NEDA Awareness Week, Day 4: THIN, a documentary

This is a film about eating disorders. When I was twelve my mother called me “fat ass” one time too many, and I began restricting and vigorously exercising. I dropped from 118 lb to 78 lb over one year. Nobody noticed, except that my mother said I “looked good.” She also has an eating disorder. Over a period of years I gained weight up to 97 lbs and thought I was horribly fat. Now I’m at the upper limit of normal BMI and very nervous about that. I have started exercising again, which is good, but having cravings to count calories and go back to logging everything I put in my mouth. This kind of film actually triggers my anorexic longings, instead of the opposite. I don’t think the people who made it intended it that way, but that’s how it has turned out for me: “I just want to be thin.”

Atoms & Empty Space: Your 'Shatter the Stigma' Database

A documentary by Lauren Greenfield, THIN follows “the story of four women suffering from anorexia and bulimia in South Florida.”

Polly Williams was found dead at her residence in February of 2008, presumably from suicide.

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Vascular Surgery

This piece was previously published in Close2TheBone.

Vascular Surgery

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 as a civilian surgeon under contract, she had met them.

 Now, reining in her reverie, 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 27-gauge needle.  2% lidocaine with epinephrine should be enough analgesia for comfort, and enough epinephrine 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 she opened 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.  She injected a bit more of the anesthetic, just to be sure.  No need to cause discomfort, which might result in unwanted movement.

 At last the artery was exposed.  She marveled at its pulsations, at the tiny arteries that nourished the big one itself, 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 hemostat, 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!  In a single motion, she swiftly removed the two clamps and was instantly drenched in red liquid.

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

Clutching her throat, she rushed to the bathroom, the very same bathroom, and strained 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 again, not tonight.

 

 © Laura P. Schulman, MD, MA 2012 All Rights Reserved

The Beginning of the End, Part 2

I stood in front of the giant mahogany desk, watching the man on the other side.  He was sitting down.  His mouth was moving, but I couldn’t hear what he was saying, due to the roaring in my ears.  I wrestled my consciousness back into my body just long enough to say, “Yes, I understand.”

The man smiled, stood up, reached over the vast expanse of desk and extended his hand.  I shook it.  It bit me, leaving two holes in the palm.  After it released my hand I put it behind my back, surreptitiously rubbing the bite.  He sat down, beaming.  I turned and walked carefully out of the office.  He shouted after me.

“Please have your accounts in by the end of the month!”

The jerk.  I always did.  Never missed. Struggling to get my physical and astral bodies aligned, I walked down the hill to my office.  Now the tears burned.  How would I tell Lorna, my nurse, and Della, my receptionist, that we had been eliminated?  Collectively discontinued?  Replaced by a newer, slicker model of practice than our old, warm, welcoming country doctor’s office?

It wasn’t just us: our little old struggling small-town hospital had finally caved in and accepted a buy-out by a looming juggernaut of a healthcare corporation.  Hell, my own mother was on the board of directors of our hospital, and even she had voted for the takeover, knowing she was signing the death warrent for my practice.  Her daughter’s practice.  Everyone’s practice, for the new corporate entity brought in its own doctors.

To their credit, they did offer me a position in their corporation, as a staff pediatrician in a city an hour and a half away.  I would be working under a director with whom I had already had some clashes over the care of my patients whom I had transferred to his hospital for a higher level of care than we could offer in East Bumfuck.  I had no choice but to decline, under the circumstances.

I was on medication at the time, but it was the wrong one, and couldn’t protect me from what was to come.  The stress of knowing that my practice was doomed threw me into a deep depression.  Added to that was the knowledge that I would not be able to start anew on my own: I had cashed out my retirement fund to start that practice.  Put all my eggs in one basket.

I did approach the juggernaut about actually buying my practice rather than stealing it, but they just out with a giant juggernaut belly-laugh and informed me that they’d take it for free, thank you very much.  So I was sitting high and dry.

Aside from my lifelong dream of being a country doctor, there was the issue of “not playing well with others” that had limited my tenure at all of my previous jobs to two years, before the powers-that-were and I started getting on each other’s nerves and throwing spitballs at each other.  From my perspective many years and medicines down the line, I can see that my hypomanic episodes might have had something to do with my feelings that I knew how to do things better than they did; or even if I did, I was unable to keep from running my mouth and offending the powers-that-were, and having an “I quit/you’re fired” moment, or a convenient lateral move to another practice.

So it was that I realized that my best chance for success was to be my own boss; and for two years it worked just fine, and was getting finer by the moment, until the juggernaut dropped a wrecking ball on my present and my future.

I dragged my tail home from the office that bitter January day, to find a Registered Mail notice in the mailbox.  Whoopee, I though, maybe Publisher’s Clearinghouse has finally come through and I’ll be able to buy back my horse farm and open another practice in Horse Heaven Acres.  I stuck it in my parka pocket and drove up the icy dirt road to my single-wide trailer.

I had been planning to live in that trailer while I built my log home on my 14 acres, but that didn’t look too likely any more.  I set my face grim and parked in the dirt turn-around. Joyous clamor roused me from my sour reverie: the two German Shepherds, the ancient yellow Lab, and the young Great Pyrenees leaped and bounced off the wire mesh of the dog lot.  I opened the door and let them out, and they cut all kinds of comic capers, each coming over to slobber on me again and again until I was good and slimy and cheered up.  I trod carefully up the icy steps to the deck and let them in.  The trailer was full of dog.  I shut the storm door, noting that the deck was covered with goat shit again.  Damn goats.  They were always trying to get into the house.  What did they think was in there?

I fed the dogs.  I fed me.  Then I settled into my recliner to have a good cry and sink into a suicidal depression.  I stayed that way until time to take the nighttime knock-out drops, did so, and fell into an unsettled nightmarish half-sleep.

The phone rang.  It was a mother whose baby had a fever.  I asked the usual questions.  It didn’t seem bad, but I gave her the guidelines.  If it got to a certain point, she was to take the child to the emergency department at what was still our small-town hospital.  If it didn’t get that far, I would see her first thing in the morning at the office.  At least I still had the office, for another four months until the wrecking ball came down for the last time. To Be Continued…..

Breaking the Silence of Stigma: Ruth Jacobs

Ruth Jacobs no borderWelcome to Breaking the Silence of Stigma, a series of very personal interviews with people who, like me and perhaps like you,       live with mental illness.

It’s only by breaking the silence and speaking out about the reality of living with mental illness that we have any chance of breaking the stigma that surrounds it.  It’s a silence that suffocates, that increases suffering….it’s a silence that kills.  

Our inaugural interviewee is the very brave Ruth Jacobs, published author, campaigner against sex trafficking and human rights violations, blogger, and mother.

Breaking the Silence of Stigma: Ruth, how long have you known that you are living with a mental illness?

Ruth:  Over twenty years.

BSS: Can you share with us your diagnosis/diagnoses?

Ruth: I have post traumatic stress disorder and bipolar – although the bipolar diagnosis is being reviewed by a new psychiatrist.

BSS:  When were you diagnosed with these?

Ruth:  I was diagnosed with a mild bipolar-like illness, cyclothymia, about fourteen or so years ago I think. It’s hard to remember as before then I had various other diagnoses. The bipolar worsened over the years until it was finally diagnosed bipolar type I.  I can’t remember when the post traumatic stress disorder was diagnosed, but certainly years after I first suffered symptoms.

BSS:  How were they diagnosed?  Did you have any special testing?

Ruth:  I am pretty sure the diagnoses have just been made from sessions with psychiatrists as an outpatient and inpatient. I don’t remember any special testing, though having said that I have a vague memory of wires attached to my head, but that might be from something medical; my memory is not good, which is probably caused by the PTSD, though could be from the numerous overdoses I took in my twenties.

BSS:  Have you ever been hospitalized due to your illness?  How many times?  Do you think it helped?

Ruth:  I have been hospitalized a few times. I can think of six but it might be seven. And actually it’s not all for my mental illness on its own, but mostly because I self-medicated with drugs. I had psychosis from crack a few times and I was a danger to myself so being hospitalized helped keep me safe for that period, but didn’t help with my mental illnesses. I was unhelpable most of those times because I wasn’t willing or wasn’t ready to give up drugs. When you are an intravenous user of heroin and crack, there isn’t much a psychiatrist can do about your mental illnesses.

BSS:  Are you on medications for your illness?  Do they help?  What about side effects?d

Ruth:  I have had so many medications and concoctions of medications, always with side effects though to varying degrees of severity. Most recently, a new psychiatrist has taken me off all medication so she can reevaluate the bipolar diagnosis. I am pleased about this, as I do prefer not to be on medication due to the side effects.

BSS: Have you ever had ECT (Electroconvulsive therapy)?

Ruth: Thankfully, I have never had that.

BSS:  What other things do you do to help with your illness?  Do you go to individual therapy?  Group? Other things?  What, if anything, seems to help?

Ruth:  I have had years of therapy, mainly individual though also in groups. Sometimes it has helped, other times not. I found eye movement therapy, EMDR, worked extremely well for some symptoms of PTSD, especially flashbacks, but it also reduced nightmares too. I had NLP at the same time and I believe that helped particularly with anchoring – something that has been very hard for me to cope with.

BSS:  How has your illness impacted your life?  Things like jobs, education, relationships, children, alcohol and drug abuse, etc.?

Ruth:  It’s affected all of it but I have to try to make the best with the cards I’ve been dealt. Although I can’t work full time at the moment, I still have writing and that’s a very important part of my life. I am sure it was my illness that enabled me to write my book; and I wouldn’t have had the knowledge without having lived the life.

BSS:  If you could give advice to someone else struggling with mental illness, what would it be?

Ruth:  Believe that no one is ever beyond hope. Reach out for help. Be honest – let those people know how you feel and what you need so they know how to help you. Don’t give up. If a medication isn’t working, ask to try another. If a therapy isn’t working, request a referral for a different kind – do your own research where necessary. If you don’t agree with your diagnosis, see if you can obtain a second opinion. If you are uncomfortable with your psychiatrist or other service provider, do what you can to be put under the care of another. I’ve found it helps to connect with other people also living with mental illness. So many people don’t understand and believe there is a way to ‘think’ yourself out of being mentally ill. In my depression, when it is already severe, this ludicrous belief is extraordinarily hurtful.

BSS:  Thanks so much, Ruth, for your incredibly candid interview.  It takes a lot of courage to break the silence of stigma.

Ruth Jacobs’ novel, Soul Destruction: Unforgivable is published by Caffeine Nights.

SD-front border

Read more about Soul Destruction, and about Ruth’s human rights campaigns, and her own brilliant interview series here.

Read Ruth’s blog and Soul Destruction Diary here.  While you’re there, consider picking up a copy of In Her Own Words….Interview With A London Call Girl, an interview that Ruth did during her research into prostitution in the 90′s.

Ruth’s recommended links:

The Sword of Damocles

Every time the phone rings I dread it.  The several times a week that I see her sour face, I cringe.  It’s happened!  She’s found my blog!   My mother, that is.

I’ve written my heart out on the topic of the rage that seethes within me at the very thought of her.  Of the abuse that I suffered at her hands as a child, and that I have continued to suffer as an adult.

Because of her I became a teenage runaway, to escape her endless screaming, name-calling, belittling, gas-lighting, accusations of imagined crimes.

Because of her I preferred sleeping outdoors or in abandoned buildings, suffering  hunger, cold, and turning to prostitution in order to survive.

And when I tried over and over and over again to make amends for the crime of  having left “home” she drove me out with curses: “You’re shit!” she would calmly observe. “You’re good for nothing!”  And once again, I fled in tears, into the forest, into the arms of any waiting man who seemed to want me, into cocaine, into the underworld of dirty Chicago….anywhere but “home.”  I don’t have a “home.”  She threw me out of it.

So I started getting degrees, to prove to myself that I was good for something.  And maybe if I was good for something, she would love me.  A bachelor’s. An M.D., with a master’s tacked on for good measure.  Head of my class, 5.0 GPA, wall full of awards.  Exercised and starved myself into ultimate shape.  Made a lot of money, legally.  Sent expensive gifts.  All-expense-paid-for vacations.  Surely that would earn me favor in her eyes?  Surely now she would see what a good daughter I was?

It did, sort of.  She sang my praises far and wide, in the public sphere.  But in private, again: “You moron!  Don’t you know anything?  How could you be so stupid!”

Yes, I know she’s crazy.  She comes from a family of crazies. I know the stories of what she did to me when I was a baby, a toddler, and how the family laughed about it, and how she said I deserved it: always getting into mischief, that one.

So I’m terrified that she will find my blog, and read what I have written about her.  She will not think: “Oh my God, what have I done to cause my only child to fear me so?  How can I fix this, how can I change, how can I make amends?”  No, she won’t think that.  She will think:  “Why, that g_d-damn  stinking little selfish bastard!  She can’t stand me, eh?  Well she’ll get hers!  I’ll give her something to fear!”  And she will.

Thirty years of therapy have not erased the trauma.  I still feel like that helpless little kid being cut to ribbons by her sharp tongue.  Some wounds don’t heal.

Angels All Around Me

Angel guiding childrenThree a.m. My beeper goes off.  Again.  Ever since I got that beeper, I suspected it was bugged with a gyroscope that sensed whenever my body was horizontal.   Then the damn thing would go off, jolting me out of whatever delirious sleep-like state I had managed to achieve.

“Doctor, these orders need to be signed.”  Good grief, can’t they wait till 5 a.m. when I’m due back on the ward?  No, not worth getting written up for cracking wise with a nurse.

“Doctor, the patient in 36-G needs an I.V. restart.”

“Doctor, the patient in 26-G has a fever.”

It wasn’t long before I had one thing figured out: “Doctor” is not a title of honor: it’s a generic substitute for “Hey You.”  So I rolled off the hard call-room cot and went to do my duty.

But that particular morning at three a.m. it was a different kind of page.  I had actually fallen asleep, all my scut work being done (scut work is what low-on-the-totem-pole doctor chores are called: drawing blood, collecting specimens of  various body fluids, starting I.V.s, etc.).  The pager went off and I peeled myself off the ceiling, cursing and grumbling as I felt the walls for the light switch, knocking the old black phone off its stand in the process.  I called the nurses’ station, wondering what trivial chore they could have thought up this time.  Maybe like last night: “Doctor, the patient in 37-D has Tylenol ordered for fever over 38.5.  Is it all right to give it?”   AAAAGHHH!  Yes, please give the Tylenol as ordered.  Yes ma’am.

But this call was different.

“Doctor, Nadine is asking to speak with you.  Can you please come now?  She’s a bit agitated.”

I threw on my white coat, bulging with tools and books, and hurried down the hall to the School Age Ward.

Nadine was a very special child.  She was 11 years old, and had end-stage Cystic Fibrosis (CF).  In those days, children with CF didn’t grow up to be adults with CF, like they do today.  In those days, they didn’t grow up at all.  The oldest known CF survivor in those days had made it to 18.  But most died in early childhood of raging lung infections.

CF affects the whole body, but especially the lungs and pancreas.  It’s a genetic disorder that causes the body to produce a thick, sticky mucus that gums up the airways and makes a wonderful home for bacteria.  It fills up the ducts in the pancreas so that the organ cannot make digestive enzymes, and the food that’s eaten just goes right on out the other end, and the child slowly wastes away from malnutrition.

Nadine was born with CF.  She got sick very soon after she was born.  She required a lot of care, and soon her father couldn’t stand it and moved out.  Before her first birthday, her mother couldn’t stand the stress of round-the-clock care either, so Nadine was left with an older aunt, who was a very good person but had not bargained for having a child at her stage in life, let alone an extremely high maintenance one.  Nadine required special breathing treatments every four hours, followed by chest physiotherapy.  That entails turning the child into all sorts of awkward positions while banging on the chest to loosen the stuck mucus and encourage the child to cough it out.  Every four hours around the clock.

So even though Auntie was very good and had the disposition of an angel, she really couldn’t do it all on her own.

Nadine came down with pneumonia several times that first year, and had to be hospitalized, given antibiotics and oxygen and chest physiotherapy from the respiratory therapists, who were merciless and very effective.  She would come into the hospital, stay for two or three weeks till she was over the infection, and go back to her aunt.  It started feeling like a pendulum, swinging back and forth, back and forth.

In order to absorb her food, she had to take enzymes extracted from pigs’ pancreases, sprinkled on applesauce before her meals.  (Pigs are biologically the most similar to humans of all animals.)  She didn’t like the applesauce, and would just spit it out.  Her aunt had to fight with her at every meal.

Soon poor Auntie just gave out.  She had no help.  There was no such thing as a home health aide that could be paid for by public assistance.  So Nadine came to live in the hospital when she was three.  Public assistance did pay for that, and she had everything she needed there, even school.  When she was well enough, she could go outside with a volunteer.  The hospital became her home, and the nurses and doctors her family.

She bonded with the nurses especially, because the nurses were more steady than the doctors, who changed wards every two or three months.  But for some reason, she bonded with me, and I with her.  If I had an odd moment that wasn’t spoken for elsewhere, I would go and sit with Nadine and read her a book, or sing with her.  She loved to sing, even though she could only get two or three words out before she ran out of breath.  But we had a good time, laughing and joking, until my beeper would go off.  “Bye, Doctor Doctor,” she would grin.  That was her name for me:  Doctor Doctor.  It was our secret joke.

As time went by Nadine got sicker and sicker.  She suffered terribly from air hunger.  If you want to know what air hunger is, just hold your breath until you can’t hold it any more, and then hold it five seconds longer. That is air hunger.  It’s suffocation in slow motion.

A funny thing happens in people whose lungs stop working.  Normal people’s brains tell them that they need to breath based on the blood’s level of carbon dioxide (CO2).  We’re not even aware of it, but the reason we take our next breath usually is because the level of CO2 rises to a threshold level, and a switch in our brain sets off the next breath.  We breathe out CO2, and we breathe in oxygen (O2).

If a person has severely damaged lungs, the brain gets used to having high levels of CO2, so it uses an alternate method of knowing when to breathe: low O2.  So the brain switches from “CO2 drive,” which is driven by rising levels of CO2, to “O2 drive,” which is driven by falling levels of O2.

This can lead to a dangerous situation: if a person is operating from O2 drive, then the brain triggers the next breath when the oxygen level falls below the brain’s preset threshold.  That means that if you give someone who’s in O2 drive too much oxygen, they will stop breathing!  But what do you do for a person who is in O2 drive, but is nevertheless starving for air because their lungs are so damaged?

Nowadays there are lung transplants.  And nowadays there are much better treatments for CF, and people are living into their 50’s and even 60’s with the disease, even without a transplant.  But Nadine unfortunately lived in the “bad old days,” where the best we could do was to try our best to keep ahead of the disease, and when our resources ran out, they ran out.

But here we had this precious little 11 year old girl, and she was suffering, and starving for oxygen, and we couldn’t give her any more because that would turn off her breathing center in her brain and she would die!

The unit director called a conference with the ward residents, the ward attending physician, and Nadine’s nurses (her night nurse even came in) and the respiratory therapists.  We tried to get hold of Nadine’s auntie, but she had moved and the phone was disconnected.

The director asked me to summarize Nadine’s condition.  It was bad.  She only had about 10% of her total lung capacity to breathe with.  It’s impossible to survive with that, and the fact that she was doing it was a testament to her fierce will to live.  She had chronic pancreatitis, which meant that she lived in excruciating pain. She could not be given pain-killers, because that would shut down her breathing.  And then there was the terrible air hunger.  She begged us to please turn up her oxygen, but that would mean instant, although painless, death for her.

The director looked me straight in the eye.

“Doctor,” he said softly yet firmly, “You are the one Nadine trusts the most.  If she gives you any indication that she is ready to go, you call me, day or night.”  I nodded, through my tears.

That next morning at three a.m. my beeper went off, and the nurse told me that Nadine asked to see me.  This time there was no grumbling: I rushed to her bedside.

The little pale face with its ever-blue lips turned up to me with an unearthly glow.  I shuddered involuntarily.

“Hi, Nadine, they told me you wanted to see me.”

“Hi, Doctor Doctor,” came the wheezy little voice.

“Doctor Doctor, do you believe in angels?”

I caught my breath.  “Well, I don’t know, Nadine.  Do you?”

She began to laugh, and a coughing spell racked her little body.  I sat her up and helped her spit out the sticky mucus.

“Don’t you see them?”  She was beaming.  “They’re standing all around us!”

That morning, I called the director and told him what she had said.  An hour later, with all of us assembled at her bedside, holding her hands, we turned up her oxygen.  Nadine grew pink as she breathed in the life-giving element, and went home with her angels.

Angel guiding childImage credits: Google Images, public domain

 

I’ve Been Pressed!

No, not by some perv in the Tube.  For this post. Actually I feel more like my favorite grind of  a dark roast Tanzanian Teaberry coffee (as I write this I get a worrisome chill: is it a product of human slavery?  Oh no! Maybe I’ll have to switch to a Costa Rican Fair Trade…) in a French press, the rich hot good liquid being separated from the rich hot good solids….it’s all good!  But the liquid is what we drink in our coffee cups.  So I raise my coffee cup to all of us wonderful bloggers, and I dedicate this honor to you, to us all, because we are the engine without which WordPress would, uh, not be WordPress, and would not run.  And for myself, personally, you, the WP community, and particularly my wonderful community of Mental Health bloggers and my Team Canvas, are the engine that keeps me blogging and continuously feeds me inspiration and ideas.

So, THANK YOU to every one of you, and especially you fellow “Mentals” who really do keep me chugging along.

Cheers!  (clink)

Laura

The Beginning of the End

I sat bawling on the orange carpet of the school age children’s unit, screaming “I can’t do it, I can’t do it!” The denim-clad form of M., the program director, stood over me, chanting “You have to do it.  You have to do it.”  My vision was blurred, and not just from the tears; my head swam, and I couldn’t keep my balance.

The morning after a sleepless night of an on-call intern.  A night filled with spinal taps, I.V. starts, sepsis workups, flying trips to the delivery room to save babies in trouble.  And now it was time for morning rounds, and I couldn’t do it.  I just couldn’t do it.  My brain wouldn’t work.  My body rebelled.  I couldn’t do it.

M. tried a different tactic.  “Don’t you care about your patients?  Don’t you care?”

There was nothing to say but “No, not now.  Right now I don’t care.  I don’t care right now!”

“Well you have to care!”

I struggled to my feet, wobbling, and staggered over to the nurses’ station to get my charts.  I had at least been able to make pre-rounds at 5 am, gathering all the data from the night: patients’ temperature, blood pressure, pulse rate, respiratory rate, fluid and solid intake, urine and stool output, any problems or procedures overnight, social issues, discharge planning.  And a progress note from the night.  I dumped these into the chart rack, and the day shift interns and residents, along with M. who was on ward attending physician duty, pushed the chart rack cart around the ward, stopping outside each patient’s room.  My role then was to present all the data and initiate discussion on the progress of the patient, and propose the direction of treatment.  I managed to get through that ritual by the skin of my teeth, then staggered to the house officers’ lounge and collapsed, even though my work day was not over until sign-out rounds at 5 pm.

M. came and found me, and gave me a sharp lecture on the subject of my failings as an intern, and how I would be on probation for the next three months.  I had nothing to say.

I think that M.’s attitude was motivated more by desperation than meanness.  Our program of 21 interns was down by three, leaving us with only 18.  One had contracted hepatitis; one had died in a car crash; and one was on indefinite leave because he had accidentally administered an overdose of a chemotherapy drug to a child who then died.  So instead of taking every third night call like we were supposed to, we were taking every other night call, and sometimes “every-every” night call.

I didn’t know at that time that I had Bipolar Illness.  I had been diagnosed with Major Depressive Disorder as an undergraduate, and had had a bad bout with it in medical school.  And I was seeing a psychiatrist during my internship, who prescribed a med to take at bedtime, since after call I was so revved-up I couldn’t sleep.   But since I could only take the medicine every other day at best, it didn’t do much, and as you can imagine, having undiagnosed Bipolar, an antidepressant not only was not going to do much, but it very well could have aggravated my symptoms.

I’ve always wondered why they never noticed that I was sick and needed help.  Instead they treated me like a bad girl, like a problem child.  I was sent to the department chairman to be lectured on my work ethic.  I sat there stony-faced, taking my licks.  I vowed to try harder, to do better, to shut up and take it like a big girl.  I did.  But every night when I came home (the nights I got to come home, that is), I walked into the house and straight to the bed, and hid under the covers, unable to sleep, unable to function.

My poor husband did what he knew to do best: he cooked me sumptuous dinners, which I could not touch for the nausea that accompanied the exhaustion.  My small son clamored for my attention, and I begged my husband to do something with him so that he would leave me alone.

I’m not saying that it wasn’t hard for the rest of the interns and residents.  Everyone had their over-the-top moments.  There was one guy who volunteered for helicopter transport call, something I was envious about because I thought it would be exciting.  But J. would come on the ward after doing transports all night after working the day before, and have violent tantrums, throwing charts and yelling at the nurses.  No one disciplined him.  He was a hero.

At last my marriage gave out and we separated.  That was actually a relief, because at least I didn’t have to try to juggle residency and marriage.  I had tried to help my husband acclimate to the unique demands of a house officer’s husband, but he wasn’t interested in therapy or in joining the house officers’ husbands’ support group, and I ended up feeling like I had two children to take care of.  So when he moved out, I had only one child and that was a relief.

So at the end of my residency I was given an award:  “Most Improved Resident.”  I was kind of proud of it, but mostly bitter, because that “improvement” had cost me so much.   And I still didn’t know what was wrong with me; only that I never felt quite right.  Suppressing my feelings had made me into an automaton.  My family was destroyed.  I suffered from physical illness: I was diagnosed with Lupus, I ruptured five discs in my spine, had emergency surgery on my neck, and wore a molded plastic brace that extended from my armpits to my groin, 23 3/4 hours a day; and still I willed myself to finish the program.  Two of my colleagues left because it was too strenuous: one bailed out into dermatology, and one, who knew she suffered from Major Depressive Disorder, went into a Psychiatry program and thrived there.  But I had tunnel vision, and now being a single mother, I just couldn’t do anything but put one foot in front of the other.

That residency was the beginning of my career as a pediatrician, but it was also the beginning of the end of that same career.

Plan B

If you haven’t heard yet, Dina Leah is ME. I’m writing a memoir about seven months of my life as a teenage runaway. My “Dina Leah” blog is made up of selections from my first draft manuscript. Some of it’s still pretty rough, but I’m charging along…and you’re invited for the ride! Oh yeah–what’s with the “Dina Leah” pseudonym? I’ll tell you in another post 😉

A RunawayLife: Story of a Teenage Runaway

Recap: Dina has run away from home, flying from Boston to San Francisco, hoping to find love and peace and somewhere to crash in Haight Ashbury.  But on the day she arrives, she finds that not only is San Francisco enveloped by a freezing cold fog, but the whole city is enveloped in a riot: America has bombed Cambodia, igniting protests that erupted into violence across the country.  Haight Ashbury was not an option.

It was time for Plan B: Call Stephanie.

I had met her at a summer arts camp the year before, and fell head over heels in love.  She was my first female crush.  5 foot 8, long blonde hair, fascinating hazel eyes that were set slightly asymmetrically, enough to fascinate and still be beautiful.  She had luscious breasts and showed them off in black lacy pushup bras, which nobody got to see except me, because we…

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The Road Less Traveled: Daily Prompt

The day’s mail dumped through the slot in the steel door of my nineteenth-floor apartment on the corner of 47th and Lake Park.  South Side Chicago, bad neighborhood, but somehow this award-winning architectural wonder had been built there, and because of its location in the slums, it had been designated as HUD housing (Housing and Urban Development), which meant that a starving premedical student like me could manage the rent.  OK, sometimes I had to hock something, or take on an extra shift cocktail-waitressing at the glitzy downtown disco where I made my tuition money, but somehow I always got the rent money together in time.

I picked up the mail and flipped through it nervously.  I had applied to five medical schools, and the acceptance (optimist) letters, or rejection (pessimist) letters, were beginning to come in.  I knew where I wanted to go, and I knew where I could afford to go; and those were not necessarily the same places.  But I had not applied anywhere I would not be happy to be, so it all boiled down to finances.

There it was.  A catch in my throat: I couldn’t get my breath.  A thin envelope meant rejection; a fat one meant acceptance, because it was full of forms to fill out and return.  Here it was: a fat envelope from the University of Illinois, one of my top choices, and affordable, as it was a state school.  I ripped open the envelope and read breathlessly:

“Dear Ms. So-And-So:

We are pleased to inform you that you have been accepted into the University of Illinois College of Medicine…..”

My eyes skimmed the letter.  At the very bottom, as if by an afterthought, I read:

“Due to your excellent academic performance and related experience, we are pleased to offer you a full scholarship.”

I nearly fainted.  My heart pounded as if it wanted to leap out of my chest.

There was a knock at the door.  I grimaced.  Who could this possibly be, interrupting my moment of orgasmic bliss?  I stomped over to the door irritably.

“Who is it?”

Giggles in the hall.

“It’s us!  Let us in!”  It was the Bosom Buddies.

The Bosom Buddies were an all-woman old-time string band from East Lansing, Michigan, an easy train ride from Chicago.  I was one of the two banjo players in the group, and we played fairly regularly.  We played for square dances and Moose Lodge spaghetti dinners and old-time festivals and dinners-on-the-grounds, and we always had a blast.  But what were they doing at my door unannounced?

“We had to come see you, and tell you the news,” said Susie the fiddler breathlessly.  “We had to come in person, so you couldn’t say no.”

Uh-oh.  Sweat started rolling down my ribcage.  What the hell could be so important that they had to take the train down from East Lansing, taking a chance that I might or might not be home?  And not say no?

“Prairie Home Companion has asked us to be their house band!” Susie squealed.

“Wow, that’s fantastic!” I hugged them all.  “Congratulations!”

But why the fuck were they standing on my doorstep telling me this news?

“And,” panted Susie, “Mary (their regular banjo player) went and ran off with Sally (her lover), and formed a duo, and now we don’t have a banjo player, so we want you to join us and come out to Minneapolis!  Will you come?”

My life flashed before my eyes.

This was more than I could have imagined in my wildest dreams.  To be the banjoist in the house band on Prairie Home Companion, the famous National Public Radio show hosted by Garrison Keeler!  Fame and fortune!  Respectability!  Getting to actually play the banjo for a living, instead of just for fun and a few bucks here and there!  Not only that, playing with the Buddies, my favorite people in the whole world!

Then I looked at what was in my hand.  The fat envelope.  My acceptance letter to medical school, and a full-ride scholarship.  I sat down on the floor and cried.

Four women sat down with me, hugging me and asking what was wrong.  I cried harder.  How could I possibly make a decision like this?  Each of these things was the fulfillment of a dream of many years.  I knew I was one of the top old-time banjoists in the country.  And I knew I was destined to be a physician.  Healing was in my bones.  And so was old-time music.

I remembered my manners and invited them in.  They had brought their instruments, so I got out the banjo and a fifth of whiskey and we had a few tunes and got all likkered up, and then I broke the news.  I couldn’t go with them.  My path in life lead elsewhere.  We all cried.

They left, crestfallen, and I spent the rest of the night bawling.  I didn’t know whether I had made the right decision or not.  It just kept bouncing back and forth in my head, and my heart felt like it was being physically torn apart.

The Buddies didn’t find another woman banjo player who was up to their standards, so they didn’t take the job in Minneapolis.  Guy’s All-Star Shoe Band became the Prairie Home Companion house band, and they do a real good job of it, but they’re not the Buddies.

We all went in different directions after that.  A couple of the girls joined other bands.  Susie hitchhiked across the Sahara desert and got a ride with an Irishman on a motorcycle, and they got married and moved to Ireland.

I went on to medical school, and then graduate school in Anthropology, and then a residency in Pediatrics.  I don’t regret my decision, but every now and then I look back to the road less traveled by and think: what would have happened if……