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.

 

Pomegranate Juice Lowers Cardiovascular Risk Factors (mobile format)

http://www.medscape.com

/viewarticle/753476?sssdmh=dm1.734116&src=nldne

Good clinical evidence from Israel, where everyone drinks fresh squeezed pomegranate juice, that the stuff is really good for you.

What goes around

I’ve been on a real down swing the past few days.  I want to blame it on the fact that my shrink insisted that the Lamectil was responsible for certain very unpleasant sensations that accompanied my last “mixed state” decompensation.  He maintains that the Lamectil was “feeding” the high side, causing my usual state of insomnia to become drug-resistant and all the rest of the unpleasantness to become worse.

Well, I don’t know if I agree with him on that one or not.  But my state of un-comfortability being what it was, I was willing to give him the benefit of the doubt and try decreasing the Lamectil.  It seemed to help, I think; yet, given the alphabet soup of drugs that I have been taking in order to quell the screams of my tortured nervous system, I can’t vouch that THAT particular tweak was “the one.”

Anyway.  The point is that I have been in a depressed state for the last few days, which accounts for the sparsity of blog posts.  My diet has spiralled down to ice cream and potato chips, which are really the only things my mouth vaguely desires.  I suppose if someone else were to prepare me a delicious AND kosher meal I would eat it; but I can’t guarantee that I would be able to tell you what it tasted like, because when I’m depressed my taste buds go on vacation, along with all the rest of my senses.  If it wasn’t such an unpleasant feeling, I might go, “Oh, just what I needed, a little vacation.”

Luckily I have kept on doing this for such a long time, I’ve come to understand that if I just keep on keepin’ on for long enough, I WILL feel better.  I hope. Or at the very least, I’ll feel DIFFERENT.  Which is in itself a kind of relief.  And I have started taking more Lamectil.

The main thing is to keep. On. Breathing.  One breath at a time.  Because, you know, sometimes “one day at a time” is way, way too much to bear.

Now there’s something I want to say that just doesn’t seem to want to come out just the way I want it.  So I’ll start this way:  to those of you who have sent me heartbreakingly beautiful emails, sharing their responses to things I have written here, I want to tell you that your words have lifted me up and given my heart the will to keep on taking its one breath at a time, one heartbeat at a time.  I could never have dreamed that anything I would say would affect anyone so deeply.  I am awed and yes, frightened by the prospect that anyone would take my words to heart, or that my own experiences would resonate so profoundly.

Yet, in reading your emails, both posted here and sent privately, I have found myself also deeply moved, sitting here pouring tears, resonating with your experiences as you did with mine.

So I think there might be something to this sharing thing.  We can lift each other up on the wings of eagles.  I bless you all.

Full moon, empty brain

The moon is glorious tonight.  I watched it rising over the ridge opposite my little cabin, clearing the cluster of dwellings wherein lie the miniature dachshund family, the hound dog puppy that is growing bigger and louder every day, the chicken lady and her chickens, many fewer roosters than there used to be because they shot (yes, shot) and ate a bunch of them (they had 8 roosters, far too many), the guinea fowl that shriek like banshees…in short, the small village full of critters and the people who take care of them, that live in the little hollow across the road from me.

I have been attempting to jump-start my brain tonight.  It doesn’t want to kick into gear.  I try to think about something, and the next thing I know, I’m not thinking of anything at all.  I start a task, and what seems like moments later I find myself doing something entirely different, and it’s two hours later.

How does this happen?

One advantage is that I can’t seem to get too upset about it, because my brain can’t stay on task long enough for even that.  Well, that’s a blessing, I suppose.  I have to thank G-d for that, because otherwise I’d just go from being insane to being crazy.

Speaking of labels, I’m astounded by the level of stigma that still exists out there.  I see it everywhere in the media.  Maybe I’m just paranoid.  “Just” paranoid?  No.  It’s real.  It exists.  As real as the nose on my face.

The other day a family friend visited us.  This friend had a cancerous lesion on his nose and his ear, and he had to have quite radical surgery to remove the cancer.  He has subsequently had numerous surgeries to reconstruct his face.

His surgery team did a great job.  You really can’t see any sign of the reconstruction unless he’s in direct light.  Then you can see the “seams” where they put him back together.

But he’s hyperaware of the difference between his face now and his face before the cancer.  He feels like people stare at him.  His wife shared a story about some rude lady who did notice his scars and said, “What happened to your FACE?”  Isn’t that everybody’s worst nightmare?  To have your face look wierd, and have people notice it?

I feel that way about my brain.  If people could only see the way my brain feels to me, they’d say, “What happened to your BRAIN?”   And I find myself wondering, “Can they tell?  Do they know how weird my thinking is right now?   Can they see my Face, the one with all the scars?   But that scarred Face is  on the inside.  The one on the outside seems to look perfectly “normal.”

In a way, it heightens my connection with my dad, who has dementia as a result of his 50-plus year dance with diabetes.  Unlike people with Alzheimer’s-type dementia, Dad is very much aware of the malfunctioning of his brain.  It causes him great distress.  Dad is a brilliant man with a broken brain, and he knows it.

We spend every Wednesday together:  it’s Mom’s day off.  Dad and I very much enjoy our Wednesdays.  Some days are better than others, of course.  And that depends entirely on how both of our brains are functioning.

This past Wednesday we had our little moments, when neither of us understood the other at all.  This led to a bit of mental scuffling, as we each tried to wrap our warped brain around both our own thoughts and the other’s.  But we got it worked out.  It was all because I had to get Dad to take a shower and get dressed, ideally before Mom got home, because they were invited out that night.  And I only had five hours in which to get that accomplished.

It was a little like steering a boat in a quarter sea.  The boat pitched to and fro, and side to side, and my job was to keep it going straight, on course.  Well, we did get there.  Not exactly on time, but close enough for jazz.

Dad used to give me a very hard time about why I wasn’t “doing something with my life.”  Before he got sick himself, he just didn’t understand.  He thought that I had somehow turned lazy, content to do nothing and “live on the dole.”

Unfortunately, now he knows all too well why I never seem to get anything done.

Nature News Special : The Autism Enigma

http://www.nature.com/news/specials/autism/index.html?WT.ec_id=NEWS-20111108

Here is a wonderful collection of cutting-edge articles on autism research.

“Half in love with easeful death….”

Darkling I listen; and, for many a time

I have been half in love with easeful Death,

Call’d him soft names in many a mused rhyme,

To take into the air my quiet breath;  (Ode to a Nightingale, John Keats)

I’m doing this NaNoWriMo write-a-novel-in-thirty-days thing.  It’s quite an exercise, for a non-fiction writer like me to just throw my hat into a fictitious ring and say, “whatever comes out, comes out.”

Last night after Shabbos I went back into my manuscript frenzy and got over the 5000 word hump.  Then I noticed something odd:  every one of the characters in my novel is modeled after someone in my life who has died violently.  One of my protagonists is even an amalgam of two different men who committed suicide by shooting themselves.

The two children in the plot, I knew from their very beginnings.

The Pretzel Lady cadaver plays herself.  I hope she is now resting in a lot more peace than I gave her, poor thing.  She was my cadaver in medical school.

I wonder if other novelists resort to such macabre strategies, mining their lives for dead people to resurrect?  But surely most people don’t know so many dead people as I do.  Or do they?

I’m not talking about the “normal” kind of death that impacts everyone’s life sooner or later.  It is natural for grandparents, and then parents, to age and die.  It is also natural for people to have long terminal illnesses, and then die.

What I’m talking about is specifically suicide, homicide, and accidental death.  The kind of thing an emergency room doctor sees over and over again.  In fact, when you see these things on a daily basis, they begin to populate your thoughts and your dreams.  So why shouldn’t they populate a novel, should you chance to write one?

It is the most natural thing on earth, for me anyway.  If I need a life to put down on paper, I reach out into my catalog of lives that have been shucked off like overcoats no longer needed.  But I’m sensing that I need to put a stop to this thread, because my mind in its current state could easily begin to perseverate on ideas far more unhealthy than these that I’ve already trotted out.

What goes up…

Oh I was so enjoying the past few days of creativity, productivity, sociability, all sorts of -ilities.  Should have used some of the energy to clean my house….but I was too busy writing my novel, which I think is going to be wonderful (and not just according to hypomanic me).

I used to write reams of poetry when depressed, only to throw it out when hypomanic;  and vice versa.  Now I haven’t written a poem in thirty years.  Nevertheless I have learned that the feelings that I feel are real, whether for up or for down.  And I don’t discount them.

My excellent psychiatrist says that just in the same way some people have sensitive lungs or sensitive stomachs, some people have sensitive brains.  Even if I were not a sensitive-braniac, I would still agree with him.  I’m sure many of you will have what to say about this.

Now it is late on Friday afternoon, and I am finishing my Shabbat preparations, which are not elaborate because I have felt like I’m swimming in a sea of cold molasses all day.  Maybe tomorrow will be better, and if not, at least it will be Shabbos and i can just do what Jews are commanded to do on Shabbos:  rest.

Good Shabbos!

Time and Novel(ty)

I’m on the upswing, and hope it’s for the better. Lithium is my friend, even though it does make my hands shake, my muscles weak, my depth perception non-existent, and my brain even foggier than it normally is. I’m counting on you, Lithium, to keep me between the ditches here. I just don’t want to end up in one of those horrid mixed states, where everything feels horrible all over, body, mind, soul, everything. I had a nasty one of those recently, I think about two months ago. You see, when these things come upon me, even time goes out the window. I have to count empty medicine bottles to see how many refills of Seroquel I’ve had, to know how many months this has been going on. Two, I’m pretty sure. I’m weaning down on the Seroquel now, and my body is wanting less of it. My shrink tells me I’m the best judge of what to take and when. It’s kind of annoying. I’d really like someone to just KNOW what to do about this stuff, and TELL me what I should do. And yet he’s right. He doesn’t know how I feel. Only I do. And that’s why I’ve kept him on my team for over ten years.

Now. It’s about this novel. It’s November. That means I’m in NaNoWriMo mode. National Novel Writing Month, where thousands of similarly obsessed individuals band together to support each other in writing a 50,000 word novel in 31 days. This is my second time through it. Last year I got to 20,000 words and had to bail out to move from Jerusalem to North Carolina to help my parents.

This year I’m IN North Carolina, and I’ve started my novel.

My life is so full of dramatic stories, they crowd and jostle each other for attention. I’ve written hundreds of them down, have a memoir in progress, and yet have never published anything except for one article in The Jewish Press that I sent in as a letter to the editor and they decided to publish it on the front page.

But fiction? My life has been so full of drama, what need have I had for dreaming up fiction? My life, if published just as it is, would rival any made-up story.

So yesterday, November 1st, I took a bunch of my life’s stories, shook them up together, threw them up in the air, and began to write. Heavens! The things that came out! Bits from here attached themselves to bits from there. I wrote frantically to get them onto the screen as fast as they were falling out of the air.

And two hours later, I came to a halt. I looked at the screen. It was the end of a chapter. Chapter one.

Today I started anew. Oh my goodness, things that have been bothering me for years and years, injustices and incongruities, working themselves out as if by magic on the screen! This is interesting, not even trying to “create,” but letting the stories tell themselves in their own terms.

Certainly this will have to become “work” at some point. I can’t expect to just throw things up in the air and let them come down into print for twenty-nine more days without a hitch. We shall see.

And in the meantime, pray that my brain behaves itself.

Fuzzy Muzzy was also a Day

Someone called my cell phone at 8:30 this morning, disrupting my sleep cycle.  Although they certainly had no intention of causing any harm, the net result is that my brain is so scrambled today that even hours later I am struggling with the otherwise usually automatic task of making pancakes.  Today the process has deconstructed itself to the point where the first one contained neither eggs, oil, salt, or baking powder, let alone vanilla.  I think the last one of the batch might be edible, if I don’t let it burn beyond recognition.  I think I’ll try to eat one now; it’s already after one o’clock.

Labels and Identities, Part Three (and then some)

I loved medical school so much that I was never even aware of the fact of “being a medical student.” I was too busy being it it, doing it, loving it, being in love with it.

Nevertheless, I had a sense of solidity that I had never experienced before. With my dual degree program came huge financial commitments, and great opportunities. I applied for and got many kinds of grants and fellowships, some as large as $10,000 and some as small as $300. They all added up, and each one was a feather in my cap.

There were jobs, too. The first years were a patchwork of lab jobs, hospital grunt work, general go-fer gigs for the administration. Then I settled into my niche of tutoring and educational program development. I helped design and implement a model of teaching medical communication skills to new doctors, and a testing tool to evaluate its effectiveness. Faced with an embarrassingly inadequate human sexuality module in our med school, I complained, and was given the green light to develop the ideal one. Med school was “heaven on a stick,” to borrow a phrase.

My marriage surpassed any expectations I could have had, if I was the type to have expectations, and I’m not. I could never have imagined the satisfaction that bloomed from the cultivation of cooperation and intimacy between two people in love with each other and with their respective and mutual work, for we shared certain teaching and administrative duties in the school. We were a team. We were even asked to write an article for the medical school journal on the art of cooperation and compromise.

I got pregnant during the fourth year of my six year program. It was not overtly planned. But since we were using the Cooperative Method of Fertility Awareness Family Planning (another of my hats, since I was a certified teacher and taught in the Student Gynecology Clinic) which required both partners to be clearly aware of where the woman is in her fertility cycle, we KNEW I was fertile and the predictable outcome did in fact result. It took us both a few minutes to get used to the idea, and then we were elated.

I was in the midst of a long subinternship in surgery at that time. A subinternship is just like an internship, except you don’t get paid. You work the same long hours, take the same night call, have the same responsibilities as an intern. Our med school supplied students to a chronically understaffed VA hospital, and there were many excellent subinternship opportunities there. It really was a great thing to do as a student in surgery. At the private hospitals, the best a medical student could hope to do in surgery was stand on a stool at the back of a crowd hoping to get a look at the surgeon working. If you were really lucky, you might get a turn holding retractors, which meant you could actually see the operation in progress.

As a subintern at the VA, I worked one on one with each of two foreign doctors. Dr. Duy was a marvelously skilled Vietnamese surgeon, French trained, with nimble fingers and a gift for teaching. The first day, he taught me how to tie surgical knots one-handed with both my right and my left hand. I still use some of the skills he gave me, even though I haven’t done surgery in more than ten years.

The other surgeon was a North Korean. He was a coarse brute who caused unutterable pain and suffering. I don’t remember his name, thank G@d

My jobs included assisting the surgeon in the evaluation of the patient, preparing the operative site, and if it was an abdominal surgery, opening the abdomen and preparing the operative field. After the surgeon had finished in the abdomen, my job was to close the layers of the abdominal cavity and finally the skin. We had a grumpy old anesthetist: if he thought I was taking too long sewing the patient up, he would “lighten up” the anesthesia so that the patient would start to cough. The old bastard.

One morning I went into the operating room and found the doors propped open. “What’s this?” I asked the nurse. “Why are the doors propped open?”

“We’ve got a leak in the anesthesia machine,” she told me. “Until they get it fixed we’re gonna have to operate with the doors open.” Oh, I though, this way we’ll only be half as anesthetized as the patients.

I inhaled Halothane along with everyone else for the next four weeks. And then, one week after I finished that rotation and went on to the next one, I miscarried. I was ten weeks along.

I had no idea how attached I had grown to that little nubbin of life that was growing inside me. I absolutely fell apart. I couldn’t function. The clinical rotation I had just started was, of all things, Obstetrics and Gynecology. I couldn’t set foot on the ward for a week after the miscarriage. I just lay in the bed and cried.

The dean ran interference for me and spoke to the OB/GYN director, who was a woman. She was the daughter of the senior OB/GYN in that town, and had joined her father’s practice. She had a strong academic background, loved power, and used it freely.

When I finally got my feet back under me I made an appointment to speak with her, for I had already missed the whole first week of my eight week rotation. I knocked on her door.

“Come in,” she called. I entered the sleek wood office. She sat writing at an expansive desk. “I heard what happened,” she said, not bothering to raise her head and look at me. “It won’t affect your grade.”

I waited for whatever came next, but it never came, so I waited some more, not knowing what she expected of me.

“You can go now,” she said to her desk, still scribbling, “The nurse will give you your assignment.”

I wandered back out into the hall, feeling very unsure of myself, and was greeted by a large and cheerful nurse who ushered me down a hall and into a clean green room whose only features were a GYN exam table, an exam light, a wheeled stool, a kick bucket (the kind on wheels that you position with your feet, that’s why it’s called a “kick bucket”), and a room divider screen, with whatever was behind it.

Not too long afterwards, the door opened again and the same nurse brought in a gowned woman, and asked her to make herself comfortable on the table. The nurse positioned the woman and left her alone with me. There was an awkward silence, since we had not been introduced.

Five minutes later the door opened again, and this time it was Dr. S. and an entourage: an intern, a resident, and another medical student. Dr. S. began to talk to the woman on the table, and intermittently explaining a thing or two to the entourage. I felt like a ghost, since no one had acknowledged my existence since the nurse had put me in there to begin with.

Next thing I knew, objects were being retrieved from behind the room divider. A tray with sterilized instruments on it. And a machine that looked like….a vacuum. It was a vacuum. For performing abortions. My stomach contorted. I begged pardon, and stumbled from the room, under the searing glare of Dr. S……