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Tuesday, May 31, 2011

on procreation

My office mate's stomach bulges a little now.  She's pregnant with twins.  Unlike me, she seems to have quietly thirsted for motherhood for years.  It hasn't been easy for her: difficulty conceiving, two miscarriages, rounds of IVF.  I wonder sometimes about people doing IVF, if they've reached some point of biological desperation bordering on insanity.  The endless injections, the endless cost, it seems like people pour their entire savings into some bottomless pit just for the chance of a child.  Just for a chance.  

For her, it seemed to have worked.  The little aliens are getting big.  She came to the office elated today after news of an ultrasound that they were estimated to be growing slightly faster than predicted.

It really didn't seem right to me.  It didn't seem right that although she is about my age, she had been through all this shit.  It didn't seem right that there are so many struggling with infertility, yearning for a family and that meanwhile there is always a sea of fertile Myrtles who don't even want kids, but are unwittingly getting knocked up.

I didn't dare tell her about first ultrasound.

I didn't tell anyone about the day I left work early to go to my prenatal appointment, how I reluctantly got onto the table and adjusted my scrub top.  The ultrasound tech chattered enthusiastically as the probe eventually centered on a little blob.  She pointed to a flicker on the screen.

"There's the heartbeat," she exclaimed.

I didn't say a word.  A tear rolled down across my temple and into my hair.  I thought how I must seem like a terrible patient, to not be cooing and delighting in the fact I was housing this healthy fetus.  She handed me a print out, a keepsake.  I didn't want it, I didn't even want to look at it, but it seemed strange to refuse it.

I wadded it up the ultrasound paper, put it in my pocket.  My husband walked me to the car.  I sat in the passenger seat for a while, just crying.  I hadn't decided if I was going to have this baby, but I had no idea that I was going to be so rattled by a fucking ultrasound.  

My husband and I had endless discussions and probably some of the most stomach twisting arguments I can remember, about whether or not to keep this little organism, which I would jokingly refer to as "a parasite."  Maybe referring to then barely-developed MiniMan as "Cletus the fetus" or "an alien" made the idea of having an abortion easier, but after the ultrasound it no longer seemed like something I could just distance myself from.

I had never wanted to have a kid in my early twenties.  It really did not fit in with my goals.  I was months away from starting a post-bac program in Vermont, and being preggo was not part of the plan.

Everything was falling down around me.  I was going to lose this child and this guy who I hadn't meant to love, but had really fallen for.  I was putting in eighty hour weeks washing eighty-year olds at the nursing home, watching the gradual breakdown of body and mind.  Medicine, from that perspective, seemed so depressing, discouragingly palliative, and even as a caregiver, I didn't even have the time to offer these people the support they really needed.  I remember initially being so intrigued by Korsakoff's syndrome, Alzheimer's disease and other dementias.  What an asshole I was, I realized, to delight in the details of disease when those very illnesses were slowly destroying people, removing personalities, piece by piece, until nothing remained but an infantile shell.  I worried an abortion, of all things, would push me over the edge, into some insurmountable depression.

I can't remember how many times I prayed that I would just have a miscarriage so I wouldn't have to decide what to do, that the universe would just take the reins and somehow work things out.  And, somewhat reassuringly the universe did work things out, just not in the way I expected.

Eventually, I ran out of time.  I had to decide.

So I chose happiness.  I decided to choose love and silliness and unrefined Christmas cookies with too many sprinkles.  Imagining my future that way, it wasn't actually so far off.  My life is definitely goofier and droolier and toothier and at times undeniably more joyful.  It's also more exhausting and slow, and financially drained, but, I guess you can't have everything, at least not all at once.

Thursday, May 26, 2011

relative calm

Things are getting a little better.  I don't know if it's the job, or the lectures, or the new TCA, or going running, or all of the above, but I'm starting feel more like myself.

There continues to be plenty of ridiculous family shit, financial shit, legal shit, and literal shit, but for some reason it's starting to be less depressing and instead kind of funny.  My husband and I set a "start medical school date" of age 30 for me (this is five years away), and although it seems slow, I think it's reasonable (and definitely doable).  I'm in the process of setting up a class for the fall.  It will be a relief to do something other than wait around and be miserable.

I'm starting to get more comfortable at my job.  I'm working with a team to update our EMR software, which is really old (it looks like DOS).  It is a huge project with (apparently, according to a recent article) a budget of 13+ million dollars.  I can't figure out if this is completely insane (it's the 250-bed hospital with a good number of outpatient services), but it seems like a ton of money.  Pretty much every form and assessment imaginable is being reevaluated and built electronically.  It's been interesting to read this stuff.  I recently came across a physician's order to "Plant Purified Pork Derivative (PPD)."

Seriously?  Is that what PPD stands for?  Anyway, in case you were wondering, I looked it up.  These days, everybody uses a synthetic purified protein derivative (so vegans and folks with religious obligations, have no fear), but apparently the original PPD was pork-derived.  Crazy.  

Monday, May 23, 2011

this weekend

I sat in a MiniMan with my parents, my husband, and MiniMan.  We had decided to take a six-hour trip to visit my grandparents, my brother, and his fiance.

I didn't want to go, but my husband kept laying it on about how MiniMan deserved to meet his great grandparents (and he was right), so I decided to suck it up and smile.

The trip was fine.  MiniMan did really well.  I guess it was a success.

Everyone is doing so well: my grandparents (who are in their 90s and independent), my parents (who just bought a second house with four bathrooms), and my brother, who is wildly successful in his likely multimillion dollar business (he has it rough because he has to travel a lot and take red-eyes).

I probably should feel happy for them, but instead I'm just bitter.

Everything seems so bleak for us right now.

Friday, May 20, 2011

far away

This week seemed impossible.

Somehow, though, it's over.

I don't understand why it is so easy to fall into a big hole.  You'd think I'd just climb out, but I wanted to curl up for a while.  When it was time to leave, though, I couldn't distinguish up from down. I seemed to have tunneled in.

Today I saw light.

Tuesday, May 17, 2011

no apology

empty

nothing to say

tired

missing something

confused

not really sure about anything

these days

keep wondering if maybe I'm

losing my mind

seems awfully melodramatic...

tired

giving up

just want to give up

go to bed

and sleep tonight and tomorrow

and the next

in and out of weeks

sleep

Monday, May 16, 2011

apology: no energy

i wonder

when's this going to be over

over over over

over over

over?

if life is going

to balance out, then

everything in store must be

wonderful.

Friday, May 13, 2011

at my hospital

They hold a lecture series that meets every Friday morning.  It's mostly geared towards the physicians so that they can obtain their CME credits, but it's open to all health care providers.  I just asked my (awesome) boss a few days ago if it would be okay to attend (when I didn't have meetings) and she said yes!  I've wanted to go to these lectures for years, but always had scheduled patient care stuff going on.  I think I'll get to go on a regular basis, and hopefully be exposed to a lot of information.

This morning one of the gastroenterologists came and spoke about proton pump inhibitors (i.e. the class of drugs that are typically used to treat GERD like Prilosec and Nexium).  A lot of the lecture went over my head, but here were two cool points that were mentioned:

-There can be a significant rebound when PPIs (proton pump inhibitors) are discontinued.  Some practitioners argue that the withdrawal can actually create heartburn in patients who didn't have it.

-People taking PPIs are more likely to develop polyps in their stomach (specifically, gastric fundic gland polyps).  This is kind of creepy, but apparently according to studies, these polyps don't seem to put people at risk for developing GI neoplasia.  So far they appear to be silent.

(Gastric fundic gland polyps - images courtesy of Medscape)

Wednesday, May 11, 2011

therapy schmerapy

Today I had probably one of the most even days I've had at work in the past year.  I was actually busy and it wasn't all mind-numbingly boring.  I was getting along with my coworkers and I wore a dress to work (I do not understand why, but find dresses both comfortable and oddly confidence-boosting).

Everything was really going well.  The weather was beautiful.  It was sunny, warm, all the flowers had popped and bowed down for a belated Easter salute.

I went to see my therapist after work.  I thought it was going to be an upbeat session.  For the first time in a while, I really felt pretty okay.  Somehow, though, everything he said pissed me off.  We talked about why I stopped singing.  It pissed me off.  We talked about post-bac stuff.  It pissed me off.  We talked about my husband.  It pissed.  Me.  Off.  He encouraged me to go to group therapy.  No fucking way.

Sometimes I am really unsure if all this talking and focusing on how screwed up things are, if it's really useful in any capacity.  Right now it feels like the minute things start to get back on an even keel, somebody has to rock the boat.  Does therapy have to make you feel like shit to accomplish something?  I'm just not sure if I buy into that logic.

Sometimes I wonder if maybe I need more of a mentor than a therapist, that I'd rather have someone cup me gently in their hands like a newborn chick and focus on the good.

Monday, May 9, 2011

I have nothing

wise to say, so I will write a foul limerick:

There once was a sinus infection
That gave Peter Paul an erection.
He noodled around
With some trash on the ground
Using tissues he found as protection.

Sunday, May 8, 2011

It's been a profoundly difficult week.

I keep wondering if I am going out of my mind.  What is real and what isn't?  I've started seeing my therapist, the one who's moving away, two times a week now.  I asked him if wanted to see me twice as often because he was "worried I was going to off myself."

He said "no."  Knock on wood.

I can't help but wonder if all this talking is making things worse; if it is only drawing more attention to my suffering; if it is better to swallow and bury it, to laugh instead.  He argues ironicalness is a coping mechanism, but not an ideal one, that it is better to feel.

I am not so sure.

I find myself driving into college town, pulling over less than a block away from that bridge.  We've become so familiar to each other.  I sit in my front seat writing goodbye notes on the backs of old pay stubs.

After long gazes, after considering the 9 foot fencing, I reevaluated my plan.  To really simplify things, I would need a ladder, and I would need to do it when there wasn't nearly so much traffic.  I would need to come back during the night or early, early morning.

Although I was tired and really just wanted to get it over with, I was okay with taking the time to do more planning.  It wasn't worth dying if I wasn't going to do it right.

I drove home.

I went to bed early.  I was exhausted; there was nothing I wanted to do.  I couldn't sleep.  I felt compelled to open the window, take of the screen and jump, but surely this wouldn't be nearly enough of a fall to guarantee death.  I started planning: what about the fifth floor of the hospital?  Is the entrance locked?  I'd have to be careful, there was so much grass in some areas.

I didn't want to think this way, but it's difficult to turn thoughts around.  I had reached a new level of desperation.  Maybe I should stop taking drugs all together.  I always used to be able to get back on track when I was at Oberlin, and I didn't take any drugs as a student.  Something had to change.

I saw my PCP a few days ago.  I sat there, flatly explaining that everything seemed pretty pointless.  After a while she started suggesting alternatives, including ECT.  I was disturbed and appalled.  I know ECT has become comparatively less...barbaric, that the delivery is less prolonged and less intense, that they sedate people.  Still, I had a friend who underwent ECT.  I knew her before and after.  It was like someone had replaced her head with a yellow balloon, bobbing happily in the breeze (but empty).  She had a lot of retrograde (and probably anterograde) amnesia, too.

I started to wonder, what would it be like to forget all these memories, to forget memories of my son, his birthdays, my marriage.  How is this living?  After all this bullshit, you want to steal my memories, too?  From what I'm read, I'm just not convinced of the efficacy of ECT and that the benefits outweigh the risks.  From what I've read, it's not uncommon for people to have reduced IQs of 30-40 points (although many state they do not feel less intelligent).  I might as well just get ECT, and go back to my job as an automaton.  That's the kind of promise that I envision.  Maybe I'm being overly protective of what memory and intelligence I do have.  Still, getting robbed of all this is - calling it frightening seems like an understatement.

We talked about trying some of the old (and now comparatively more obsolete) tricyclic antidepressants.  My husband took my script to the pharmacy (which apparently doesn't routinely stock it).  I told him to just get it filled - that I didn't want to read about the side effects, that I was worried if I did I wouldn't bother taking it, that I was desperate.

I don't know.  I just keep going through the motions.  I keep trying to put on a brave face, but in this job, where I am grossly underutilized every day, I just have too much time to think.  This thinking, it's not pretty: counting down the minutes, plotting my demise.

Everyone once in a while something real slips out.  A narrow beam of light through a cracked doorway: excitement about xanthomas, about knowing something, about actually being useful in some capacity that is above that of a trained monkey.  Every once in a while, something very real and very sad slips out, too.  I find myself reduced to a puddle of goo, trying to hold back sobs as I sit in my car, driving down the road, listening to the radio.  Sometimes I feel as though I am carrying around the entire weight of the world, that I just need to lay down and cry, that I am not capable of much beyond that.

I don't know what's happening.  Things are changing, but I can't seem to discern if it's for better or for worse.

Friday, May 6, 2011

healed by a xanthoma

I was really being a stinker yesterday until I went to the Emergency Department EMR upgrade meeting.  We were running through a whole bunch of the nursing assessments, and at some point we got to a visual assessment.

The director and her staff were scanning the form, and someone asks "what the heck is a xanthelasma?" 

No one seemed to know what it was.

I don't know why I remembered, but a couple years ago I had read about xanthelasmas when I was reading some cardiac stuff.  So I told them it was a yellowish lipid deposit under the skin around the eye.

I don't know why, but this made me feel much better.  Much more alive, anyway.

Thursday, May 5, 2011

Don't want to get dressed.

Don't want to go to work.

Everything feels bad.

Tuesday, May 3, 2011

still chugging along

All of a sudden, it seems like the childcare options have started to multiply.

My parents offered a few days ago to watch MiniMan for us (as a substitute for daycare) for the entire summer.  I'm sort of baffled.  I'm actually really confused about my relationship with them.  I'm used to them not being supportive at all or sort of passively being involved.  Maybe my father feels guilty for banishing me for the last three years or something. 

We also found another daycare that is about the same price as the other one.  It was also pretty close to home, safe, clean, and the lady who ran it was not scary and seemed very competent and fun.  The only downfall is it smelled like those artificial air fresheners and I had a headache by the time I left.  My husband said he was concerned about "exposure to solvents" (from the air fresheners, or cleaning supplies, or wherever this scent was originating).  I wonder if anyone was done studies on the adverse effects of "air fresheners."  They seem like one of those things that would just piss mother nature off.

So, things are okay.  I saw one of the day nurses from the ICU in the cafeteria yesterday.  Apparently all the day people think that I'm still working nights, there.  It seemed odd.  Usually the nurse managers there are quick to send some kind of mass e-mail alerting the entire staff to someone leaving (followed by party or food/alcohol destination).

I can't help but wonder if the lack of communication was some kind of alienating gesture.  I didn't expect a party or anything, but I thought that it might be worth mentioning that I was leaving.  Probably I'm overanalyzing...