawal, the suicidality has dropped way off, I can actually sleep, I am somewhat interested in medicine again, learning a bit as I go along seeing patients – opening books, asking colleagues. Today I ran, realizing that I lost almost all my physical conditioning in these last few months. I feel alive. Soon, I hope that feeling of coming back to life, of rising from the grave delighted and full of energy and thrilled to the core, flirtatious and funny and fun will be back.

I am also perversely glad that if I slip into mania, the shrink will not be around to witness it and insist on more drugs. It has been so long since I could write, want to fuck, feel alive at all…I don’t want to quite give that up, no matter what the cost. I need, from time to time, to remember who I am, what I want, to know where I am unhappy in my life.

I also realized, holy shit, it is almost September. I realized that this episode, the idea of changing meds, has been going on for almost 9 months. At first it was a month lost, then three – a season, a delayed start at my new job, and now I am 9 months down the road, having been through hell, sicker than I have been in five years, with no end in sight. This is terrifying. How much more of my life will I have to sacrifice to this cruel master? Soon, it will be a full year, another lost year. I do not want to be sick. I want to be me, thorny and obstinate and moody. I do not want to spend my life in a psychiatric-drug-induced haze. Even if it means I am a bitch. Is that so wrong?

And now that my old self, the one that can save herself, is back…well, now I’ll finally be ballsy enough to quit this stupid shrink. Which, of course, is a sign that I am not medicated well…

How the fuck did this get to be a blog only about therapy? That fucking blows. No more of this. I need my life back. I need my pen. I need my cunt. I need blood.

It’s all coming back to me now

It is so strange how you can be okay for a while, enjoy life, live normally, and then, just when you breathe, overnight it all comes back. You’re crazy again, hurt again, suicidal again.

I must admit, even though I went back to an old, previously successful drug routine, I haven’t really stabilized out. How do I know this? Because when I am really stable, I don’t think about my mood every day, every hour, every minute. When I fully recover from a mood episode, I am horrified at myself, the monster that took over my body for a while. I think back to my meticulous suicide plans and all of the details and it is as frightening to me as if I had planned a murder. And how I acted. The shame, so much shame. Worse than being drunk in front of everyone, but similar in tone.

I didn’t get that far this time. I still don’t feel the horror. I still don’t really want my life back.

I am doing well at my new job. I am one-upping people with much more clinical experience than I have, in fields that are their specialties, not mine. I have made obscure diagnoses before anyone else raised the possibility, and been right on things when every expert thinks I’m wrong. I am again the shiningflamingscorching star I was apparently meant to be. It all comes so naturally. Other people are knocking themselves out to do half as well as I do.

And the big secret: I don’t really want it. That’s how the universe gets you.

It is strange and ironic and sad that in the cutthroat arena so many people would kill to do what I do, for the sprezzatura with which I do it, to be me. And all of this, all of it, all that I can do and all that I did do and all that I do means nothing to me.

I am not yet 30 years old. I am relatively at the start of my career, one that apparently, despite anything I do, has the auspices of being a brilliant career.

And yet, last night, awake and pacing and storming at 4 AM, hating everyone and everything and impatient and restless and full of animal fury, I couldn’t help thinking that it isn’t good for someone to be like me. I mean, it’s good for the world and the patients and the hospital and whatever. But for the person, to do it all and see it all so young, to be unstoppable, without struggle, to be where nothing impresses me at all, to have everything so easy and nothing to look forward to or work toward…to be empty and bored already. I would trade it all for a little happiness. Not big happiness, just the ordinary happiness that ordinary people have. Picnics without rain. Seeing kids playing and not seeing the years of tragedy that await them.

A few rough days and nights, a heat wave, exhaustion, the mood swings again, and I am back to wishing I weren’t alive. Moreover, I’m so restless and so very fucking angry that I can’t help thinking about jumping off buildings, a giant fuck you to the universe, for giving me everything except the ability to live with it. And for some quiet. To know that I will never, ever, have to do anything I don’t want to do again.

When every moment of every hour of every day consists of something you don’t want to do, and everything you see in the possible next ten years is more of the same, the relief inherent in this idea is considerable.

I lost my temper today. The reason was, at least on the surface, justifiable.
More work for me due to someone else’s doing less work. Unfortunately, I ended up taking it out on the messenger. And having to do more work for all these women who are pregnant and men whose wives are pregnant. I am considering starting to tell everyone that I am pregnant. It seems to be an all-purpose, unquestionable excuse for anything. But I’d never really be pregnant because I couldn’t possibly bring a child into the world.

People always ask me why, seem to think this is strange. Don’t they see? I don’t even want to be alive. It’s sort of like when people admire me. (No, I don’t think they like me much, but a lot of them in medicine admire me.) I mean, they see some stuff and think they’d like to be like me. No one ever seems to notice that I don’t even want to be like me.

This is self-indulgent and rambling, which I guess is fair enough, considering it’s the internet. Time for a fucking med change, methinks.

But before I get myself drugged into mediocrity, one question: why the fuck can’t I just get a little euphoric mania for once?

Mixed states?

I can’t sit still and can’t find anything to do, having finished a million projects today and now I am filled with an insatiable appetite for anything physical. Sex, food, violence, motion. I forgot how strange a trip it is from starting medication to the phase where you are balanced again. Crossing all sorts of strange valleys, strange depressions and strange manias. The med has done enough to drag me out of depression but not enough to make anything feel right.

This leaves me pacing like a wild animal. All instinct, no intellect. Normally, in this state of activation, I’d write, but my cognition is still too slow to do anything like that successfully, my mind is still depressed. So instead, I pace, clench and unclench muscles, feel cagey like an animal. Eat apples again and again – something about their crunch is satisfying, raw, the just-right substrate for my fangs. I feel like prowling the streets, looking for sex or a fight. I feel like growling and hissing.

And, unpleasant as it is, at least when it is unsatisfied, I am not altogether sure I want this feeling to end. It feels like me at the core, stripped away to my most raw, untrapped by drugs, society, identity. While there is no place for this person now in my life, my location, I wouldn’t want her to disappear forever. I just wish I knew what to do with her, what she needed, what she is trying to say.

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