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.

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?"

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?"

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.


  1. As I read this post, and others, I'm struck by the similarity of what you describe to that of people I know suffering from debilitating grief.
    I know that reading too much into what gets said and done on the internet is folly, but reading your pain has made me wonder what it is that you've lost, and what you are searching for.

    I had a similar experience as I struggled (and still struggle with to this day) the loss associated with my adoption. That loss was so basic and so pervasive that I never realized it was there. But once I realized how awful of an experience the total and complete rejection by the one person who is supposed to be a sacred ally was, I found this whole layer of pain in my soul I never knew I had.

    One should know when their very paradigm is fucked up, right?

    So much more subtle.

  2. I wrote a long response, but it's too long. So will post it in stages. Here's stage 1.

    I've just discovered your blog (after you discovered mine). You're really going through a rough patch right now. I'm sorry.

    As an opera singer who went to med school, we do have a few things in common. I have a few thoughts...(and keep in mind that I don't know you, so my thoughts may be totally off base). Take what resonates and you find useful...ignore the rest as the long-winded ramblings of a confirmed busybody.

    -I agree with the previous poster. One thing that struck me, as I read through your blog, was how nonchalantly you described being kicked out of the family when you became pregnant. That kind of betrayal by the people who are supposed to love you unconditionally, IMO, warrants a MUCH bigger response. Could it be that you're so used to eating shit from the people who are supposed to love you (no matter how badly you screw up), that you've come to equate this with normal? And your body is trying to tell you it isn't?

    -You strike me as a bit of perfectionist. You are trying to do and have it all, AND get a perfect score on the chemistry test. It's a common trap that artists get in; needing the approval of our audience, because it validates our own feelings of inadequacy. I think that many times, this need for the approval of others comes from our not having had the unconditional approval and emotional support we needed from our parents. And many of us never stop trying to get that love and approval from our parents, our audience, the world...even though they are incapable of giving it to us. What you have to do, is give it to yourself. Practice giving yourself what the psychs call "unconditional positive regard." (UPR) Tell yourself "My infinite worth as a human is not changed if I fail a chemistry exam." "My infinite worth as a person would not change if I gave everything up and went and lived in a cardboard box under a bridge." "I am a lovable person."

  3. Stage 2

    -I apologize for the armchair psychology, especially as I've never met you, and only know you from some of your writing. But I do know a little about where you're coming from. I had some pretty dark days (who am I kidding, years) when I was trying to figure things out. I was singing like shit, I wanted to go to medical school but kept getting turned down, I was working dead-end jobs hating every minute of my life. And I felt like the clock was winding down, and I was getting older every minute.

    (It didn't help that my twin sister is a doctor, and that she'd gotten into medical school out of undergrad, and she was doing what I desperately wanted to do. I resented her, and hated myself for it.)

    I felt trapped. I hated my life, I hated work, I hated feeling rejected all the time. Things started to change for me, slowly. There were several things that helped. I started to deal with some personal shit (some PTSD related to violence I witnessed as a child). I came to terms with the fact that my parents (especially my father) were not going to give me the emotional acceptance I needed, and no matter how well I sang, and how well I did in life/school, I was never going to get what I needed from them, so I might as well give it to myself. I learned this lesson a couple of ways; I read some books by Gabor Mate (who I highly recommend), and I started "The Artist's Way" I suspect you've heard of it, a 12 step program for developing your inner artist. I found it enormously useful, especially the journaling. I developed more insight those few weeks writing stream-of-consciousness blather for a couple of pages every morning than I had in my previous 20-something years. I realized that a lot of what had been motivating me, was to try and get something out of my parents (even the stupid shit I'd sunk to, trying to get their attention any way I could). I realized my parents had done the best they could with the emotional resources at their disposal, but that any more emotional nurturing I needed was going to have to come from me.

    -So I started to develop my own UPR. And I started to sing for myself. I no longer cared what other people thought of my singing. I sang the way I wanted to, and stopped caring what others thought of it. And eventually, I was at a point where I could apply to medical school in the Caribbean (with all the associated stigma) and go.

  4. stage 3

    -Part of what made my own journey so difficult was the feeling of being trapped. Something that helped me a lot, was coming to the realization that I always have choices. I could choose to live in a cardboard box under a bridge...drop the student loan payments, and become a bum. You have choices too. You could abandon your family, and move to florida and live under a palm tree. I'm not for a moment suggesting you do this, and I suspect you wouldn't choose to do it, but realize that no matter how trapped you feel, there are always choices you have the power to make that can get you out. Sometimes, the only thing that makes being in a cage bearable, is to say to yourself "I choose to be in this cage." Which is pretty bleak, I know, but you have to take what you can get sometimes.

    -You can't do it all. Seriously, two heavy duty lab courses and night shifts? Girlfriend, a body needs to sleep. And some bodies need more sleep than others. Your body is telling you that you cannot sustain your current level of stress. You want to sleep all the time, probably because you need to sleep all the time. Stress is hard on the body, and you need to allow your body to recover. And frankly, sustaining that kind of pace and schedule is impossible when one is eaten up inside with feelings of inadequacy and panic that one won't measure up.

    -Something has to give. Right now, what's giving is your emotional equilibrium. As Dr. Phil would say, "how's that working for you?" I see depression as one of your body's ways of talking to you. It's telling you that something has to change. Don't fear the depression, use it. You've been using coping strategies that aren't working any more. You probably laid them down as a child, and they are unconscious, but they aren't doing their job. So you are going to have to do some digging and find coping strategies that work. Listen to your body, and above all, trust your instincts.

    -And that is the hardest thing of all. I think, especially for an artist trained in the current environment. We are taught to listen to everyone but ourselves: teacher, coach, artistic admin, opera queen online, our colleagues, critics, random audience members, mother, father. But woe betide the singer who thinks and/or sings for themselves! Listen to you gut. Listen to your body. There is enormous wisdom inside you, but I suspect you are unused to hearing it.

    Take care of yourself. Be a little bit selfish. Listen to your inner voice. Trust that things will work out, but not in a way you expected them to.

    One of my favourite Gabor Mate quotes (from "When the Body Says NO") is (and I'll stop rambling here):

    "Always choose guilt over resentment."

  5. well I can't necessarily say I agree with the above. two heavy night courses and night shift is just a touch of what its going to be like in medical school. try taking those two heavy lab courses in a period of 4 weeks and then be expected to retain it for boards later. you probably need to ask yourself "why do i want to become a doctor" this realy isnt apparent to me in any of your posts. it almost feels like a challenge that you have set for yourself and you are fighting an inner battle to try to beat that challenge. it wouldn't surprise me at all if you one day woke up and said "i dont want to be a doctor" and then felt a sudden release of pressure in your life. without any psychology knowledge or the need for any it is simply a fact that many intelligent people set goals for themselves, sometimes unobtainable goals, and then succumb to the fact that they can't win. what is it about being a doctor that attracts you? if its caring for patients, which it should be, then it wasn't evident in this post at all. you can't be operating on someone and be thinking about problems back at home, etc.. this simply just cannot happen. no on realizes the pressures of medical schoool till they get there. no matter how much anyone tries to warn you ahead of time. the pressures of your job and family life will seem trivial when someone looks you in the eye and expects you to know whats wrong with them.

  6. to sum up what i have said and to the first comment. i think you have lost the reason you want to become a doctor and trying to find your way back is killing you. sometimes you need to not look back and move forward. as easy as that sounds theres no other way.

  7. I can't say I agree with anonymous, but wholeheartedly agree with Beach Bum. What anonymous said might be correct in some situations, but I think it's mean and uncalled for in this situation (and certainly unhelpful!). Working nights as a CNA is NOTHING like being on overnight call as a med student with no responsibility behind one's actions (let's face it, what you say and do doesn't count in the real world) and no license to uphold. Your responsibilities are different as a med student and your workload is a different type of work, not physical, but mental, and one might argue that it's harder, but it's still different and does not take the same toll on your body as being on your feet for 12 hours at a time doing task-work. I agree, it's all stressful and I'm totally with you that med school is nothing like anyone had ever done until you do it, I believe you, but it's a different TYPE of stress, it's a different TYPE of reality and that, anonymous, you're failing to take into account.

  8. To anonymous: right now I am not so directly focusing on medical school, but rather to get myself back to a spot where I can get by. I have to say that I don't really agree with your comment, but if the day comes that becoming a physician really isn't is a goal that I wish to pursue, I'm okay with that.

    However, I do think that if you were on your fourth year of flipping burgers at McDonalds, you would likely sometimes feel overwhelmed by having to deal with customers, and you would be starting to feel desperate to get out of a job where you were overqualified and underutilized.

    If you would like me to articulate my reasons behind my interest in becoming a doctor, here they are:

    -I have a fundamental need to be challenged (which is probably one of the reasons that medical school is enticing) and every depressive episode that I can think of has occurred during a time when I have not been intellectually challenged.

    -I am strongly attracted to the process of problem-solving and troubleshooting that physicians must go through; the diagnostic process and "puzzle-solving" (or at least attempts at this) interest me. I don't want to be the person who only follows someone else's orders.

    -Of course, I want to help and care for my patients (although admittedly, this isn't my sole motivator. If it were, I'd probably be more likely to go into nursing). Also, physicians are spending a significantly smaller proportion of their time with patients. It is easy to go into healthcare with a very caring and optimistic attitude (as I did four years ago), but many people will find that with long hours of caregiving (and I'm not talking about asking questions or explaining the nature of an illness, I'm talking about toileting, bathing, feeding, repeatedly having to tell someone they can't have more narcotics every five minutes, waking a person up to do Q1 blood glucose levels every hour all night, etc.), the constant social interaction can become a challenge during particularly stressful times. I would consider this point in my life a particularly stressful time, mostly because I have gone from being a very high-functioning person to being totally stagnant.

    -I am amazed by the intelligence of the human body and it's physiological processes, and I love that medicine is so dynamic. There are always uncharted areas and processes that aren't yet understood, there are always new technologies that are being developed. It is a field that has become limitless and is constantly undergoing innovation.

    -On that note, I am immensely attracted to the lifelong process of learning that accompanies a career in medicine. Although there are elements that will become repetitive, I like that there will always still be some variation, whether it be changes in a treatment algorithm or just a new patient.

    -I like hearing patients' stories. They may be sad, interesting, way too long-winded, or hilarious, but there is constant variety.

    -I really miss the social environment of being in an incredibly rigorous program and being around people that I share commonalities with. Being in a conservatory setting isn't exactly the same, but I have friends now who are singing with the Metropolitan Opera and other top-notch companies. We had LONG hours of study and the competition as a professional singer was fierce. I really miss being challenged on that level, and also being around people who were going through the same battle. We shared something that we could never completely explain to anyone else.

    -I believe that I am intelligent, hardworking, and tenacious enough to succeed in the application process, in medical school, and throughout my career. My undergrad GPA was 3.79, and my continuing post-bac average has been a 4.0.

    This is what I want to do. If you think these aren't sufficient reasons, though, I'm curious what you think they should be.

  9. I completely disagree with anonymous. What you were doing to yourself is not what medical school is like. Residency, perhaps. Definitely not medical school (unless you're incredibly disorganized?). I slept 8 hours most nights of my first three years of med school, including during my sub-i. Did I have a life? On easier rotations, yes. But I was well rested. It's all about making it a priority.

  10. by the "Quotable Osler".

    The practitioner of medicine...wer are here not to get all we can out of life for ourselves, but to try to make the lvies of others happier.

    Everything that you dictated about wanting to become a doctor sounds like if you want a challenge: get a physics PhD.

    It basically is summed up by the fact that you need to be challenged. No offense to you but this is the problem with doctors these days. I have no doubt that you might have the intellectual means to becoming a physician but is this really what makes a physician? Medicine is an art. And while you are well versed in the arts, it is a different type of art. Sir William Osler was not known for his genius but rather for his humanity, beside manners, and compassion for the individual. None of these stem from any sort of challenge. I have been where you have been. Working the 12 hours on your feet and as I said before there are all kinds of different doctors. Not everyone can share the same compassion for medicine but medicine would be better if we all did.

  11. As much as I disagreed with the first comment by anonymous, I agree with the last. Finding a compassionate physician is not easy these days. I think people get burnt out on insurances policies, lack of reimbursement, rambunctious patients who read Googled material and see themselves as experts all of a sudden, arguments, law suits, questioning of authority... etc. I think it's easy to lose compassion for some patients. I have to say at my work I know 1 maybe 2 physicians who are compassionate AND truly love what they do, many others just like what they do, maybe love, but I don't see the same compassionate attitude toward patients, families, etc. So, if you, anonymous, were to become/are already a physician who has both and are encouraging your students/residents to be both compassionate and love their job - all the power to you. You'd be on the right track to help many people.

  12. I've gone through the very same issues, with the crying jags and everything, thinking about ways to kill myself. Took me *many* years to realize - it's because I don't sleep enough! Now that I do eat and sleep better, the tears are much less (only after an long night at work), and suicidal ideation has vanished.

    Sleep deprivation has been linked to depression, so getting yourself on a proper 8 hours of sleep per night regimen I think is more important than anything, even your job.

    I think you need to create a bedtime routine, where at the same time every night, you slow down, have a warm bath, maybe read a little light fiction, and you hopefully will find it easier to function. If you're a light sleeper as I am, a sleep mask and maybe even earplugs are very useful.