Happy Western New Year

I never remember whether you call the calendar Gregorian, after Pope Gregory, whom I never liked much, or Julian, after Julius Caesar, who was worse in some ways and better in others.  It must be Gregorian because of the time thing.

Oh, that time thing!  It has been playing tricks on me lately.

Taxi Dog reminded me that I haven’t written a post in two weeks.  Part of that is due to my mother’s contracting a wracking case of bronchitis.  She was just coming down with laryngitis when I pitched her a curve by throwing her a gigantic surprise party for her 85th birthday.  I’m sorry to say that she had such a good time that the infection got into her lungs and she got right sick with it.  She’s better now, B”H (Baruch Ha’Shem=Thank G@d).  But it took quite a bit of nursing, and taking care of Dad who is forgetting how to do a lot of things nowadays, and going to the grocery store and providing dinners.

My parents, who are 85 and 87, live at the end of a dirt road which is at the end of another dirt road which leads to a road that is not on most maps.  They built their house out there when they were young and hale and romantic.  Now they’re none of the above.  Well, maybe some romantic.  And my mom gets around better than many people 20 years her junior.  She’s more than determined.  Last year she climbed out the second story windows in order to sweep branches off the roof.  But she was only 84 then.

Things keep falling off the house.  One of the early symptoms of my dad’s dementia was that he developed an aversion to having anything repaired, because he had a delusion that they didn’t have enough money.  And he was used to fixing things himself, even though he rarely actually did much of it.  He was too busy dreaming and making astonishing art that bubbled up from the depths of his dreams.  Now he still dreams, but he can’t do anything about it because his brain has betrayed him.  And he’s given up trying to control things, so when, for instance, a big branch impaled the tin roof during a wind storm, my mom just called a roofer and had it repaired, just like that.

I have been struggling with foolish things, like trying to get the dishes done, making my bed, putting away the clean laundry.  I get just so far, and then something else calls me, breaks my attention, and there you go.  But it’s not ADD.  Oh, no.  Shrinks have dosed me up on stimulants and I have gotten a terrible case of the creepy crawlies.  I remember that feeling from juvenile adventures with LSD that was cut with meth.  Now why on earth would anyone take speed for fun?  Ugh.  Even my son, who really does have ADD, says the stimulants make him feel creepy, even though they help immensely.

He started Ritalin in second grade.  It made the difference between a kid who cried a lot, got into fights, and couldn’t sleep, and a kid who enjoyed life, got straight A’s, and loved school.  The problem was, he had a mom who often forgot to give him his morning dose.  His teacher would call me at about ten o’clock:  “Doctor, did you forget to give C__ his Ritalin this morning?”  Luckily his school had a nurse who was willing to give him his AM dose as well as his after lunch dose (those were the days before time release), so he just went to the infirmary as soon as he got to school every day.

As a pediatrician, I often treated kids who were referred by the school or their parents for ADD.  In those days there was still such a thing as sugar pills, so I’d give them a two week supply of sugar pills labelled “A” and a two  week supply of Ritalin labelled “B.”  They were to give medicine “A” for two weeks, then switch to medicine “B.”  Both the teacher and the parent filled out daily questionnaires rating attention.  Then they’d return to me with their questionnaires and we’d see whether the Ritalin had made any difference compared to placebo (medicine “A”).

Sometimes I’d get a kid who had a weird reaction to the Ritalin.  Instead of becoming more focused and less frustrated, they’d become tearful and just fall apart.  Those were kids with Bipolar Disorder.

In those days there were very few psychiatrists willing to diagnose Bipolar in a child under 16.  Even fewer willing to treat with Lithium, because there was little research published, it was not FDA approved for under 16, and of course Lithium is a potentially toxic substance.

But if I had a kid who was moody and weepy one minute and aggressive and smashing things the next, or staying up all night playing Demolition Derby with Tonka Toys, you bet I treated with Lithium.   I think I might have had four or five kids like this in my sixteen years of practice.  It was magical to see these kids go from miserable and constantly being scolded to happy and relaxed, just being kids.  And you can imagine how relieved the parents were.

I think about those kids from time to time, and hope their lives were smooth, and that the magic Vitamin L made everything all fine for them, Happily Ever After, The End.  But I doubt it.  Life is not that simple.

So: not all attention problems are ADD, or ADHD, as people like to lump things today.  Bipolar Dis-ease can wreak havoc on your attentional abilities.  Weeks can go by, and you can even forget that you are writing a blog.  Thank G-d for friends from afar who are concerned enough to drop a line and say, “Are you all right?”  Thank you, Taxi Dog.

Back at it.

Between the devastating psychological testing results and the intensity of planning and carrying out a surprise birthday party for my mother, who has now completed 85 years on the planet, I have not been in the mood to sit and write.

The party came off last night, a huge hit.  My mother has been a very active part of her community for forty years.  Everyone came out to celebrate with her.  At least a hundred people.  It was, as I have said, huge.

I hired the local Klezmer band.  People danced with the children.  Not to say that children aren’t people, but, oh, how would you say that anyway?  You know what I mean.  Grownups got up and grabbed up the children and danced.

Everyone brought food.  Five long banquet tables groaned under the weight of finger foods and covered dishes.  Another table for wine and beer, another for hot drinks, another for deserts.  The Cake, too.  Egad, there was a lot of food, and it all got eaten up.  What little was left I sent home with my son, to take to his lab full of hungry graduate students.

A wonderful friend of mine, a fine fine fiddler, came out, and we had a few tunes while the band took a break.  That was a real treat.

For those of you who don’t know, I’m an old-time clawhammer banjo player http://www.cdbaby.com/cd/laurapschulman

You can click on the tunes and hear them for free on there.

After my last post, which had a lot of doom and gloom about it, I put in a call to my psychiatrist.  I left him a message, carefully worded, no drama, one doc to another, you know.

And I know that what he heard in my carefully controlled message was:  help, I’ve just been diagnosed with a wormhole in my mind, what the hell has caused this, and is it likely to eat the rest of my already poorly functioning brain?

He sent me a text message.  My shrink likes text messages, I don’t know why.  The text said, in all caps, “MEANS COGNITIVE IMPAIRMENT PRIMARILY SHORT-INTERMEDIATE MEMORY FROM CHRONIC BIPOLAR DISEASE AS MAIN CAUSE”.

Somehow I found that soothing, as if by confirming the meaning of the diagnosis without addressing my deepest fear, that fear would be ablated.  Or maybe I would just forget to be afraid.  Wouldn’t that be nice?

Ah, but I’ve forgotten to tell you what all of this is about.  Wouldn’t you know it.

This past month I spent two days having a battery of cognitive testing done.

One of the neuropsychiatric tests I underwent was the “Story Recall Test.”  The tester reads you a short story that is designed to be very interesting and filled with unique and colorful words.  You are then asked to repeat the story verbatim, using as many of the original words as possible.  This process is repeated twice more, so that you have the opportunity to listen to and repeat the story three times.

While listening to the story, I had a feeling of near-deja vu.  Why?  Because I was experiencing the exact sense of loss of control of my memory that prompted me to ask for the whole battery of neuropsych testing to begin with.  I listened to the story, heard it, understood it, and then it was as if I could actually see the story vaporizing before my eyes.  Poof.  Gone.  All those beautiful words, up in smoke.

I was able to recall seven percent of the story.  SEVEN PERCENT!  Barely a skeleton.

When I think about the irony of this happening to someone whose entire life has been devoted to listening to other people’s stories, waiting until they leave the room, and then writing those stories down, I don’t know whether to laugh or cry.  I have been doing both, by turns.

My psychologist is triumphant.  She has been telling me for years that I cannot possibly return to the practice of medicine, and although I have not done so for sundry reasons, she now has objective evidence to back up her assertion that I would fall apart like a box of matches under the strain of any of the myriad tasks necessary for returning to practice.

I am being patient with her.  She is right, and I know it.  What I would really like to do is scream and throw chairs in her office, but it would frighten her, I think, and it would certainly traumatize my dog.  So for now I am trying to content myself with ceasing to feel guilty about being really and truly disabled.

What You Can’t See (might very well hurt you)

I’ve been doing a lot of “doctoring” lately.  Not the kind of doctoring that I prefer.  That’s the kind where I’m the doctor.  No, I stopped doing that ten years ago.

Now I seem to specialize in going to a seemingly infinite array of doctor-types.  I won’t go into all of them.  It’s depressing, and none of us needs more of that.

Of course I have my weekly therapeutic hour with my Ph.D. psychologist.  She’s very good at keeping track of my brain’s peregrinations.  I’m grateful for that, since I find them bewildering and tend to get lost without someone having a firm hold on the end of my hawser.

I’ve noted on other people’s blogs and on group lists that many people with mental illness have a DH, or a DW, or a BF or GF.  I really do envy those people, and I admire the significant others for their devotion and willingness to hang in there and be an anchor for their troubled spouse or SI.  I feel kind of cheated that I don’t have one, but I think the fact that I don’t is “just” a feature of my disease state.

My psychologist lately insisted that I apply for Social Security Disability.  She feels that I am paying way too much in premiums and deductibles and coinsurance, even with the Federal Risk Pool insurance that costs exactly 1/3 of what the Blue Cross people offered me ($1400 per month), out of the goodness of their hearts.  So I am proceeding through the laborious and distressing process of applying.

Distressing, because I have to go through the details of what my illness looks like and prevents me from doing.  These are things I’d much rather not look at:  “But you look so well!”  But my Global Assessment of Functioning number is 40, and that kind of puts the brakes on my delusions of normalcy.  I demanded an itemized inventory of how she arrived at this appalling figure.

So we had to go through the litany of Disastrous and Failed relationships.  I make a distinction between the “Disastrous” and the simply “Failed.”  The Disastrous ones were the ones that put me in the hospital or on the run.  The Failed ones were less poisonous.  I guess you could say the Disastrous ones were like eating Death Angel mushrooms and needing a liver transplant, while the Failed ones were like wandering lost in the forest until running across a road to hitchhike on.

Noted among the dead and decaying relationships were not only marriages and significant others, but also work relationships.  And those friendships:  the ones I don’t have.

Now, I DO have some friendships in Israel.  They are based on a form of Orthodox Judaism, and very structured.  I wonder if this is what one needs in order to form friendships in general?  I wouldn’t know, to tell you the truth.  I can literally count on one hand the people that I have become close to in this life, close in a heartfelt sort of way.

Now there’s the part about leaving the house.   I don’t, usually.  I used to get out more, especially to play music, before my hands betrayed me and started requiring operations in order to maintain the general appearance and function of hands.  But they hurt too much to use for very long at a time, so playing music doesn’t work so well anymore.  So that knocks my Global Functioning score down a few notches.

Isolation is not good for mental illness.  This we know.  And there are things that I could do to ameliorate this.  But I am not a social person, at heart.  I become anxious and start fantasizing about doors that say “Exit” when surrounded by people I’d rather not be with;  and that equals most people.

My answer to the loneliness issue is my dog.  I have a Llasa Apso who is my Psychiatric Service Dog.  Her name is Noga, which means “Glowing Object” in Hebrew. She is at this very moment tucked under my left arm, which does make typing somewhat awkward, but I’m happy to put up with that because she is here.

When I got her at 7 months, I wasn’t sure she would have the qualities required in a PSD (Psychiatric Service Dog), which are to detect negative emotional or behavioral states and to alert the owner to them.  Now, at 18 months, she’s learned to detect when I am depressed, when I am heading into a manic state, when I am going into a dissociated state, and she gives me specific alert signs for all of these, thus meeting the Americans with Disabilities Act criteria for a PSD.  This means that like a Guide Dog for the Blind or any other service dog, she has the legal right to be with me anywhere.

Plus, she’s funny and cute and makes me laugh.  And she’s very patient with me.  She is a treasure.

Noga, my Lhasa Apso PSD, getting her beauty sleep

Back from the NaNoSphere

My goodness, it’s been an interesting month.  I’ve been immersed in the NaNoWriMo  “write-a-novel-in-a-month” challenge, and just finished!  I’m so relieved.  For a while it seemed like it wasn’t going to happen, couldn’t, surely wouldn’t.  It wasn’t that my novel didn’t turn me on.  It just seemed like I was going to let the sticky net of daily life and family relationships, combined with what is for me a high-maintenance holiday, throw me off course.

Luckily, the intrinsic fascination of the story I am telling exerted an equal and opposite magnetic force, and with a little of my own will power thrown in, the balance tipped in favor of getting the required 50,000 words pounded out before the end of November 30, 2011.

And now it seems like just the beginning, because the characters are starting to become real people, the story has taken on its own twists that have taken me, its author, by surprise, and I find myself eager to keep on writing so I can find out what happens.

Hmmm.  That does sound familiar.  I must go and read my “About” page again.