Yet another Shrink’s Line of the Day

Yesterday I decide that I feel bad about quitting the shrink all abruptly and in a rage. That I didn’t want to end like that, if just out of politeness. I really wanted to call and leave a message apologizing, and wishing him a happy holiday. I said that I was going to be the bigger man here, be the one to let my ego come down off the high horse first. Because, true, he shouldn’t have gotten sucked into the whole yelling and power struggle, but I participated too. I felt bad. I decided that, for the sake of my own dignity, that no matter what he said or did, that I wasn’t going to get into another knock-down-drag-out. I was going to be mature and in control, like my first therapist taught me.

Unfortunately, he answered the phone, despite my best attempts at timing to get voicemail.

“Hi, this is Sara. I just wanted to say that I’m sorry for losing my temper, and I didn’t want to end on that note. So…I’m sorry for anything I said or did that was inappropriate – ”

At this point he cut me off and said ominously, “Well, I’m sorry too that you’ve chosen to be like this and end things this way.”

My blood pressure immediately rose and all of a sudden I was almost ready for a fight again. I mean, even if I and my personality flaws are 90% at fault, there was at least some unprofessionalism on his part.

I took a deep, deep breath, and said, “Let’s not go into this again. I really just wanted to apologize for yelling, and wish you a happy holiday.”

He could hardly control his anger and snapped back at me, “Happy Holiday!” and hung up.

* * *

I promise, soon to get to the post on recurrent/long-standing mental illness and what the Buddha has to teach us. You know, something that might be of use to someone.

But since this is my journal, I can use it to think in writing. This incident raised so many questions for me.

Am I so crazy that I am imagining the anger/stubbornness/power struggles coming from him? Is that projection or some other psychological bullshit I am doing because I’m really as fucked up as he says?

Is there a legitimate therapeutic reason ever for being obscure or concealing the therapeutic mechanism? Is it ever right to say to a patient: I don’t think we can discuss your condition, how we are going to go about treating it? Is it ever ok to refuse to discuss the kind of therapy you do? Is it ok to say, “You just have to trust me” – and not at a given moment, but as a guiding policy? Especially when the patient is going through considerable distress as a result of the treatment? I mean, if I give a patient steroids for a serious disease, and they complain of side effects, I feel obligated to explain why I think that the benefit of the drug outweighs the side effects, what it is doing to them. Is psychiatry really so different?

Is it ever ok to refuse a patient their record, especially while refusing to give a reason? (Thanks to Jay for some perspective on this one.)

Is honesty on the part of the therapist always an important part of therapy? I mean, to me, it seems like that’s exactly what I’m paying for – someone else’s honest and trained opinion. But maybe I am understanding wrong – maybe I am supposed to just let him do whatever it is he is doing?

Is there a rule that therapists should never apologize? I mean, this whole thing would have been avoided (in retrospect), if he could have just said something like, “I’m sorry you feel hurt.” I wouldn’t even expect an apology for the content of what he said or anything – just some sort of acknowledgment that I was upset. Is there a rule in therapy that it undermines authority/transference/focus on the patient to apologize? I mean, my natural instinct in a similar situation with a patient – no matter how nuts they are – is always to say something like, “I’m sorry you’re so upset.” And when I’ve lost my temper or gotten annoyed with a patient, I always apologize – but maybe out of my own sense of guilt and remorse rather than concern for them?

The reaction I got was, “Why are you upset? There’s no reason for this to be upsetting to you. Why should this (being called both narcissistic and borderline in two sentences, one after the other) be a cause for concern?” This seemed so invalidating after I had said it was worrying to me to think that that might be the problem and asked what the treatment would be, what to do about it. I think I would have been ok if he had said something like, “Yeah, it’s hard to hear.” But a total failure to understand why I was upset – and then to tell me to “not be upset” was incredibly invalidating. It’s ok to tell a patient, I think, that their feelings are colored by their past experience or knowledge, that maybe they are taking offense or being hurt excessively – that, after all, might be part of what brings them to therapy. But to flat-out say that someone has “no right/reason to be upset” seems sort of anti-therapeutic to me – I mean, isn’t part of the idea of therapy recognizing and acknowledging feelings (even if one wishes to change them)?

Is any problem always the patient’s pathology?

And most importantly: Why do I keep seeking validation and understanding in a place where I so obviously am not going to get it? Why am I seemingly endlessly attracted to going back to someone who repeatedly hurts me, hoping for a different outcome the next time? What buttons is he pushing in me, or what screwed up need do I have that I keep running right back in for another round?

* * *

I’d like anyone, but especially therapists working in various schools, to respond to any question that catches your eye.

Anyway, if anything, that phone conversation should have cemented my position. From time to time, the situation catches me and I feel kind of bad. Not abandoned or whatever – I mean, I know if I’d just give in and stroke his ego a little, I’d be welcomed back and “forgiven.” It’s not like he’s kicking me out. I am, as he said, “choosing to end this way.” I think the choice is being made rationally, for sound reasons. I mean, I have to trust my own intuition and logic – it’s the only source I have. The real question is why I’ve been ignoring the signs for so long.

But still, I think it’s ok to feel a little sad. After all, even if he never did offer me much in the way of comfort, even if I’ve gone downhill under his care and felt worse for it…it still is, as Tony White would put it, an attachment, even if not the healthiest one in the world. I did like the guy as a person, if not as a therapist. And we’ve known each other a long time. And he did try to help me. Maybe I’m just unhelpable or unreasonable. So I think it’s ok to feel kind of bad, knowing that in the long run I’ll be better off. And I think I really do need to examine why, after so long and so much of my gut and brain telling me otherwise, I kept being pulled back.

Is a big part of it hope and regression? That he promised that, as deeply flawed as I am, that there was hope of a “cure” if I’d just keep coming and talking to him? (A lot of my frustration that brought up the conflict was that this therapy seemed to be going nowhere – that it was just like chitchat…with no change in anything.)

* * *

About the comment on the last post about the colors and design of the blog being dark and depressing, well, true. But I rarely see them anyway – I just see the compose window and get the comments by email. I almost never look at the finished blog, so I forget the dark colors and photograph. I feel sort of like I do want to leave it, just because this is the place I can let the darkness out, my place to be the goth teenager I secretly always wanted to be. My other blog, the one about my real life and not my mental patient life looks nothing like this at all. Though it is a good point. I do take a lot of these kind of suggestions in real life – exposing myself to sun, to sunny people, exercising, keeping the Dali posters off my walls in favor of something warmer – definitely a good point.

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Enough

I finally wrote what I thought was a reasonable letter to the shrink, since he never seemed to hear what I said…about how I can’t live in the dark about what is wrong with me or how to fix it, that I was deeply hurt and concerned about the borderline thing, etc. I hoped that we could work something out.

But today, we met. True, I knew I was in a bad mood going in. But on the other hand, he claimed I had nothing to be upset about, accused me of splitting between him and the GP (I knew from the minute they started “coordinating care” that sooner or later I would be accused of this and tried to be so careful not to say anything negative about either of them), said he couldn’t understand why I would be upset, that he was so sure I’m just trying to push away. It felt like always – I say and mean one thing, and he sees it through his filter. Refused to tell me why he thought I was borderline (and then later, when I was angry, said, “See – that’s classic borderline. You’re upset, so you’re trying to make me upset.”), what he thought my problems were, or how we planned to work on them together. (“Part of your problem is needing to just trust me.”) In short, it was the classic psychoanalytic bullshit – the shrink is always right and the patient is always crazy.

To top it off, I requested my medical records and was refused.

The whole scene was incredibly upsetting – to be so totally invalidated. But I had spelled out that I just am not interested in paternalistic care, where my problems and how they will be treated are hidden from me. That if this is the care he gives, I’m not interested…not interested in his diagnosis and not interested in buying a treatment that can’t even be explained to me. That I need collaboration, I want to change, but need the direction on how.

No good. “I can’t understand why you are so upset.”

I left, finally. It was sad, and it was scary. I’m now without a safety net and badly medicated, though I did meet a hippie clinical psychologist I sort of liked (woman).

I drove home and cried a little, felt like throwing up. It was so humiliating, invalidating. But – I also drew my lines in the sand. I can’t say I was totally calm; in fact, I was angry. But I spent months examining myself closely to see if what he said could be true, if there was justification in my anger. I decided there was, and that I needed some acknowledgment of that. I really didn’t expect not to get it at all. But I didn’t.

And that’s just not ok with me. No matter how sick I am, how bad I feel, how much I need help…I don’t need it that bad, bad enough to believe that I am so crazy that I am totally out of touch with reality.

So, through my tears on the way home, I reminded myself that I can save myself, that maybe only I can save myself, that I’ve done it before, and that I can do it again. That I’m somehow going to be ok. That I am a decent person, despite how broken I may or may not be.

I might go re-read The Color Purple. I think that is the message that I need to hear – remember Celie? Raped as a child, beaten, cast-away, unloved by anyone, half-literate…she knew somehow that she was a human being of intrinsic worth, one of God’s creations, one of the things that is included in the phrase “God love everything you love–and a mess of stuff you don’t.” That even if she was poor and ugly and a woman…the universe had created her with love. That God loved her, even if nothing and no one else did. That she existed, just as lovely as a wildflower.

I may suck at being happy. At being patient. At controlling my temper. I even may suck at loving the people I love. But I can do some things – I can comfort people and I, on a good day, can write words that mean something, that capture something real that happens to people. I can forgive. On a good day, I can be grateful, and on a great day I can pray, or at least I used to be able to. I can be part of the universe sometimes, and of the human race when I am not sick. I can overcome my fears. I can see the color purple. I can survive the dark night. I am a living, breathing part of the universe, and sometimes, that is enough.

I just need to remember that, to remind myself that during the moments when it seems like everyone is trying to tell me to the contrary.

  • * *

Note to self for next post – remember to post the thoughts about chronic depression, the idea of depression as an addiction, why some people can’t seem to give it up, and the Buddha.

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.

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.

Today something happened to me that never happened before.

I got reprimanded at work.

I apologize for the quality of this post ahead…I’m too tired and my brain is too fried to write well. Here’s what happened.

The last few weeks went surprisingly smoothly, the anger was under control, I was performing ok, and things seemed to be moving along reasonably considering being off all meds. My mental well-being surprised even me.

I think if not for two things, I would have been ok.

One was menstruation, which always fucks me up, and the other was another marathon of on-call nights and sleep deprivation.

It started last Wednesday around 1 AM, I started to lose patience, a hand laceration came in to the ER. I didn’t feel comfortable closing it, so I wanted the plastic surgeon or ortho on call to do it. They refused…and I started to blow. I was exhausted and overwhelmed. I did not want to cause permanent nerve damage to anyone’s hand. After being so proud at how I’d held together so well, I lost it again, had a hissy fit of misery about how I hate my job. Mature, I know. I wish I could take it back. But I just snapped.

(I also ended up suturing the hand. I’m sure that after my vocal refusal and claimed lack of know-how, the patient was thrilled to receive me as his doctor.)

I was so tired, and on top of everything, the attending was jerking me around, making me see every patient (while she is paid ten times what I am paid to be there, and it is part of her job to see patients, she isn’t there as a preceptor or consultant, she’s the main doctor on call) – actually running over me about every decision I made, then going and re-seeing every patient I saw. I couldn’t figure out why she was riding me so hard. I wondered if I had recently made a mistake she had to cop to or something.

For example – a 22 year old healthy guy comes back from a long, exhausting trip with mild diarrhea as chief complaint, and, as it turns out, upper respiratory symptoms. (Why he was in the emergency room in the middle of the night, god only knows…) So I write a quick discharge: Diarrhea – Presumed Infectious/URTI. She goes in there, makes this huge deal about how it is URTI with diarrhea, tears up my whole discharge letter because I wrote it as a “diarrhea” letter, including suggesting giardia check & stool culture if it continues (he had camped and drank from streams). I got a huge lecture on how the diarrhea is part of his respiratory infection, how I went way too far…yet on a similar patient, I got also yelled at earlier for not writing a referral to a GI to rule out IBD if symptoms continue. She was just being nasty, and I didn’t know why. On one hand I got knocked for being too thorough, on the other for not being thorough enough.

This weekend I started to sink into the same old depression. I did some meditating and other things, which helped (didn’t run, though) but it hit hard this morning with a busy ER. She kept doing the same shit. Asked me to present at the level of a med student, checked everything I did. Also, though there were three of us, she sent me all the patients, including orthopedics and urology ones, who are supposed to be covered during the day by ortho and uro. She made me see them just for the sake of making me do it. Then she would return their file to the ortho/uro stacks, meaning that they would be seen by ortho and uro, that my work would be useless.

I admit, I was doing a shitty job. I didn’t miss anything big, but my brain is so slow, I just can’t think quickly like you have to in the ER, didn’t delve into anything that wouldn’t have a direct effect on treatment plan. Presented sloppily – while in my head I had a clear picture, I was scattershot about presenting. I felt so overwhelmed.

I almost got to tears, even while dealing with patients I was trying hard not to tear up; I was already teary from the damn depression. I slipped out at noon or so and called the shrink, told him I wasn’t doing very well, asked what to do. He told me to take some benzo, and I said I didn’t need anything that would slow me down even more. I asked if I should start the bupropion again or what, and he sort of got impatient.

“You’re a big girl, you’re a doctor, you do what you want, you don’t need me to start it again. I can’t deal with this on the phone.” I really am not sure where the hostility came from, except I’m getting it on so many fronts that I know that I must be provoking it.

I just wish he could have been nicer. He’s sick of me too.

I also thought: Now I’m the kind of patient that they don’t even try to limit the benzos for anymore. Take as many as you want, just shut the fuck up.

Then I went in and one of the nice nurses who is my age saw I was falling apart and gave me a hug, said it’s a hard place to work, that that attending can be a bitch to work with, everyone knows (I actually get along with her usually, and I like her). Usual girlfriendy type stuff. I was immensely grateful.

Well, the doc saw this and dragged me off into a corner (in front of other people), and started in about how she’s torturing me for a reason, that I’m lazy and just because I’m smart that doesn’t mean I can be lazy and have such a bad attitude and do a shitty job and the whole reason she’s treating me like that is that I brought it all on myself. How everyone has days they don’t feel like working and they don’t get like me.

This went on for about five minutes. In front of multiple docs. Pointing out many of my failings, personal and professional, number one among them being my laziness.

Ironically, she also said, “I just don’t get it – sometimes you have these periods when you’re so ON, do everything beautifully, you’re unstoppable. And then sometimes you just don’t care and everything you do is shit.” My heart stopped, for one heartbeat I thought she was going to accuse me, then and there, in front of everyone, of being manic-depressive. But she didn’t. She just went on shitting on me.

And get this: I didn’t even care, really. I think that’s a pretty good sign of how depressed I am. Usually something like that would send me into a shame spiral. Now, I’m too far gone to get upset. It’s not like I need any more people telling me how wonderful I used to be, how shitty I am now. I’m living it.

As it went, I just mouthed off back, agreed in that sarcastic way I always did as a kid when I got in trouble, the one that makes them just want to pound you more.

I think I thought that it was better to let them think it was laziness and bad attitude than crazy.

* * *

On the way home, I stopped and bought a sweater for my partner. For some reason, this almost made me cry too. I just wanted to do something nice for someone. Show a little love, which is another thing that has been gone from me for a long time. I wanted to give him so much more, and somehow this crappy sweater just seemed so inadequate, a mute trying to recite poetry. A symbol of the broken shards of what I wanted to be able to give. I want him to be happy. I want him to be warm. I want him to be loved. But I can’t give him any of those things. I can’t give anything to anyone anymore.

Maybe I just cried because I sort of wondered if it was going to be the last thing I ever gave him, and was sorry it was so crappy.

* * *

I then drove to my family doctor, who has office hours this evening. I knew that without an appointment I’d wait, and that was all right. Where was I going, anyway? The shrink was obviously not going to be of any help. I can’t really bring this down on any of my friends. They are under as much stress as I am. I don’t talk to my partner about these things, they aren’t the kinds of things that need to be in a relationship. I didn’t have anywhere else to go.

I brought my dark Soviet novel that I haven’t been able to concentrate on, sat down in the waiting room and tried to read with tears in my eyes. Some elderly woman sat down next to me and started chatting. She was tremendously nice, not annoying at all, but I really didn’t want to make small talk. Maybe she saw me and was trying to help, I don’t know. It was kind of nice finally being somewhere where they didn’t know I am a doctor…to have waiting-room chit-chat with someone on the outside. Someone who, thankfully, didn’t bitch about how bad her doctor is, and who wasn’t a sucking pit of need.

One of the staff members I guess had a birthday and they had a little thing with cake and candles and then passed it around the waiting room. I couldn’t even lift my eyes, though it was a nice gesture and feel in the room. The glowing candles and the singing, a little surreal.

The doc saw me sitting there and called me in fast. I don’t know if that was professional courtesy or what. Of course, having come from work, I was dressed semi-decently and still had on makeup, combed hair. I didn’t look depressed. I don’t think I ever do.

I just told him the depression was back, go ahead, pick a drug, doesn’t really matter what. He tossed me a prescription for citalopram. I also took one for bupropion. I can choose later which to take. He asked what I had taken before. I rattled off a more or less complete list. He asked why I took lithium. I told him, “Because I get like that, sometimes, too.”

He asked what about the shrink, and I told him that I think he’s just frustrated, sort of given up. “You know how it is,” I said. “The patients who don’t get better, no matter what you do. After a while, you just don’t want to see them anymore.”

He said I should try valproate, but that wasn’t his job to deal with. I told him that mostly what was bothering me is that I’d had a year of bad function and was scared I’d never be normal again. He asked in a general way about “dark thoughts,” the kind of thing I could answer, “No more than usual,” without feeling like a liar. He didn’t ask directly about suicide.

* * *

I guess I’ll start taking one or the other. Maybe the bupropion, because it worked so fast. Probably should cancel the shrink later in the week – I can’t see how it could do anything but make me feel worse.

I’m scared. I’ve had plenty of internal disasters, but I’ve always been able to hold it together externally. I know that in this last year, I’ve ruined my reputation everywhere I’ve worked, that no one wants to work with me because of my attitude, which isn’t really attitude but rather me doing my best through a granite tsunami of depression and mood problems. Mood disorders. I am mood disordered. I am disordered.

* * *

From the outside, I can’t escape a feeling that these little things are all harbingers of doom. I can’t help thinking about all those statistics and sayings, the ones about x% of people visit their regular doctor in the four months or week before suicide; about the typical case study, the perfectionist who fucks up, some seemingly inconsequential narcissistic insult that somehow is the invisible riptide that pulls him under. If I were watching this like a movie, like a novel, I couldn’t avoid the heavy-handed cues, the foreshadowing: Things do not bode well for our heroine.

Does long-term, non-remitting mental illness need a psychiatrist?

Over at Vicarious Therapy, Aqua is really upset about an article by the Canadian Psychiatric Association. She says that it basically justifies dumping chronically mentally ill people out of the system.

I’m not sure I agree with her interpretation of the article, but I can see why she is offended. But I’m  not. I think they have a point. Maybe it’s just seeing things from the side of limited medical resources, how people with adjustment disorders and so-called mild crises can’t receive services. These are people who are easily “cured.” They would greatly benefit from a short time with a psychiatrist, whereas someone like me, well, all my time and effort has been a waste at best, and may have left me worse off than I started.

At some point, my shrink should just point out he isn’t helping/can’t help me and stop taking my money and time and giving me false hope.

I’ve been thinking a lot about that lately – that I need to quit going to him, but he insists that whatever voodoo he thinks he’s doing can help, so I keep going. At some point, it’s fraud. And it’s hard for me to give up, for obvious reasons –  who in my situation wouldn’t be a sucker for hope of a better condition, even a cure? But doesn’t he have some responsibility to just tell me what that article says? That I probably will never be well, probably will never be what I was with the ideal drug combo. Shouldn’t he be “emancipating” me at some point to learn to deal with this sub-par life?

It’s a huge issue in medicine – the public’s perception of what can be done (everything can be treated/cured, resuscitation on 95 year old grandpa is malpractice if he doesn’t live). But this time, I’m seeing it from the patient side. It is hard to accept that nothing further can be done, that I will probably never be alright again. But I thought we were moving away from the paternalistic view in which the doctor doesn’t tell the patient about the bad stuff, the bad prognosis, offering endless treatments to keep the patient hopeful and busy, when there’s really nothing that can be done.

And then, of course, in this case it’s complicated by the fact that shrinks get all wound up about failure too. As mentioned at the end of the article, not being able to fix me gets me tossed into “personality disorder,” which is a blame-the-patient stunt if I ever heard one. (The worst part: I almost believed it.)

So I do think the article has a point. (Though I highly disagree with the recommendation to send them back to their GP, as if family docs are a catchall system.) If a medical treatment can no longer help someone, doctors are obligated to stop providing it. It burdens the system, puts false hope into the patient, and is paternalistic. Why is psychiatry exempt?

On the other hand, I am starting to understand why people keep going to faith healers and alternative treatments for cancer. Sometimes they promise hope, when we no longer do. Is my continuation any different?

* * *

Here’s a Shrink’s Line of the Day in the same vein. Last time I was there, I brought up how one of the drugs, either the lithium or the Wellbutrin or the combination, was making me vomit incessantly. (Most likely a creeping-up lithium level, but I had no time to get it checked.)

The backstory: one of the completely unsuccessful new fancy drugs he put me on a few months ago caused, as a rare side effect (one that I did not know existed until it happened) massive hematomas on my whole body. I just wanted to quit the drug, since it wasn’t doing me any good anyway, but he insisted on sending me to a hematologist friend of his, who said she’d never seen anything like those bruises (the drug itself was too new for her to comment). So I ended up undergoing a massive clotting factor and platelet function workup (ristocetin, anyone?) which found nothing. Eventually I stopped the drug because it was useless, and one of those weird reaction reports was filed with the company. There were other cases on file.

At my last appointment, I mentioned the vomiting (I lost 2 kg in about 10 days). His line of the day: “Well, all these side effects, right out of the textbook, somewhere in your mind, you’re making an opening for your body to react that way, expressing your feelings toward the drugs.”

Isn’t that yet another phrase that is worth firing? Blame the patient 101. And I’d like to point out that I didn’t even know that the other could do bruising (neither did he, and the company only admitted it after it was reported). And I also pointed out to him that my great drug combo had worse side effects than any of these combined, but I never complained because at least I felt good.

I am scared that I will never be really ok again, back to where I don’t have to think about my mood every day, to being to where I can’t understand how I ever considered suicide, to where I’m not concerned with sleep and anger. But on the other hand, as more and more time goes by, maybe he should be transitioning to pushing me out and learning to live like this. I wouldn’t tell a new-onset diabetic that one day it would all go away; why should he be telling me the same?

My Answer to the Commenters

I started to put this in the comments and then just decided to post it as a regular post, because it was turning into one in length.

Thanks for writing, everyone. Thank you especially 5150 for reminding me that it will fade. I kept telling myself that during the worst of it…that it wouldn’t be forever like this.

I have zero benefits or anything. The one private disability insurance I bought probably wouldn’t cover this as a pre-existing condition and it only replaces about $700 a month of income anyway (a percent of what I am paid by the hospital and not the government – and the government pays most of my salary). Jjunior docs have no benefits at all – we are almost hourly wage employees – do not even have personnel benefits at the hospital that the cleaning staff has.

The option would be another job. I constantly remind myself that approximately 99.999999% of the jobs in the world are something other than “physician.” But it seems like such a shame, when I am so close to finishing training not to just suck it up and pull through.

On the other hand, when I find myself on the roof again and again, I keep telling myself, just walk away. You have a choice. You do not need to do this.

And the worst part of it is that it isn’t the practicing medicine that is killing me. It’s the bickering with the nurses who walk all over me, the paperwork, the phone hassles to get tests done. It’s not the essence of the job itself. Sometimes I even think that being decent to people and helping ease their way through something is what is keeping me going.

Another thing is that I quit taking the Wellbutrin and the lithium a few days ago and feel immensely better. One of them was doing something bad to me. I’m not sure which one…but I could feel it physically – shaking, throwing up, feeling drugged and surreal. You’d think that that was a creeping up lithium level, right? But it also came with a terrible agitation and that unreal feeling was never something I got from lithium. It felt like that first time I took the Wellbutrin and flipped out. Lithium, even at its worst, always chilled me out. I semi-wanted to call the shrink and ask what he thought but never managed to have a free moment to do that while it was a decent hour. And don’t even think about getting to a lab to have lithium levels done during business hours. I’ll probably slowly restart the lithium today.

The other thing I am slowly coming to accept are some limitations. While the idea of leave scares me, I realize that I just can’t keep up with my peers with the no sleep thing. They consider a day after call a day off. I can’t even move, and if I don’t sleep through until the next work day morning, I’m crazy. This saddens me. I used to be unstoppable, so ambitious, wanting to take care of everything, be the best at everything.

And I’m also coming to accept the idea that since my good cocktail is gone, I just may never feel totally well again. It’s been a year now, or almost a year…and nothing is any better than when I first started. That’s what sort of fucks up the idea of taking leave to fix the meds – the meds may never get fixed. I may never be what I was.

I think I could be okay with that if I could do a few things that are really important to me. First is to write – which I can’t really do in this state. Others are a creative habit that I can no longer do because my hands shake too badly, and flying, which I can’t do because I’m always on the edge of vomiting anyway. My three passions in life have been stripped away, which is hard. Maybe I just need to throw myself into medicine, which is something I can still do well, and find a real life in it, which is something I never have been able to do. Satisfaction, sometimes. Purpose, yes. Pleasure at using a skill for the good of others, yeah, I guess.

But passion…never.

Yes, I am a tremendous whiner, compared to so many people whose lives have been much more devastated than mine, I’m bitching about having a job as a physician. But still, a dream lost hurts, no matter how grand or small, and I dreamed of something so very different than this squalid sleepwalking broken-down life I am left with.

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