All posts in category medical school

National Child Abuse Awareness Month: Verbal and Psychological Abuse

Child Abuse Can Be Prevented

Child Abuse Can Be Prevented

“You’re nothing.”  ”You’re useless.”  ”You’re shit.”  ”Can’t you do anything right?”  ’Well if you don’t know, I’m certainly not going to tell you.”  ”You couldn’t find your ass with both hands and a flashlight.  (laughter)”  ”You’re too sensitive.”  ”Grow some skin/a thicker skin.”  ”Fat ass.”

Just a few of the loving epithets hurled at me daily.  I never did grow that “thicker skin,” so I always dissolved in tears and ran out the door, if the weather was good, or up to my room to hide under the covers while the rage downstairs continued with slamming cupboard doors and curses muttered and shouted in mounting fury.

I know what it’s like to go on tiptoe, to see what the “mom weather” is like at the moment, and how to disappear quickly.

I know how to appease the rabid beast, by bringing bribes of flowers and candy and “I love you” handmade cards.

I know how to avert the armageddon, at least temporarily, by making a surprise dinner (although since I allegedly did not know how to do dishes, and this was a thing so simple that any idiot could do it and therefore I should not need to be taught, unless of course I was an idiot, dinner could be a shark tank).

I know how to have suicidal fantasies.  In fact, I know how to commit suicide.  I just haven’t done it.  Yet.

I know how to get straight “A’s” in school in order to please her.

I know how to get a bachelor’s degree, a master’s degree, and a Doctor of Medicine degree, to please her.

I know how to run away from home, when the pain got too much:  first, at age 16, to the other side of the country; and later, at age 50, to the other side of the world.  Both helped for a while.

And yet: and yet….even now, when she is 86 years old and I have dragged myself out of my personal heaven in Jerusalem to help her, one word, one look, and I am that terrified child, nauseated, shaking with terror and homicidal rage.

I have touched her twice: once when I was 16 and she had seized hold of me when I was doing the dishes wrong…I grabbed her by the wrists, wrenching her clawing hands off of me and pinning her against the wall of the kitchen.  She spit, struggled, kicked at me, but I held her till she went still and met my eyes.  I could feel my eyes burning into hers and knew I had won that round, the first and the only.  I threw myself away from her and ran out the back door, not daring to come in until after dark and my father was home.

The second time happened only a few years ago.  We were sitting at the dining room table.  I don’t remember what set her off, but she grabbed my forearm with her claws, and I grabbed her wrist and ripped it off my arm and threw it away from me.  She continued as if nothing had happened.  I desperately wanted to pound her into mush, but I swallowed my rage and pretended there was nothing wrong.  Nothing at all.

Maybe I am thinking of these things, not only because of my Child Abuse series, but because the anniversary of my last failed relationship is coming up.

My psychologist, who I have known for ten years (and perhaps more importantly, has known ME for ten years) and who has seen me through a number of relationships, tells me that a healthy man would not feel right to me because I don’t know what a healthy relationship is.  At first gasp that seems like a negative thing to say, doesn’t it?  But really it’s quite true.  I grew up with a harpy for a mother, and a father who, although I love him dearly, was quite content to step aside and let the chips fall where they might, and hand me his handkerchief afterwards to dry my tears, making excuses for my mother:  she had her period, she was having a hard day, blah blah blah.

Years later when I was in my Pediatrics residency there were posters everywhere that showed a little girl curled up in a corner crying, and a caption that said, “Words can hit harder than a fist.”  I remember looking at those posters, puzzled, wondering what that could mean.  Words can hit harder than a fist.  I actually did not understand the meaning of those words.  In fact, it was not until recently, 25 years later, that the meaning dawned on me.  Verbal abuse can be more damaging than physical abuse.  And I realized why it has taken all these years for me to “get it”:  PTSD.  It was just too traumatic to let into my psyche at that time.  I was not in a safe place, and I had not had the distance from my abuser that would allow me to process that statement: Words can hit harder than a fist.

I am lumping verbal and psychological abuse together for now, because I cannot parse them out.  There are certainly other psychological ways of abusing children (and adults), but from where I am standing at this moment they seem all tangled up together, verbal and psychological and emotional.  I plan to work on this over the next few days and see if I can untangle them, and be more clear.

I know what it is to be confused.

2 Comments
by Soul Survivor on April 14, 2013  •  Permalink
Posted in child abuse, family, medical school, Post Traumatic Stress Disorder, triggers, Uncategorized
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Posted by Soul Survivor on April 14, 2013

http://bipolarforlife.me/2013/04/14/national-child-abuse-awareness-month-verbal-and-psychological-abuse/

Blog For Mental Health 2013!

I am proud and humbled to have been pledged by Ruby Tuesday of A Canvas of the Minds as a Mental Health Blogger for 2013.  It’s not an award, but a commitment to keep on blogging with the aim of erasing stigma and creating community among those of us who live with mental illness.  Our Mental Health Blogger community is a place where people living with mental illness as well as their families and loved ones can come together in mutual acceptance and support.  It’s awesome!  So here’s the pledge:

I pledge my commitment to the Blog For Mental Health 2013 Project.  I will blog about mental health topics not only for myself, but for others.  By displaying this badge, I show my pride, dedication, and acceptance for mental health.  I use this to promote mental health education in the struggle to erase stigma.

Here is where I’m supposed to write a short summary of my own journey with mental illness.  Where to begin?  I’ve had issues all of my life with PTSD and dissociation.  Likewise, I cannot remember a time when I was not depressed.  I ran away from home, permanently, when I was 16 and only by the grace of G-d did not die or end up trafficked to Mexico, although there were some close calls.  I didn’t know I had a mental illness till I was in college and desperate to make money.  There was an ad in the student newspaper: take drugs and get paid!  No, really, it was a study that the Psychiatry part of the medical school was doing.  So I went and applied, and had to take a whole day’s worth of psychological testing before they would give me the drugs.  Some guy called me the next day and said, “You have to go to Student Mental Health right now!  Your testing shows you are Severely Depressed.”  Humph.  I didn’t feel any different than I always felt, but if I had to go to Student Mental Health in order to get my drugs, that’s the way it was.  I went.  There was a nice lady behind the desk in a cozy room.  She smiled beneficently and asked, “Why are you depressed?”  ”I’m not depressed,” I said. “Then why are you here?” she asked.  ”The Psych Drug Study made me come,” I said.  She shuffled through my slim chart and said, “Your testing shows you are severely depressed.”  She looked up at me with that saintly smile and said, “You get good grades.  You have a good job.  You’re good looking.  So why are you depressed?”  I stood up, thanked the lady, and walked out.

The next time I got an inkling that I might be depressed came when I was in medical school, married, with a baby who never slept.  I adored him, and many years later I still adore him, but the fact is, he never slept through the night until he was five.  So at that time I think he was maybe ten months old, and I had not slept since he was born.  I was in the middle of my Cardiology clinical rotation.  Everyone had gone to lunch, but as usual I had no appetite and was uninterested in hanging out with people, so I was sitting in a study carrel reading EKGs.  My Cardiology attending came over and said, “Aren’t you going to go get some lunch?”  And I said, “No thanks, I’m not hungry,” avoiding eye contact by studying the EKG.  ”Look at me,” he said, and I did, mechanically.  ”You’re depressed,” he said.  ”I want you to go home and get some help.  You need to see a psychiatrist.  Please call me tomorrow and tell me what you have done about this.”  And head hanging, I went home.  My ex-husband came home and said, “What are you doing home so early?” since I usually stayed late studying.  ”I’m depressed,” I said.  He turned on his heel and walked out.  ”Let me know when you’re better,” he said on his way out the door.  I called somebody at the medical school whom I trusted, and told him the situation.  Five minutes later I got a call from a psychiatrist, who gently demanded that my (ex) husband accompany me to an appointment on the following day.  He did.  The shrink explained to him that I was physically incapable of doing what I was doing, taking care of our son all night and being a medical student all day (and sometimes all night too).  He explained how to give the baby a bottle.

He also gave me my first psych drug, imipramine, which not only knocked me completely out, but gave me a horrible itchy rash from head to toe.  Then he gave me antihistamines for the rash.  I dimly remember lying on the cool hardwood floor wishing I was dead but having no control over my body and therefore being unable to act on it, which was good.  After I got over that, he gave me some other drug, which allowed me to make it through med school in one piece.

Then I got to my residency in Pediatrics, where the standard work week was 120 hours.  More sleep deprivation.  And still with the non-sleeping child, who, bless his heart, sleeps like a baby now that he’s in his 20′s.  And then there was the husband who needed attention too.  So I went to a shrink and got Wellbutrin, which is very good for some people, but me it tipped over into hypomania.  Only nobody in the medical world in which I lived seemed to know about Depression and Mania and those kinds of nervous system brain sorts of things.  They only knew about Show Up For Work And Keep Your Mouth Shut.  I had this private joke: if one of us residents died, they wouldn’t give us time off to go to our own funeral.

As it happened, three of us residents DID die, and another one got taken out of service for accidentally giving someone the wrong medicine, which caused their death; so instead of every third night call, we had every other night, and sometimes “every every” night, which meant we didn’t get to go home much.  I really don’t know how the program directors thought that flesh and blood human beings could tolerate that for three years and not kill themselves or die in car accidents falling asleep on the way home, both of which things did happen in our little corner of Hell.

Anyway.  Fast forward from the late 1980′s-early 1990′s when all this shit was going down, to Y2K.  That’s right, the nearly infamous Year 2000.  Well, it WAS infamous for me, because a whole conflagration of disasters hit me that knocked my pins right out from under me and I ended up in the hospital.  And I became disabled, just like I am now.  The only good thing was that some shrink finally noticed that I’m bipolar, and put me on Lithium.  But by then my medical practice was in ruins, my family life in tatters, my finances non-existent, and worst of all, I had lost my identity.

I’ve wandered around some more since then, and although I’ve just been declared permanently and totally disabled by a Federal Social Security judge (and that feels pretty rough), I’m writing more than I ever have.  I’m blogging, and have become part of this wonderful community that is centered around A Canvas of The Minds.  I’m FINALLY writing my book, having used NaNoWriMo for the past two years to give me the kick-start I’ve needed to get two of the volumes well into progress.  I’m slowly redefining myself, and even though I still have attacks of  ”the mentals,” I’m bumping along, and that’s OK.

Oh all right, that was not short.  I am Incapable Of Writing Anything Short.

Now comes the part where I am supposed to pledge five other Mental Health Bloggers.  OMG.  How am I supposed to choose????  I’ll just start, and when I get to five I’ll stop.  Maybe.

PAZ, of Melancholically Manic Mouse

Lunch, of Lunch Sketch

Nicolas, of Puncture Repair Kit

bpshielsy at The Pipolar Place

survivor55 at Bipolar and Breastless

I hereby pledge to remember to let all of the above know I’ve pledged them.

Lastly:  I am supposed to remember not to forget to link back to Canvas, so here it is.  I think I’ve linked back to Canvas about six times in this post, but I’m feeling kind of wacky today so if I’ve messed up in some of this stuff I hope everyone will forgive me.  And feel free to let me know!

Love to everybody and sending good juju for staying healthy this winter, and looking forward to another wonderful year of Mental Health blogging together!

Soul Survivor

8 Comments
by Soul Survivor on January 27, 2013  •  Permalink
Posted in Autistic Spectrum, bipolar illness, blogging, Disability, family, humor, medical practice, medical school, medications, Mental Illness, Post Traumatic Stress Disorder, Recovery, relationship, symptoms, Teenage runaway, tests, treatments, triggers, Uncategorized
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Posted by Soul Survivor on January 27, 2013

http://bipolarforlife.me/2013/01/27/blog-for-mental-health-2013/

Crazy People Get Sick Too

“Crazy people get sick too.” a professor of mine in medical school told me, as we walked through a crowded urban emergency room.  He firmly emphasized to his small crowd of followers that it was nothing short of criminal to instantly brand every human being who presented to the ER (or anyplace else) with a medication list that included psych drugs, or was delusional, or disoriented, or hallucinating, or even violent, as being a “crank,” and ignoring the possibility that this person might be physically ill, just like anyone else.

I took that lesson very much to heart, even though I was not officially among the mentally ill at that point.  It made all the sense in the world that mentally ill people could still get heart attacks, and strokes, and kidney stones, and life-threatening infections.  It even made sense that people who were not diagnosed with a mental illness could have conditions that might mimic conditions normally associated with, say, a psychotic break or an overdose: acute liver failure can cause hallucinations and stupor; uncontrolled diabetes can cause disorientation and lethargy progressing to coma; hypoglycemia can cause uncontrollable tremors, delusions, and hallucinations progressing to unconsciousness and sudden death; brain tumors can cause auditory and visual hallucinations, personality changes, depression, mania, paranoia, and just about anything else.

Then there was the lady who kept vomiting and vomiting for almost a year.  The gastroenterologists did every test in the world and it all came back normal, except for her serum electrolytes, which were screwed up from her constant vomiting.  They branded her a psychogenic vomiter, which means  they blamed the vomiting on something psychological and that was not their department, so they discharged her from their care.  A few months later she presented to the ER, this time vomiting up fecal matter (sorry).  Yes, it was really gross, and my heart went out to this poor lady, who had been branded a “crank” simply because the doctors did not know what was wrong with her.

This time the ER requested an acute surgical consult.  The surgeon decided to take her to the OR the next day for an exploratory laparotomy, which means they would open her up from guggle to zatch (my terminology) and wudge around in her innards to try to find the cause of her awful condition.  Luckily, I happened to be on the surgery service then, so I was pressed into service holding retractors.  (N.B. anyone who has a question about any of these terms is welcome to leave a comment and I will explain.  I figure that most people watch all these medical shows they have now, but since I don’t own a T.V. I don’t know what they have on them.)

Where was I?  Oh yes.  Holding retractors.  So.  When the surgeon got in there, he found, to his great surprise, a gigantic tumor in the middle portion of her small intestine.  Now, the small intestine is notoriously difficult to evaluate due to its extreme length (about 20 feet) so you can’t just stick a periscope down there and look around, like you can with the large intestine.  So all kinds of weird shit (excuse the pun) can hang out down there and go on with its dirty business undetected.   So when he opened this lady up and found a grapefruit size tumor like a donut surrounding the tube of her small intestine, he was shocked and amazed.  I was ecstatic.  The lady was vindicated.

The surgery turned out to be very messy.  I will not go into the particulars.  I had the immense satisfaction of bringing the news of the positive surgical findings to the attention of the arrogant asshole gastro people, who pretended that they thought something was the matter all along.

Oh, I forgot to tell you, this lady had a diagnosis of anxiety disorder and was on two or three meds for it.

One piece of good news is that since then there have been many new developments in medical imaging.  It is doubtful that things would have got that far without a CT scan, or an MRI, or both; and either of those would have revealed the weird tumor.  But given her diagnosis of anxiety disorder, would she have been taken seriously enough to even get to the point of imaging before she started throwing up shit?  I really don’t know.

Next post, I will tell you why I wrote this one.

18 Comments
by Soul Survivor on December 5, 2012  •  Permalink
Posted in bipolar illness, medical school, Mental Illness, Post Traumatic Stress Disorder, symptoms, tests, Uncategorized
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Posted by Soul Survivor on December 5, 2012

http://bipolarforlife.me/2012/12/05/crazy-people-get-sick-too/

It’s Official: I’m Crazy!

Yes, I know I’m writing on the Sabbath again.  It was a choice between that, or taking lethal doses of drugs that I have especially tucked away for the purpose, should the time come when I really can’t bear it anymore.

I went before a federal disability judge today.  He looked exactly the way I saw him in my dream last night: 40-ish, dark haired, looking beneficent in his dark robes.  If he were not so cherubic he might recall the Grim Reaper.

The hearing lasted all of fifteen minutes, quite the anticlimax for a two year span spent gathering a stack of paper charts and reports several feet thick, going to court-appointed mental health examiners, showing up at lawyer appointments, ad nauseam, and for all that not really knowing what the benefit to myself could possibly be.  I have a very nice (thank God) private disability policy that I paid for out of my pocket while I was working, and I had to fight tooth and nail to force the *&^% insurance company to pay up when I got sick, all the while so deep in depression that I could not get out of my chair, let alone fight a battle with an insurance company that would stop at nothing (including surveillance) to keep from parting with their money.  That was in the early years of the 2000′s, and I have been kept not nearly as comfortable as I was when I was working, yet certainly not starving.

And now comes my therapist and starts pushing me to apply for Social Security Disability, mostly because half of my present income goes to paying deductibles and co-payments, and she feels that the Medicare that comes with the SSD would provide substantial financial relief.

I suppose that is true.  I won’t receive more income really, because the private insurance might possibly decrease in proportion to the government payments, which won’t be much anyway because of the twelve years that I was a student becoming a doctor and did not earn enough to pay taxes.  Ironic, that.

But all of that financial stuff is not what has me writing on the Sabbath.

It is the judgement, the final judgement, and the finality of the judgement, that I am mentally disabled.  That I cannot go back to work in the profession I love, that I was so deeply in love with that I sacrificed almost everything.

I am Officially Crazy.

I feel like I should immediately take shopping bags and fill them with dirty clothes and go out on the street with my hair looking wild.

Maybe I should have a scarlet letter “C” tattooed on my forehead.

I’m glad I have an anti-suicide pact with my oldest friend (I wonder if he remembers).  It helps me to stay away from the lethal cocktail.

I wonder, will the news reach the State Medical Board, and will they take away my license?  Even though I haven’t practiced medicine since April 4, 2000, I have carefully maintained my license, religiously racking up the Continuing Medical Education points every year, even though I can no longer afford to go to the snazzy conferences that I used to go to, to learn about all kinds of tips and tricks and topics and shmooze with the colleagues, when they would speak to me: after word got around that I am mentally ill, I found myself shunned by my pediatrics chums so I took up going to surgery meetings instead, where nobody knew me and I could learn in peace.  Ah well, those were the days; they are no more.  I will never practice medicine again.  It has been too long, and the disease and the drugs have taken their toll on my cognition.

I think I’ll just keep on getting drunk tonight.  I have a pretty good start already.  I don’t like being drunk, generally speaking; but I need something to numb the pain, and I don’t dare open a pill bottle.

Crazy Person, good night.

6 Comments
by Soul Survivor on November 16, 2012  •  Permalink
Posted in bipolar illness, medical school, Mental Illness, Post Traumatic Stress Disorder, symptoms, tests, triggers
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Posted by Soul Survivor on November 16, 2012

http://bipolarforlife.me/2012/11/16/its-official-im-crazy/

Tears and Fears and Feeling Proud (thanks, Joni)

“Tears and fears and feeling proud

To say I love you, right out loud…”

–Clouds, Joni Mitchell

As much as this song has been the soundtrack to my life, so much more now.  My father is failing, day by day.  His mind is eaten full of holes by dementia.  I see the desperation in my mother’s face and for once, I feel pity for her.  And I am frightened by her own lapses, forgetfulness that goes beyond the simple effects of stress and depression that accompany her own slow motion loss.  I wonder for myself, how will I navigate this mine field alone?  There is no choice.  Certainly when the time comes when both of them are completely disabled, I will be able to enlist others from the community.  There is hospice here.  My mother started it, over twenty years ago, because there wasn’t any.  Now it will be ironic to be making use of that service.

 

No one ever thinks that they will be disabled, let alone old and disabled.  So few people make plans for that “in case.”  And yet, as one of my medical school professors put it, those of us who are still walking around with all our limbs intact are only “temporarily able bodied.”  TABs, he called us, from his wheelchair.

 

One day, coming in the door from his day as a medical student, he tripped over the door sill and fell down.  The next day he fell down again.  He kept on falling until he went to see a neurologist and was diagnosed with Multiple Sclerosis.  He was a second year medical student.   He was 28 years old.

 

He did not quit med school, but kept on going, at first with crutches, then in a wheelchair.  He did his residency in Rehabilitation Medicine.  So when the newly paralyzed, the new amputee, the new stroke patient became frustrated and wanted to say, “But you don’t know what it’s like….!”, they had to shut their mouths and get on with their therapy, for there was Dr. Mitchell in his wheelchair, looking at them and saying nothing, for nothing needed to be said.

 

My father was an exercise freak, in his day; in fact, he still is.  Until he was 83 years old (he just turned 88), he rose every morning at six and did a half hour of cardio exercise and half an hour of weight lifting.  And then he would start his day of throwing around 100 pound sacks of clay and glaze materials, always busy doing something radically physical when not seated at his potter’s wheel turning out exquisite works of ceramic art.

 

Everything he used, he made himself, from small hand tools right down to the potter’s wheels themselves, up to the huge walk-in kilns.  If he needed something made of metal, he welded it.  If he needed something electrical, he wired it.  I grew up that way, too.  He taught me to take lack as a challenge to create.  If I wanted to make a lamp out of a piece of driftwood, I went down to the hardware store, got the pieces that would make a lamp, figured out how to splice wires (they are color coded, it’s not hard), and made a lamp.  I never knew that you “couldn’t” do anything.  It was a matter of not knowing how yet.

 

So to see my father now, standing precariously balanced on his feet, with his arms completely tangled in a sweater that he couldn’t figure out how to put on: well, I can’t even express my feelings of grief and loss and sadness for him as well as for me, because he has lost the man that he built from scratch, and he is cruelly aware of it.

 

He tries hard to be philosophical.  He has always been a philosopher.  He acknowledges that there is no point in fighting it–and then he resolves to do battle with it, and he does, for a moment…then he falls asleep, or becomes disoriented, or gets distracted; and it seems that he has lost yet another rung in the ladder that only ever seems to go down, anymore.

 

But I am proud of him, nonetheless, for trying.  He does get on his exercise bicycle every few days, and there he pedals for a few minutes, and sleeps for a few minutes, and goes back to pedaling.  I made him a seat belt out of a luggage strap, because one time he fell asleep on his bike and fell off and hit his head again, and was tangled up in the pedals and arm rests besides, and my mother had a time getting him out (I wasn’t there).  So now he is very careful to put on his seat belt, because if my mother catches him without it she will give him hell, and he will do almost anything to avoid that.

 

I admit that I am afraid that I too could end up like that.  And even though my mother does give him a hard time, she is there for him.  For me, it will be different.  I have little hope of having a partner, anymore.  So I would be in some kind of “home,” as they say euphemistically.  I don’t relish that idea.  It makes me think about premature endings.  Even worse, it makes me think of being helpless and at the mercy of strangers.  I try to envision Dr. Mitchell looking at my self pity with quiet amusement; then I think about the wife that he comes home to every night and the effect vaporizes.

 

I wish I had a better ending for this post.  I love to end my pieces with something snappy, but tonight, nothing comes up.  I will have to take yet another lesson from my father and when in doubt, just keep putting one foot in front of the other.

4 Comments
by Soul Survivor on November 8, 2012  •  Permalink
Posted in bipolar illness, family, medical school, Mental Illness, Post Traumatic Stress Disorder, relationship, symptoms
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Posted by Soul Survivor on November 8, 2012

http://bipolarforlife.me/2012/11/08/tears-and-fears-and-feeling-proud-thanks-joni/

Guest post on Soul Destruction blog by Ruth Jacobs

I’m so very honored to have been asked by Ruth Jacobs who is a strong voice in the fight to dispel the “happy hooker” myth and get the story out there about what it’s really like to sell your body and with it, your soul.

I really went out on a limb with this one. If you have the intestinal fortitude to see why, click the link http://souldestructionblog.wordpress.com/voices-of-prostitution-survivors

5 Comments
by Soul Survivor on September 19, 2012  •  Permalink
Posted in family, medical school, Post Traumatic Stress Disorder, Rape, relationship, Teenage runaway, triggers
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Posted by Soul Survivor on September 19, 2012

http://bipolarforlife.me/2012/09/19/guest-post-on-xlondoncallgirls-blog/

Judge Rules In Favor of Fired Employee With Bipolar Disorder – ABC News

Judge Rules In Favor of Fired Employee With Bipolar Disorder – ABC News.

This is great.  Guy gets fired because he needs a few days off to get himself back on track, takes his employer to court for ADA violation, wins.  In the meantime he goes back to college and gets a degree in physical sciences.  No dummy, and quite functional.

I love this.  On the other hand, there are so many people with bipolar disease and other mental illnesses who are too sick to advocate for themselves the way this guy did.  Most of us would not have the focus, orientation, drive, or even enough positive self image to search out a proper lawyer and sue the bastards.

Lawyers usually want to be paid for their services.  Some will take a case on contingency, so that they get paid a percentage of the settlement if they win the case.  Therefore they will only take the case if they are very sure they will win.

I am not aware of any advocacy organization that helps people with mental illness who have lost their jobs or been denied employment due to their disabilities.  If any of you, dear readers, know of such a thing, please educate me and everybody else who reads this blog.  What we need is a one-phone-call hotline that can match people who have been discriminated against with appropriate legal resources.

I’m sure that if this were the case, employers would be much more careful about discriminating against people with mental illness, especially when the people in question are perfectly capable of doing the job in question.  Yes, we may need some accommodation, such as sick day allowances, but this certainly does not differ from the needs of anyone with a chronic illness of any kind.

It’s true that there is discrimination against people with chronic diseases of the “physical” kind.  I know of people with kidney disease who need to go to dialysis two or three times a week, who have been terminated from their jobs.  True, they are physically incapable of holding down a 40 hour a week job, but there are many cases where part time positions have been available yet the persons were denied.  Of course the reasons for denial are trumped up, because it is officially illegal to deny someone employment strictly on the basis of a disability, as long as they are capable of performing the tasks of the job.

The result of the denial of employment to people with mental and physical illness is the staggering epidemic of people on disability.  As a person who relies on disability payments for my livelihood, one would think that I would be the last person to complain.  However, if my work environment and the culture of my profession were tolerant of my needs to attend therapy, observe regular working hours rather than shift work and an 80 hour work week, and take a day or two off every once in a while (and by this I mean every 6 or 8 months) to get my center of balance back under me, I would still be working.

However, the world of medical doctors is built upon a mythology of superiority:  physical, intellectual, and psychological.  Thus, medical residents are subjected to the hazing ritual of 36 hour shifts and 120 hour work weeks.  If you survive that, you are welcomed into the hallowed halls of the elite.

I will never forget running into one of my former teachers at a medical conference, long after I had graduated and was running a large pediatric emergency center.  She asked me how I was doing.  I replied, “To tell you the truth, I’ve been suffering a bit from depression.”  Her face closed up as if a curtain had come down.  She turned on her heel and walked off without saying a word.  From that moment I knew that having a mental illness was taboo in “our world,” and I never mentioned it again, to my great detriment.

A few years later, a colleague who worked alongside me came up to me and whispered that he was feeling a bit depressed, and could I write him a prescription?  This was a man who was an Air Force veteran of the first Gulf War.  He had headed up a commando unit that had rescued premature babies from a hospital in Kuwait that had been occupied and all the doctors and nurses killed.  He was a hero of the highest order.

I told him I would give him a week’s worth of Prozac on the strict condition that he see a psychiatrist.  He said he was afraid that the administration would find out and fire him.  I told him he had no choice but to see a psychiatrist, and that I would keep an eye on him and make sure he did.

The following week I was called in to work early, to cover this young doctor’s shift.  He had locked himself in a motel room and shot himself, because he was depressed and felt helpless and hopeless, and he was afraid of losing his job because of his condition.  It was a senseless tragedy, a loss of a wonderful human being and a brilliant doctor, because of a hostile professional culture.

I’m looking forward to seeing an article in the paper about a physician successfully suing their employer for discrimination against them due to mental illness.

8 Comments
by Soul Survivor on May 23, 2012  •  Permalink
Posted in bipolar illness, medical school, Mental Illness, Post Traumatic Stress Disorder, Recovery, Uncategorized
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Posted by Soul Survivor on May 23, 2012

http://bipolarforlife.me/2012/05/23/judge-rules-in-favor-of-fired-employee-with-bipolar-disorder-abc-news/

The Psychiatrist and the Lightbulb

The husband and wife sat stiffly, as far apart on the stiff divan as the laws of physics would allow. The intervening silence froze the air.

“Well?” the cordial voice of the psychiatrist punched through the waiting silence, and it shattered and fell tinkling to the office floor. The man glared at him malevolently. The woman raised her eyebrows and nodded to the psychiatrist knowingly, while making a barely perceptible motion with her chin in her husband’s direction.

“I SAW that, Gladys!” the man accused angrily, rising slightly from the couch and shifting to face his wife. Gladys sat up primly, pursed her lips and folded her hands, gazing straight ahead beneath hooded eyes, her blue permanent curls trembling slightly.

“Now,” said the psychiatrist soothingly, “why don’t we start at the beginning?” And as there was no offer of a beginning, he took the more direct approach and asked the man:

“What brings us in here, today?”

“What brings US in here today,” snarled the husband, “is my WIFE! If you want to know why we’re here, ask HER, since she knows so much.” And he shut his mouth with a snap that could be heard all across the office.

Even I heard it, and I was just a second year medical student. This was my first time observing a psychiatric office visit, and it was turning out to be much more interesting than I had expected.

The psychiatrist sighed and tried again.

“Well, Mrs. Jones, why did you accompany your husband here today?”

“Thank you, Dr. Smedley. As you know, I had to lie to get him here, and he’s awful mad about that.” Mr. Jones snorted like a bull. “You can say THAT again. That’s the last time I fall for THAT line of__”

“Mr. Jones,” purred Dr. Smedley, “Your wife is only concerned for your well being.” Mr. Jones fell into a seething silence and glared at the doctor from behind thick black-rimmed glasses that made his eyes look twice as big as they actually were.

“Now, Mrs. Jones, if you would like to tell us all here what you told me on the telephone, I think that might be a good way to begin.”

“Well,” began Mrs. Jones uncertainly, darting anxious glances in the direction of her husband, who seemed to be occupying himself by entraining a psychic death-ray in her general direction, “It all began a few months ago when Gerald here started talking to the light bulbs.”

“I wasn’t talking to the lightbulbs, you little idiot, I was talking to the ALIENS who use the lightbulbs as an instrument of communication!” Gerald exploded, spraying saliva all over everything in his immediate vicinity. I had instinctively jumped back, but Dr. Smedley was wiping his eyeglasses with his pocket handkerchief.

Mrs. Jones simply nodded, shrugged her shoulders a bit and raised her palm as if to say, you see? This is what I’m talking about. Dr. Smedley frowned, scribbling furiously on his steno pad.

“Mr. Jones, may I call you Gerald? Thank you. Gerald, how long have you had this delusion that aliens are communicating with you through the light bulbs?”

“Delusion? DELUSION? What kind of an idiot do you think I am? Better yet, what kind of an idiot are YOU? HAH! YOU’RE the kind that they would NEVER speak to, so of course you don’t know. Of course you think it’s a delusion, because you’re a petty, ignorant little pissant that aliens wouldn’t waste their precious time on. And their time IS precious, too.”

Gerald climbed up and stood on the arm of the divan, directly beneath the ceiling light fixture, and cocked his head to bring his ear closer to the bulb. He closed his eyes and listened, nodding his head vigorously from time to time. His wife wept silently at the other end of the divan.

Here I got a little excited, hoping that he would go on and tell us more about the lives of aliens and their experience of time, but my hopes were dashed.

“Gerald. Please sit down. Now, I am about to demonstrate something about the nature of light bulbs, and I hope that after I show you this, you will be able to understand that light bulbs do nothing more than convert electricity into light. They are not capable of transmitting sound or any other kind of means of communication.” Dr. Smedley opened his desk drawer and produced a light bulb and a hammer.

Gerald’s eyes grew large with fear. “No. Doc, please. Please don’t do it. Those are very important. They contain essential classified secret emissions.” Dr. Smedley wrapped the bulb carefully in a tea towel. “No, Doc, you don’t understand. Once you bust those things, it’s all over. All is lost. You can’t go back—” CRUNCH! With a satisfied smile, Dr. Smedley carefully unwrapped the tea towel to reveal the shards of the light bulb, its now naked element quivering in shame.

“Do you see now, Gerald? This is nothing more than a piece of tungsten metal attached to a special piece of glass. No one could possibly use this as a communication device, even if there WERE aliens,” he said kindly.

“Gladys, get up. We’re going. This man is dangerously insane.” Gerald collected his wife and hustled her out the door. She kept her eyes down, this time, no longer seeking the eyes of Dr. Smedley. He had discredited himself a little, I think.

“Well now, what did you think of THAT for your first outpatient psychiatry case?” Dr. Smedley turned his high beams on me.

“Well,” I began carefully, “personally, I really wanted to hear more about the aliens in the lightbulbs. Like, what did they say to him, and how often did he talk to them, that sort of thing.”

“Ms. L_,” Dr. Smedley glared at me. “Aliens do NOT talk to people through light bulbs!”

I knew I was pushing it but I had to advance my case. “Dr. Smedley, isn’t it true that each person experiences reality in his own unique way?”

He nodded, “Of course.”

“In that case, is it not possible that this man’s reality happens to be that aliens communicate with him through the lightbulbs? I mean, whether or not this is the objective truth, it’s still his reality, right? So who are we to argue with him about what is real or not real for HIM?”

As I delivered my speech, I observed Dr. Smedley becoming redder and redder in the face, but somehow I could not stop myself. All of the outrage that had been building pressure during the absurd and degrading occurrences of the interview with the Joneses came pouring out all at once. I felt suddenly, triumphantly, at peace.

But oh, no! What’s this? Dr. Smedley climbing upon his desk–where just five minutes before Gerald had stood upon the divan—and Dr. Smedley is jabbing his forefinger at me, for emphasis, and shouting “WE—ARE—THE–AGENTS–OF–REALITY!” Over and over, again and again. WE. ARE. THE. AGENTS. OF. REALITY!

Aghast, I backed slowly out of the room and closed the door, never to return. Just like Gerald and Gladys Jones.

THE END

Postscript~with very little poetic license, this is a true chronicle of the first day of my psychiatry rotation in medical school, in 1983.  Proving, once again, that truth IS stranger than fiction.

 

ⓒ 2012 Laura P. Schulman, all rights reserved. All reproduction without express written permission of the author is prohibited.

 

9 Comments
by Soul Survivor on January 2, 2012  •  Permalink
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Posted by Soul Survivor on January 2, 2012

http://bipolarforlife.me/2012/01/02/the-psychiatrist-and-the-lightbulb/

Short Story: Carotid Surgery

WARNING:  IF YOU ARE SQUEAMISH OR FEEL THAT YOU MIGHT BE UNSTABLE TODAY, PLEASE DO NOT READ THIS NOW.

 

There’s a good reason women make the best surgeons, she thought. Quick, deft hands, single-pointed concentration, focus. She thought of the women jet engine mechanics she had met in the Air Force. Not that she had been in the Air Force; but in the course of her duties she had met them.

Now, however, she was intent on the task at hand. Drat this light, she thought. She really needed a more direct light source, but one has to work with what one has at hand.

Slowly, painstakingly, she drew the outlines with a surgical marker: carotid triangle; carotid vein; carotid artery. This, the artery, was what she wanted.

She steadied the syringe she had readied with an oh-so-fine needle: 27 gauge. 2% lidocaine with epinephrine. Enough analgesia for comfort, and enough epi to ensure a relatively bloodless field. She couldn’t help chuckling: bloodless indeed.

Squinting in the insufficient light, she injected the layers: first the skin, then the loose fascia of the neck. Lastly, the layer surrounding the vessels of the neck, careful to avoid direct injection into the wall of the vessel, which might cause a spasm.

Now it was time to cut. She picked up the number 11 scalpel and steadied her hand. Carefully, carefully opening the delicate skin of the neck, noting with satisfaction that the epinephrine had done its job. There was no need for the tiny hemostats she had ready, in case of superficial bleeders. The next layer, the loose fascia, pulsated bluish, overlying the great vessels of the neck. These she would blunt dissect with the larger curved hemostats, just teasing away the delicate layers of gauzy tissue to expose the artery. She injected a bit more of the anesthetic, just to be sure. No need to cause discomfort, which might result in involuntary movement.

At last the artery was exposed. She marveled at its pulsations, at the tiny arteries that nourished the big one, and the miniscule veins that issued from it, carrying its waste into the larger system of veins, to be cleansed by the liver and kidneys downstream.

Holding her breath, she slid the first hemostat jaws open, under the artery. Clamp. The vessel, trapped in the jaws of the clamp, stopped pulsing abruptly. There was no going back now. Now the second hemostat, exactly one and a half centimeters below the first: clamp. She raised the surgical scissors, poised for the definitive cut between the clamps.

Tilting her head to see better in the mirror, she cursed the dim light in that bathroom again. And then, the definitive cut! She removed the two clamps and was instantly drenched in red liquid.

A scream of agony splits the night as she sits bolt upright in the bed, heart pounding, drenched in sweat, clutching the sodden bedclothes as she struggles, locked in the arms of the Angel of Death like biblical Jacob.

Frantically clutching her throat, she rushes to the bathroom, the very same bathroom, and strains toward the mirror in the same dim light.

Nothing. Her throat, graceful and bluish white as ever, shone back at her from the reflection.

Sucking in a deep gulp of air, letting it out in a sigh that brought the dog running, she splashed water on her face and neck, toweling off the sweat.

“It’s OK, buddy,” she whispered to her whining canine companion, “just another nightmare.” The dog smiled anxiously, wagged his tail tentatively, and licked her calf. She reached down and patted his faithful head.

“Good thing I have you,” she murmured. Stripping off her sweat-soaked nightgown, she rinsed off in the shower before throwing on a fresh one. She sank into the recliner with a book: sleep would not visit her again, tonight.

ⓒ 2012 Laura P. Schulman, all rights reserved. Reproduction in any form prohibited without express written permission from the author.

4 Comments
by Soul Survivor on January 1, 2012  •  Permalink
Posted in bipolar illness, medical school, Mental Illness, Post Traumatic Stress Disorder, psychiatric service dog, Uncategorized
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Posted by Soul Survivor on January 1, 2012

http://bipolarforlife.me/2012/01/01/short-story-carotid-surgery/

Stigma 101

Shalom, friends.  I have been thinking about my lost professional life a lot lately, as I have been working on my NaNoWriMo novel, which is loosely autobiographical.  NaNoWriMo means “National Novel Writing Month.”  It takes place every November.  It’s an organized event wherein several thousand crazed writers attempt to rough out a 50,000 word novel in a month.  It’s wicked fun.

This is my second year doing it.  So far I haven’t managed to get to the finish point, but what the heck.  I’ve learned a lot.  And who’s to say I won’t do it this year?  Oh all right, it’s November 19th and I’ve only got 20,000 words down.  You never know.

As I was saying, my novel is “loosely” autobiographical.  Deals with a, you know, woman pediatric emergency physician who, etc. etc. (I won’t tell you the plot yet, as I am still struggling to get a strangle hold on it myself and don’t want it to slip me a mickey while I’m sneaking up on it).

One of the things I have not done with my protagonist/heroine is to make her bipolar.  I just realized that tonight, while sitting down to write this post.  How extremely odd!  Imagine, if I had copped to the fact that she is bipolar from word one, I probably would have topped 50,000 by now!

Why haven’t I done it?  One word suffices:  Stigma.

I lived my entire career petrified that someone would find out.  Because in my personal experience, once a physician (psychiatrists excluded) has a known psychiatric diagnosis, s/he may as well pack up the old kit bag and light a shuck for Somewhere Else.  Wherever that is.  Because there is nothing that will turn one’s colleagues into non-colleagues faster than a psych diagnosis.

Once I ran into a former mentor from my pediatrics residency program during intermission at an American Academy of Pediatrics meeting.  She asked how I was doing.  For some odd reason, the words that exited my mouth were, “Actually, I’ve been struggling a bit with depression.”  Her mouth snapped shut and she did an abrupt about-face, and was off into the crowd faster than you could say “Stigma.”

The fear of discovery of my condition actually lead to my downfall, as I often went without treatment rather than take the risk of disclosure.  When I did get treatment, I paid out of pocket for my psychiatric visits, therapy, and meds, so that they would not be on my insurance records.

How strange that I found myself envying an alcoholic colleague, whose stints in rehab were looked upon with broad approval by all of our colleagues, when I was unable to disclose my own disability because those same colleagues had nothing but nasty talk about another of our brethren who had taken time off to deal with an episode of mania!

I’ve read several blogs by other physicians with affective disorders, and a common thread is the need to keep their condition secret, trying to juggle heavy meds with 27 or 30 hour shifts, all the while trying to keep the old brain between the ditches and function in the 99th percentile.

And I know some of you who are reading this are doing the same thing, being very careful that no one suspects that you have a “diagnosis.”

How long are we going to keep this charade up?  For me, it’s too late.  I’m out of the game.  But it makes me sick to think that my brothers and sisters who are physicians, teachers, and other professionals who deal with the public on a day to day basis, are not free to just “be themselves” but have to be very careful not to inadvertently “disclose.”

No, I wouldn’t have wanted all of my patients to know I’m bipolar.  But for some of them, it would have been a big boost if they could see that even doctors can be bipolar.  Kind of like having an endocrinologist who’s diabetic.  See, diabetic kids can grow up and become doctors, too!  Bipolar kids can grow up and be doctors, teachers, lawyers, folk singers!  Folk singers?  Oh, never mind.  You catch my drift.

 

13 Comments
by Soul Survivor on November 20, 2011  •  Permalink
Posted in bipolar illness, medical school, Mental Illness
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Posted by Soul Survivor on November 20, 2011

http://bipolarforlife.me/2011/11/20/stigma-101/

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