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Sunday, February 27, 2011

empty

Still can't sleep.

I find myself staring into the darkness next to my husband, feeling kind of numb. Instead I wish I were sad. I wish I were hysterically upset, sobbing, throwing things at the walls. Why would I want that? All these months I've spent trying to regain some kind of semblance of normalcy -- it doesn't make sense. Maybe I brought all this on myself. Maybe I have some kind of deep-rooted seed of self-sabotage.

Ten minutes later I'm rubbing my barely-awake husband's broad shoulders and crying, but I don't even know why. And then it's gone. Nothing. Back where I started. I want to turn the dial and stop being. Turn the radio off. No more static.

Can't sleep. Can't sleep.

I try to imagine being dead. Usually this is soothing and I can fall asleep, but this time it isn't. Now it's upsetting. I'm so confused. I feel like I'm floating away from the earth, alone in space. Profoundly alone. Just me, the stars, and the darkness.

Saturday, February 26, 2011

on sleep

Nearly every night I find myself in a vague state of dissatisfaction. Definitely not a crisis or anything near that, but always kind of in this place where I don't want to be awake but I don't want to go to bed. I'm tired but I can't fall asleep. I feel like I should be up doing something, because it's rare that I have much time to myself, but there isn't anything that I want to do.

I'm sort of lonely, but I don't want to be around anyone. I don't want anyone to touch me. I think somewhat longingly of my last bed in my last apartment in Oberlin. It was nice to have my own space; to be able to sleep diagonally across the mattress; to hog my pristine white covers; to not have someone next to me snoring or a toddler climbing in constantly during the middle of the night.

MiniMan has a lot of trouble falling asleep on his own. Most days I lie down with him before he takes a nap and when he goes to bed. It probably isn't a good parenting practice to do this, but it is so exhausting to walk him back to bed over, and over, and over again (sometimes for over an hour) that I've given up. Instead, I get into bed, hold him close, slow my breathing and close my eyes. I pretend to be asleep. It's probably as much of a comfort for me as it is for him.
Usually he falls asleep quickly, although sometimes just as I think he's begun to relax, I'll feel a tacky hand caress my face, then fingers on my brow line.

"Eyebrow," he says.

A finger gently presses against my closed eyelid: "Eye-yashes."

Then, a finger pries my eye open. "Shiny eyeball!"

I laugh.

Maybe I should just give up on sleep. Maybe I should adopt the toddler philosophy: it's more fun to stay up even if I get cranky. Somehow, I'm not really even sure about the fun part, though.

Friday, February 25, 2011

Is psychotherapy mental prostitution?

One day when I was on my way home after seeing my psychologist, I started pondering how bizarre the patient-therapist relationship is. After only talking for a few hours, I felt like this person understood and accepted me more than my family or my friends. The whole thing struck me as kind of strange. And so I began to wonder: is psychotherapy some form of social prostitution?

Think about it: you're paying for a relationship where the terms are at least somewhat defined; you know that you'll be the chief subject of attention (instead of giving out the attention); you get to connect intimately with this person almost immediately, but you don't have to worry about any social obligations when you're not in a session. The terms are pretty clear cut. You are the sole subject of focus. Maybe you're not getting a blow job, but the playing field sure isn't equal.

Oh, but, let's stop talking about me.

Taking the focus off of yourself apparently crosses some kind of professional barrier, but the therapist is expected to at least objectively care about you. It's a fundamentally unbalanced relationship: one person's livelihood combined with another's personal life.

I wonder why it is so acceptable to have this mind mistress or sorts, when it's clearly not to spend some money to obtain a little sexual healing. Isn't prostitution one form of taking care of yourself on one of the most basic levels, uncomplicated by commitment? If someone were to ask me my opinion, I'd probably be an advocate for the decriminalization of prostitution. After all, with legalization comes some level of regulation. Regular STI screenings, more tax money (instead of illicit income), a decreased amount of workplace violence and significantly more comfort reporting it. Legalized prostitution sounds way less sketchy and scary. I wonder why we choose to make it so scandalous and culturally unacceptable.

Sex and psychotherapy - they're both trying to fulfill some pretty basic desires. A therapist will listen and maybe put you on a trajectory to becoming a more emotionally satisfied human being. That kind of relationship seems as (if not more) intimate than a strictly sexual one. Weird.

Wednesday, February 23, 2011

the bake fest continues

I took MiniMan to the 'dinosaur museum' (paleontological museum) this morning. He was thrilled to see towering collections of bones; to sit at a station for kids and look for fossils; to play with and name the toy dinosaurs. After we left the museum, we drove into town and split a bagel for lunch. We had a nice time.

As we were driving home and he was starting to drift to sleep in his car seat, the sun was reflecting off the crusty snow. The edges of huge round hay bales were glowing. The snow was sparkling. I wanted to drive faster and faster, to accelerate until my car took off into the sky. I wanted to disintegrate into the air.

That's the thing about having a toddler in the back seat, though. Your car never really turns into a plane. At least not a real one.

I'm home now. MiniMan is sleeping. I should be cleaning the kitchen and bringing in wood, but instead I'm preheating the oven and waiting to slide in a second attempt at the perfect sunflower raisin bread.


The first one came out okay. It was crusty on the outside and moist on the inside. I was out of sunflower seeds so I used walnuts. They stained the inside dough a kind of brownish purple. This time I've added more whole wheat flour in hopes for a denser loaf, sunflower seeds instead of walnuts, and sultanas (golden raisins) instead of the more familiar deeply brown raisins. We'll see how it goes. There's something very transformative about bread...to take a slurry of ingredients that are so simple: flour, water, salt -- and turn them into fragrant, cracked golden mass.

Tuesday, February 22, 2011

another dreary post

It's not that late, but I'm tired. I don't want to go to bed. Every time I lie in bed my mind starts to drift to everything I've been trying not to think about all day: unpaid bills, dread about what will happen with work, apathy towards the future, skepticism that I will ever be able to function the way I used to, disgust with my body and my constant state of frumpiness, death, death, and more death. Sometimes I just lie quietly and cry. Other nights I hope that I'll have an aneurysm in my sleep and die. It's funny, sometimes the only thing that brings me comfort is imagining that I'm dead.

I want to be sedated. Even just being able to fall asleep, to reboot, would be a comfort, but it always seems like when I really want to, I just can't.

I've been entertaining the idea of trying Seroquel. Some of the side effects, though, like brain damage and death were kind of a deterrent. Then again, maybe it would be great. Maybe I could walk around in a bathrobe like a zombie all day.

I don't want to feel anything.

Monday, February 21, 2011

the rambling path continues

I haven't been blogging lately, or communicating with anyone really, because I am so much more content to ignore reality and draw pictures of cows with my toddler.

Last week I had a meeting with my boss and Mr. Slimy Schmoozer in human resources. I ended up agreeing to resign from my job.

Before all of this, I kept going to work. I had all this anxiety about it. I had to bake a cake (to bring to work) before every shift to convince myself to walk out the door. Despite the cakes, I usually only made it through the entire night about a third of the time without flipping out beyond the point of no return. The aftermath was worse. I felt so shitty for crying uncontrollably, for not being able to do this basic job, for not being able to pull myself together. It seemed to take a couple days just to rebuild my confidence to do it all over again.

So, I'm not working. I'm not totally divorced from the hospital. Part of all this talk with boss and Mr. S. Schmoozer was the offer to let me work in another department. Right now, any place that offers a little hermitage sounds good. Morgue? Yes. Histology? Yes. Sweeping the floors in the basement? Yes. Okay. I lied. Nothing sounds good. But I have to try to ignore my pessimism, right?

But, again, I'm not currently working (once again). Anything even remotely resembling plans for the future seems kind of bleak and just emphasizes what a loser I am, so instead, I continue to divert my attention with carbohydrates. The latest craze is bread. My current endeavor is to replicate this chewy, dense sunflower raisin bread that one of the local bakeries sells. I'm thinking that with all this free time, maybe I should try to grow my own sourdough starter, too. Then I can have a little fermenting gooey pet. It will be like having a second child (who is much pickier about what to eat). I will try to fall asleep tonight thinking of baby names for my sourdough starter. Suggestions are welcome.

Maybe I should just get a lobotomy and become a baker. Actually, there's a lot of food science behind baking, so perhaps the lobotomy isn't necessary.

All this bread has made life a little easier to tolerate. I mean, who can have a mental breakdown when the house is full of warm yeasty crustiness?

Wednesday, February 9, 2011

Am I a diagnosis?

I know some people who define themselves by their illness(es). I guess you can spin it either way: it's a tolerably miserable parasite to live with, or you've somehow triumphed over evil and now you want to shout it from the rooftops.

I don't think I want to do either.

As for that whole bipolar thing, I did end up talking to my doctor and I did end up talking to not one, but TWO psychologists (I was getting a little frustrated with that whole finding the right person process, so I decided to get a little polygamous and improve my odds). After talking to my GP, she seemed utterly convinced that bipolar disorder was a more accurate diagnosis.

I'm not really sure how I feel about this. I think that as someone who works in healthcare, I enjoy labeling things. I find comfort in grouping symptoms together. It was kind of a relief to have a diagnosis that to me, made my life suddenly make a little more sense. I was equally saddened, though. Old MD Girl mentioned in a comment that she thought I knew I was bipolar, but that I didn't bring it up because of the associated stigma. She's right. Depression isn't much of a big deal anymore, but telling someone I'm bipolar?

"Well, I used to think I was just sort of whimsical. Turns out I'm actually seriously nuts."

I dread the day that I encounter another physician (who is treating me) or am filling out some kind of college health form and have to list my medical history. I almost wonder if the stigma is actually worse in healthcare. In the ICU, it seems like the patients with a noted history of mental health issues are always the ones who are suspected of not being credible, of not being compliant, and that they may be trying to manipulate us. I'm not gathering this from any personal experiences I've had with these patients, I'm gathering it from my coworkers attitudes (my generally really kind, not terribly judgmental coworkers).

What's up with that?

Is it just a social norm? I hate to admit it, but I can't deny that I've been uncomfortable around patients who are admitted with psychiatric diagnoses, or that I've sometimes viewed them as somehow less human, as if they were a departing subspecies.

And now, is it reasonable for me to expect everyone to treat me the same way? I really haven't changed; all I've done is let someone slap a new label on me. I really worry that that label is going to follow me around, though. That even when there comes a day when I can come to terms with it and peel it off, there's still going to be all this residue; that even after I go after it with a razor blade and some goo gone, it's still going to be apparent that something was there.

Sunday, February 6, 2011

A visit with Death

The comments from "anonymous" on my previous post prompted me to reread some things that I had written during my first healthcare job, before I had a blog, where I worked as a caregiver in a nursing home. I've been rereading my blog, and realize I do sound a lot less compassionate now than I used to. I can't decide if I'm bothered by this. I really don't think that I lack empathy, and I definitely don't act or think cruelly of towards the patients I work with. I used to wear my heart on my sleeve, though, and that was not sustainable for me. If being extremely compassionate meant that I was too distraught to do my job (or to get completely burnt out in a matter of months), then it also wasn't something that was good for my residents. I think it is extremely important to offer someone whatever kindness you have, to always give a person the benefit of the doubt, but I don't think it's usually practical to experience a person's troubles on a deeply emotional level. It would be an excessively painful existence, I think, to fully immerse oneself in the pain, suffering, and death that inevitably we are exposed to.

Here is something I wrote not too long after starting that first job as a caregiver:

Dr. Schechter stood no taller than five feet, a likely contributor to her height being the pillow of white wispy hair formed into a bun on top of her head. Permanently misplaced dentures lent to her immediately endearing incisor-framed toothless grin. She seemed like the present-day manifestation of the old-fashioned tiny, cackling witch from Hansel and Gretel (the cackling probably due to her asthma).

I used to bring Dr. Schechter a cup of tea and sit on her bed where we would have looping and nebulous philosophical conversations. I left her always feeling that we had spoken about something profound, but being unsure about exactly what it was. A retired Viennese psychotherapist, she was one of the more interesting and magnetic residents, but her loneliness made me sometimes avoid putting away the laundry in her room or bringing up her lunch because I hated to leave her.

She used to walk into the hallway hunched over and confused, thinking that she was reliving her time as a refugee during the holocaust. I would gently take her arm and walk her back to her room, where she would sit on her bed rocking and moaning. I once asked her why she moaned all the time. She told me she liked to listen to it. I never knew Dr. Schechter as the person who she used to be, and maybe for that reason it is not difficult to accept her as she was.

She eventually became so confused and maybe desperate for interaction, that she would smear her excrement onto herself, the walls, and onto the furniture in her room. I would clean her up and comfort her for forty-five minutes or an hour, but it was never really enough; she was never really peaceful when she was by herself.

Aging seems terrifyingly lonely. Sometimes I wonder if it isn't so lucky to live into old age -- to see everyone you love die; to either lose your independence and watch your body decay while you still understand what's going on, or to have your mind deteriorate as you struggle to recognize your own children.

We knew she was dying. When I sat beside her bed on her last night, it seemed out of character to see that charming little old gingerbread witch so silent. I brought her morphine every hour and lorazepam every two. She didn't open her eyes or moan anymore. She couldn't talk or swallow anymore, so I had to crush the pills and mix them with a little water and use a syringe to squirt them into her mouth.

I don't know if she could hear me that night. I read to her from a book of German poetry I found on her bookshelf. When I picked up the book to thumb through it and read her a little, it opened to Der Tod und das Maedchen: a poem that was immediately familiar to me because Schubert
famously set it as a lied. The poem is dialogue between a young woman and Death: she begs him not to come for her, but Death tells her to be unafraid, that she will sleep softly in his arms.

I stopped reading after a while and just sat quietly by her. When she stopped breathing, I didn't believe that she was dead. I kept thinking that maybe I saw her chest rise a little bit. I insisted on listening for a heart beat again and again, but could only hear my own body. After the funeral home came to take her body, I went upstairs to her room.

Her bookshelves still held Beethoven symphonies, Mozart operas, Brahms songs: recordings that would have made me like her before I had even met her. I turned on her CD player, wondering what she had listened to last. I was rather proud of myself for staying so calm and composed throughout all of this. But as I bent to make her empty bed and the Strauss waltzes began to play, I realized that all day I had just been maintaing a facade.

Friday, February 4, 2011

One step forward, eight steps back

I'm becoming perplexed about work.

Remember how I said everything went really well last weekend? Well, it was kind of an exaggeration. I came in the first night; it was great. The second day, for whatever reason, I just couldn't deal with it. About four hours before my shift, I couldn't pull myself together. I was crying and I didn't know how to calm down. I wanted to be dead. I just kept thinking that I'd rather be dead than go to work, and that if I had to drive to work, then I'd drive to meet death instead.

I kept trying to tell myself things that I thought would help: you just have to get through tonight; it's only twelve hours; you'll feel better when you get there; things are going to become less weird at work; we need the money, you need to suck it up a little; you're not going to be stuck doing this for the rest of your life; your patients will be great; you adore the nurses; you made a cake, you need to bring it in and share it. Instead I just cried more. I called in and fell asleep on the couch about ten minutes later. The third night I went back to work; it was like nothing had happened. I was fine again, in a warm and silly mood.

Well, now I'm on my next hump. The other night, I went to work. I waited for things to get more comfortable, but they just didn't. Some nights it would take me about four hours to start to feel comfortable, to stop feeling sad. I kept trying to stay busy. I kept trying not to think too much about anything besides my immediate tasks at hand, but I was just getting more and more worked up. I was cleaning IV pumps and restocking procedure carts and doing finger sticks and my eyes were brimming with tears. I kept trying not to blink so they wouldn't splatter anywhere. I didn't want to do this crying thing again; it was really beginning to annoy me, and also starting to scare me. All I could think was I need to get out of here. I felt like I couldn't talk to a single patient or coworker without losing my composure.

I was recording some vital signs and realized I was going to blow. It was sort of the brief warning someone might get before puking, only this time, it was sobbing. I rushed to the bathroom, locked the door, sat down, head in hands, apathetic about the germy floor. This time I couldn't stop, I really couldn't stop. Thick strings of mucus were dripping onto my scrub top. I didn't care and was too unsettled to move the three feet to reach for toilet paper. I was trying to keep quiet, but one of the nurses must have heard my ragged breathing through the door.

"E."
Muffled crying.
"E, it's Judy. Are you okay."
"Yup." More crying.
"Can I come in?"

I pressed down the handle on the door. It swung open a few inches. Judy came in and sat on the floor across from me. I continued to cry.

"Did something happen?"
"No."

She handed me some toilet paper. Other than my sniffles and honks as I furiously blew my nose, we sat there in silence.

"Is there anything I can do for you?"
"No."

I stood up, patted off my face, washed my hands, and walked back out into the nursing area. I continued to work, silently blinking away tears. I kept telling myself I have to stop this. I'm going to scare patients if I look like this. My coworkers are going to think I'm a nut. I'm never going to get anything done if I can't stop crying. I focused on another task, and by the time I was done, I couldn't hold it in anymore and returned to the bathroom. I cried for about ten more minutes and went back to work. Things seemed no better than before. I still couldn't stop.

After two hours of crying and little improvement, Judy told me I should go home and get some sleep. I left work about four hours before my shift was supposed to end. It was about 3:00a.m. Instead of going home, though, I drove the opposite direction. It was cold and snowy. I was wearing my warm and comforting down winter coat, just like in my fantasy. I watched the snowflakes flying into my windshield and imagined that I was flying away from them. This is just how it was supposed to be. This is the perfect night. My husband won't be expecting me so he won't be worried. There will be no one on the street; no one will see me; no one will try to call the police. I can become splattered on the rocks and I won't have to worry about anyone bringing my body to the hospital.

I drove through town and up the hill, closer to the bridge and the gorge. I sat in my car while my engine idled. I sat and thought about MiniMan and started sobbing violently. And then I thought, you really should be nicer to yourself. This really isn't very nice. You're tired. Go home and go to bed. Get some sleep.

So I turned around. I turned around and drove home, all the while continuing to cry.

* * *

Somehow this turned into a narrative, but still, I really don't know what to do. Sometimes I feel fine and sometimes I feel out of control. The day after that I couldn't hold myself together and called in again. I am becoming so unreliable I'm worried I'm going to get fired from my stupid job. I don't know how to manage these "bouts" any means except sleeping. I'm being honest with my doctor and my psychologist, but I still haven't found any good ways to cope. Everyone keeps telling me that things will improve over time, but I feel like (at least with my job) I'm running out of time.

As I'm getting dressed

MiniMan comes over, pulls down my underwear and sticks his head against my crotch.

"Hey, get out of there!"

MiniMan continues to burrow his head against me.

"You know you came out of there, right? That's how you got into this world."

"Oh." Big pause. "Sorry, Mama."

Wednesday, February 2, 2011

Bipolar II? Early onset medstudentitis?

hypomania hy·po·ma·ni·a (hī'pə-mā'nē-ə, -mān'yə)

n.
A mild form of mania, characterized by hyperactivity and euphoria.

The American Heritage Stedman's Medical Dictionary

I always assumed that if my mental health status had to be summarized by an ICD-9 code, that my diagnosis was major depressive disorder; after all, that's the conclusion that my healthcare providers always came to. Whenever bipolar disorder was considered (or maybe more accurately, bipolar I) it was always dismissed because I never had any kind of full-blown manic episode. I was just a high-functioning person who was depressed. The other night, though, I started reading about bipolar II disorder, which, by the DSM criteria, must include at least one major depressive episode and one episode of hypomania. I'm wondering if maybe bipolar II might be more accurate diagnostic framework to work from. After all, it opens the door to a lot of new medications that might be a hell of a lot more effective for me.

Based on what I've read, hypomania is mainly distinguished from mania by it's lack of psychotic features (hallucinations, delusions, etc.), and that the person experiencing the hypomania often maintains a high or improved level of functioning.

I don't know if I'm just being paranoid, but I started jotting down a list of hypomanic symptoms and personal examples that I could think of:

Decreased need for sleep; increased productivity: a huge chunk of my time as an undergrad consisted of never sleeping and working all the time. Then again, that can be normal, right? It's normal to be motivated and work hard for the things that you want. And it can be normal not to sleep if you're working hard. Then again, here is a post from the fall where at the end I describe my sleep deprived self as being "invincible." I'm also really not sure why I thought I would be able to pull off that insane schedule, other than the fact every time I had tried to stretch my limits in the past, it had worked. I was convinced that everything was just a battle of will.

Risky behavior: for no reason that I can really explain (clearly I knew better), I would repeatedly have unprotected sex (and eventually unintentionally became pregnant); I would regularly participate in an illicit activity that I won't go into detail about right now; I sometimes would spend significant amounts of money on an impulse; I would go joyriding (always alone).

Psychomotor agitation: there are a few things that I find myself doing but that I really have no desire to do: jigging my leg; scratching my scalp, sometimes until it bleeds; chewing on my hair. The hair thing is new, and equally disgusting, I think. I keep catching myself mid-act, stopping myself, and thinking: that's gross -- if I don't stop this I'm going to have to chop all my hair off.

It makes sense that bipolar II was never considered, because for the most part, I've never talked to anyone about this stuff. Why would I want to? It's all kind of odd, gross, stupid, or embarrassing.