An Anorexic’s Nightmare

I’ve been out of touch.

Quite literally.

My waking hours are wasted spent “running to doctors,” as my grandmother of blessed memory would have put it.

So many doctors, so little time.

And the striking thing, the thing that literally renders me speechless, is that none of them ever touch me.

Not even with gloves on.

They “listen” to my heart and lungs through the three layers of clothes on my torso: camisole, tee, and blouse. 

I’ll let you in on a trade secret: the stethoscope has to go on bare skin.  Otherwise all you hear are three layers of cloth moving against each other: scritch, scritch, scritch.

They don’t look into my eyes, nose, or mouth, although volumes are written there.

Nor do they palpate my abdomen, which, if they did, would give them a surprise, since I have a couple of tender masses in there.  In fact, my erstwhile gastroenterologist, who had it firmly in her mind that I had IBS before she examined me, mashed into my belly like a jackhammer, and while she watched me peel myself off the ceiling, she mumbled, “Hmmmm.”  Yet she did not question her diagnosis.  I fired her.

I got a shock the other day when I requested a copy of my latest MRI from a specialist who had only touched the affected part of my body one single time, out of the several times I’ve seen him.  On that first visit he did pretend to listen to my heart and lungs.  I had a sweater on that day in addition to the above mentioned layers, so his exam was extra special.

When I picked up my MRI report, the receptionist handed me a copy of the clinic notes from my most recent visit.

It said:

“Well developed, well nourished white female in no acute distress. 
Pupils symmetrically reactive.  Cranial nerves grossly intact.  Trachea midline without deviation.  No jugular venous distension.  Heart: S1, S2 normal, no friction rub or gallop.  Lungs clear to auscultation and percussion without wheeze or rales.  Abdomen soft, non-tender, no masses…..”

In short, whether or not you know the jargon, here is an entire “normal physical exam,” none of which was ever done. 

This is the gift of EMR, Electronic Medical Records.  It provides a default “normal” physical exam, altered only if the provider inputs other findings.  One would think that this amounts to falsifying medical records, wouldn’t one?

When I was a medical student, we (or at least I; I can’t speak for the other students) practiced this catechism of normal findings, writing it longhand over and over until I had it memorized in my sleep.  That way we knew what was normal and what was not.

There were two differences, though: in my day we actually wrote things in paper charts.  We had to write really fast, so our notes looked like this:

“WDWNWF in NAD C/O SOB x4H”

Translation:

“Well developed, well nourished white female in no acute distress complains of shortness of breath for the past four hours.”

The other difference is that we actually laid hands on the patient.  We had them undress and put on a gown so we could lay the stethoscope on their chest and close our eyes and listen for those subtleties and nuances of the music the heart makes.  I remember silently cursing chest hair: scritch, scritch, scritch….

And if we didn’t examine something, we wrote: NE (not examined).  But we were not allowed to not examine something, unless the patient objected, in which case we wrote:  PUC (Patient Uncooperative)!

Although we are no longer allowed to describe physical findings in strings of acronyms (although we are apparently allowed to falsify that we actually examined the patient), there is one acronym I will never let go of, especially now that I am getting some practice being a patient.  It is:

WNL

Which is supposed to stand for

“Within Normal Limits”

When I was a student we had an inside joke that WNL actually stood for

“We Never Looked”

Only nowadays, it’s no joke.

Oh yes.  The Anorexic’s Nightmare.

I lost two inches because my spine in collapsing.  Therefore, my BMI is now 25!!!!   I’m suddenly overweight! 

How did this happen?

It’s not fair!  It was that rice I ate yesterday.  That must have been it.  Oh, wait!  I ate a cookie!  Gaaaaaa!  And I’m not bulimic, so I can’t do a thing about it! 

Gaaaaaa!!!

I’d Do Anything If Only

Atina!  Stop shredding your bed!  Atina!  You can’t have chocolate!  You’re a dog!  Chocolate is NOT good for doggies!  Atina!  Get that goddam wet ball out of my face!  Atina!  SHUT THE FUCK UP!!!

Sigh.

Last night was a total wreck.  For some reason Atina spent her night growling, woofing, and outright barking, at something that I could not see. 

We are in a well-lit campground, so if there was, like, a bear strolling around, or a bull moose, or a hedgehog, I’m certain I would see it. 

Maybe it was some perv hiding behind a tree, whacking off.  All night.  Sheesh.

On this premise, I chalked Half #1 of the night up to Virtuous Vigilance on the part of the Pup.  But when Night Half #2 rolled wearily around, I got cranky.  I shushed.  I gave orders.  I YELLED.  I cursed. 

As grey dawn faded into a grey rainy morning, I felt worse and worse.  If there’s one thing that kicks me right out of orbit, mentally and physically, it’s sleep deprivation.

And of course my baby still needed her walkies, and breakfast, and more walkies, and playtime…And I needed large quantities of thick coffee, and something to force into my queasy stomach so I could take my pills, and I needed to use the bathroom, and brush my teeth, and put on clothes…And Atina, none the worse for her own sleepless night (who knows, maybe 🐶 s only take 😸 naps anyway…), was red hot and rarin’ to go, while I was dragging serious ass.

I got to feeling cross and cheated and just plain ill-tempered, and then I thought about something that happened, and my mind changed.

Here is what happened.

1989. I was pulling a two-week stint in the Pediatric Intensive Care Unit–the PICU. 

My residency program was working us like slaves because we were down four warm bodies.  One, my sweet ward partner, died in a car crash.  One got meningitis from a kid she was treating.  One got hepatitis from her dear boyfriend when he got back from India.  And one was on a sort of permanent leave, because he had miscalculated a chemotherapy dose and the child died.

So the house staff were stretched much thinner than usual.  Instead of every third or fourth night call, we were on every-other or every-every night.

In the PICU we usually did every-other-night, actually 24 hours on, 24 off.  But since we were so badly strapped for staff, the PICU director came up with a brilliant plan:  he would live in the PICU for two weeks, and I would live in the PICU for the next two weeks, and then we’d switch off again for another month.  That way we’d both get to see our families, for the two weeks we’d be off.  And of course if things were slow, our families could come and visit us in the call room, which was an 8 x10 ft luxurious affair made of beige-painted cinderblock, with a tiny bedside table to hold up the phone, and a worn metal chair.  

When you switched off the overhead fluorescent lights, you were instantly plunged into darkness.  Fortunately, every doctor carries a penlight, so at least you could find the bed, if you ever got a chance to actually lie down.

Hypervigilance is a common symptom of PTSD.  Therefore, since half of my consciousness was always scanning the PICU for problems, I never really got to sleep. 

One night when we had a truly puzzling and terribly critical case on the unit, I lay staring into the velvety black of the call room.  Everything had been taken care of, rounds, orders, and the nurses were wonderful and right on top of things; so there was no reason not to catch a few winks.

But I was in the grip of free-floating anxiety, so I felt my way along the wall until I found the light switch, and lacing up my Rockports, I sidled out into the unit.

We’d received a case that day that came in via the ER.  It was a little three year old boy, who presented with a high fever and blueberry muffin looking rash.  I mean really, he looked like a blueberry muffin.  But unlike muffins, which are good, he was not good.  He was in very bad shape.  Septic shock of some kind.  Our usual tests could not detect the pathogen, or anything that could have caused his condition.  This was 1989, remember.  We’ve learned a lot since then.

We ran through every possible infectious disease that we knew about, and every form of toxic ingestion or exposure, and every possible cause of bleeding and organ failure, but nothing came out positive.

So we did the only thing we could do: we put the little guy on life support, gave him fluids and antibiotics and steroids, and prayed that with supportive care, his body would come through whatever it was, and heal itself.

This was not to be.

Even with maximal supportive care, his body deteriorated.  He had been unconscious when he came in, and never opened his eyes or gave any indication of awareness.  His kidneys stopped working, and fluid was backing up into his organs and tissues.  We tried our hardest to keep up with that too, but soon it was clear that this little boy was not going to make it.

I can’t remember who we were waiting for.  His mother had died, I remember that.  It was just his father alone who took care of him.  We must have been waiting for someone else…to be there…when we took him off the vent.

As I turned the corner from my call room to the unit, I saw the boy’s father sitting on a hard chair, his knees up against the bed, stroking his little boy’s swollen hand and weeping, his shoulders heaving.

I laid my hand gently on his shoulder and said nothing, waiting.

“Yesterday,” the father sobbed, “He was running around making so much noise, I told him to shut up…Oh, if he would only make that much noise again!”

The Agony Of Pregnancy Loss

This is going to be another heavy hitter, Dear Readers.  Please consider whether this is good for you to read before proceeding.  It contains graphic descriptions of a miscarriage, surgery, and references to abortion.

I’ve given myself away, but then this is not fiction.

My medical school had an agreement with a VA (Veterans Administration) hospital, where third- and fourth-year medical students could rotate through and get some up-close-and-personal experience being on the front lines.  Rather than standing on a stool (if you were short like me) holding retractors in the operating room, we were taught to actually operate.

And in the medical wing, we learned by doing, and by working closely with the attending physician.  This was much better than standing at the back of a crowd of students, interns, and residents on ward rounds in the private hospital.

I had lots of harrowing adventures at the VA.  I loved it.  Everything was edgy and often dicey.  The patients were high morbidity.  The doctors were all foreign medical graduates, some of whom were the best docs I’ve ever worked with, and some of whom…well, I sure wouldn’t want them working on me.  You just never knew, from day to day, what you would end up in the middle of.

I loved surgery.  Part of that was Dr. Duy, a brilliant Vietnamese surgeon who taught me how to tie one-handed knots down in a hole (in those days, gall bladder surgery was done through an open incision, and you were literally working in a hole up to your wrist).  He taught me how to amputate a gangrenous leg–we had to do that a lot because of the diabetic veterans who were “drinking men” and didn’t take care of themselves.  (That was one of the intake questions:  “Are you a drinking man?”  It was crucial to know, because if he was, if deprived of his alcohol he might go into DT’s and die on us.  For “drinking men,” part of the admission orders were two beers or two shots of rye whiskey per day, more if indicated.)

I dreaded operating with Dr. Chung, a Korean doc who didn’t speak much English and was a clumsy brute compared to Dr. Duy. He did a lot of abdominal surgeries looking for metastatic cancer.  In those days the way you did that was by opening somebody up from top to bottom, and taking biopsies from all the major organs, to send to Pathology.  Then you would stand around in the freezing OR, hugging yourself and jumping up and down until the frozen section came back.  After that you either did or did not take out more stuff, and finally you closed the abdomen and took an x-ray to make sure you hadn’t left anything in there.

My job was to close the abdomen.  There weren’t surgical staples back then, or any of a million conveniences we have now–just a bunch of different sizes of suture material, either dissolving or non-dissolving.

Dr. Chung would walk away, stripping off his gloves, and I knew that I was going to close.  It was no easy task for a small person, especially if the patient was large, pulling the wound together and tying the knots, with nobody to put their finger on it to keep it from slipping.  Yes, it was that simple.

Dr. Chung used to tell me to hurry up and just to make sure I did, he would tell the anesthesiologist to wake the patient up while I was still working!

The reason I’ve gone into all this is: One day I walked into the operating suite and smelled the distinctive odor of halothane gas.  That is what we used in those days as the anesthetic.  I’m sure some or even most of you have smelled that smell.  There is nothing like it.  It triggers my PTSD just thinking about it.

I walked into the OR and asked the scrub nurse, who was scurrying around setting up for the next case, what the deal was with the gas.

“Oh, the anesthesia machine is leaking,” she said in mid-scurry.  “We have a requisition in.”

Uh-oh.  That meant it might get fixed today, or next week, or next month…

So we operated with the doors open.  I tell you, we were all half-anesthetized.  I hope those patients did all right, because I don’t remember a thing.  I spent two weeks half-gassed to death, and then my rotation ended and I could breathe again.

But not the baby I was carrying.  I was married, and this was my first planned pregnancy.  I was 16 weeks along, and I loved the little flutter in my tummy with all my heart.

Then one day, at the end of my surgery rotation, the fluttering stopped.  The bleeding began.

I called my OB doc.  He put me on strict bed rest.  I was torn between being panicked at the prospect of losing my baby, and being panicked because my own OB rotation was supposed to start in a few days.  But the bleeding got heavier, and finally waves of pain had me curled into the fetal position, panting.  Then something warm and wet came out in a gush of blood.

I sat up and looked.  It was a little alien, wrapped in its delicate capsule.  All of it was there.  I could see the tiny limbs, and the beginnings of a face….I wrapped it up in plastic wrap and took it to my OB.  I don’t know what they did with it.

I can’t begin to describe the grief.  I think losing this pregnancy unleashed all the grieving I hadn’t been able to do for the abortion I had suffered 13 years before.  I was overcome, and could do nothing but sob for two weeks.  Then I picked myself up, put on my whites and went to my OB-GYN rotation.

I knocked gingerly on the attending’s office door.  She was the daughter of an OB with whom I had done a rotation as a 3rd year student, and we mutually hated each other.  The daughter was worse than her father.

“Yes, come in,” she said to my knock.  I entered.  She did not offer me a chair.  In fact, she did not even look up from her charting.

“I heard what happened.  It won’t affect your grade,” was all she said.  Then, awkwardly waiting for some other utterance, I perceived that there wasn’t going to be any, so I left her office.

I was met by a nurse in scrubs, who said “Come with me.”  I followed her into a room where a woman was lying on a table, her feet up in stirrups, a stainless steel bucket on the floor between her legs, and what looked like a large suction hose…..

“Go ahead, sit down,” commanded a senior student.  “You’re going to do this one.”  I looked from the apparatus at the bottom of the table to the ashen face of the Hispanic woman at the top…

“Is this what I think it is?” I whispered.  The senior student nodded.  I threw up in the bucket and ran out.  I ran all the way home and collapsed on the bed, hysterical.  My husband came home and found me that way.  It was the only time I ever saw him in a fury.  I know that he went to the dean, because on another occasion when I was stuck holding retractors for the OB father and daughter combo (I had to repeat OB after that episode), they skewered me about my husband going to the dean.

All these years later, I just can’t, in my wildest nightmares, imagine expecting a woman who had just lost a wanted pregnancy, to go on abortion detail.  I know there are many things more cruel than that in this world, but for me, at that moment, I would rather have suffered a horrible death than to perform an abortion.

All the while I was thinking of that woman.  I found out her history, why she was there to get an abortion: she was a Mexican migrant worker, she already had six children, and her husband had threatened to punch her in the stomach if she didn’t abort, because six children was enough for him.  Birth control pills were beyond her reach financially, and her husband refused to use condoms.  So it was she who bore the consequences.

I firmly believe in a woman’s right to control over her own body.  If that includes abortion, who am I to judge?  When Rebecca, who was childless at the time, said “Give me children or I will die!”  Isaac replied, “Am I instead of G-d, that I can give life?  Go and pray!”  I too feel that way:  Am I instead of G-d, who gives life and brings death?  I am just a mortal human, trying to feel my way as best I can.

As it says in Ethics of the Fathers (a Jewish text), “Judge not, lest you also be judged.”

When Does Life Become Unlivable? Thinking of Frida

Dearest Readers, rest your minds, I am not there yet.

Today is rainy and soggy.  The ground is thawing out in our Spring Thaw, which is a prelude to actual Mud Season.  I grew up mostly in New England where there is a time of year called Mud Season, generally starting the end of February and going on and off through March.  It’s a beastly time because everything from horses to tractors–not to mention cars and pickup trucks–gets bogged down in the mud.  You can’t get any “purchase” (traction) because under the foot-and-a-half of mud is the frost line from the winter, which will stay frozen even into May, as any New England gravedigger will tell you.

What this weather means for me is misery.  My hands hurt.  My hips hurt.  My neck is even now packed in pillows so I don’t forget and move it.  Et cetera, ad nauseam.  Oh and my asthma is suffocating me.  Go away, damn it, and let me just LIVE!!!

I saw my orthopedist this morning for another cortisone shot into my right shoulder.  Unlike last time, when the needle slid in so easily I didn’t even feel it, he had to do quite a bit of wudging around till he was able to get the needle into the joint.  It hurt.

I remarked on this, in a casual tone, like this:  “Fuck a duck, Doc, what the hell are trying to do to me???”

Actually I did not frame it in those terms, more because I know that all 6’5″ 300 lb of him are made of good nature and kindness–he and his saintly wife have, on top of their own eight children, adopted eight more, all of them older children who needed a good home.  Even if he wasn’t on the short list for sainthood I would still try to maintain a modicum of dignity and say something more like, “Sonofabitch, Doc, that hurts!”

He grinned and mentioned casually that I am certainly going to need that shoulder operated on at some point, as the joint is proliferating with calcium deposits that will need to be “scraped off” (oh, I don’t like the sound of that!) so they don’t tear up the muscles.

Here my vision goes blank and all I can see is my father lumbering along with his elbows stuck out to the sides like a chimpanzee, because both of his shoulders had frozen up….eventually becoming bone-on-bone.  He was literally stuck, couldn’t do anything with his hands–and he was a ceramic artist.  Hell on Earth.  And it didn’t stop there.  The arthritis ate his spine, just like it’s been slowly but surely eating mine since the 1980’s.

I had emergency surgery on my neck in 1987 for a ruptured disc that was pressing on my spinal cord.  Over the next 3 years I ruptured 4 more.  The spine surgeons proposed installing steel rods on either side of mine spine–no thanks!  I’m a dancer, a horse-and-dog trainer, a hiker, an aspiring Yogini.  A rigid spine does not suit my lifestyle.  So I spent 12 months in a Minerva Jacket, which is a hard plastic shell that the brace shop guy molded directly to my Stockinet encased torso, from just below the armpits to just above the groin, so that I could kind of sit.  It had Velcro fasteners in front.  I was to be encased in this walking tomb for 23 3/4 hours a day–with 15 minutes off to bathe.  I admit that I had to take the damn thing off at night.  Nobody could sleep with that thing cutting into your skin no matter how many layers of cast padding, etc., they fixed up for me to try to make it more comfortable.  I even coaxed the brace shop guy (“You have a perfect hourglass figure…!  He crooned, while I was immobilized in plaster yet again…stupid sod, I thought, only worse) into punching hundreds of 1 cm holes in the thing when it got to be summer and I was overheating in it.

Yah.  I spent that entire year standing up 120 hours a week–my work week–because the tension on my spine from sitting down sent the nerve pain all the way into my feet, and all the way into my hands.  But I soldiered on.  I refused to let the pain stop me.  I was young, and had the iron will that sustains my people.

Look, I follow a lot of people who have it much worse than I do.  Much, much worse.  And they keep right on living, kvetching now and then as is their right.

But I am staring into the face of a dilemma, which is:  I can’t work if I can’t look down.

Say what?

I can’t work if I can’t look down.  Not at my regular streams of income, at any rate.

I had to give up practicing regular medicine, not exclusively because of my brain, which wasn’t doing so well either but got right-side-up very quickly once I got the proper diagnosis and the proper meds, but mostly because my hands gave out due to whatever it is that is eating away at my connective tissue.

So I relied upon my acupuncture training.  Palpating meridians and slipping needles into the right places takes no strength at all.  But damn it, the last few treatments I’ve done, I swear I’ve squawked as much as my client!  I can’t look down without incurring an acute, unremitting ache that spreads into my shoulders and down my arms.  Nerve pain.

Writing.  I don’t sell much yet, but then I haven’t made much of an effort.  I get going with writing and at some point my hands seize up and won’t work at all.  I am experimenting with Dragon Dictate.  It is a pain in the arse, but many people swear by it (I swear at it, cliches be damned!).  I’m starting a proofreading and copyediting business.  That should be a good income stream, if I can market it successfully.  There must be a way to mark-up copy using Dragon or something, right?  At least I can get my computer at eye level.  God, I can’t stop thinking about Frida Kalho.

Money.  At the moment I’m fine.  I made one single good investment in my life, which sustains me now.  That stream of income goes away the moment I turn 65, if I make it that far.  I’m socking away as much as I can, but one little bit of extra expense can throw me seriously in the hole.  It’s unsustainable.  I have to find another way of supporting myself.

This is where the equations meet.  I cannot live as an impoverished cripple.  Please do not play the “Oh, no, you’re going to be just fine” game.  I get that enough from people I live around.

The truth is, I am not and will not be fine.  I have two progressive diseases, and if one doesn’t kill me, the other will make my life a living hell, just as it did to my father.

Dad didn’t want to live like that either, but he got taken by surprise.  It was as if he woke up one morning mostly paralyzed.  He was too bunged up to even take his own life!  So he lived another 5 years in unrelenting pain, totally dependent on the kindness (or unkindness, as the case often was) of others.

When we were alone he would ask me, “How much would it take?”  He was referring to his insulin: how much would it take, to take him out of his misery?  I could not, would not tell him.  He would smile sadly, saying “I know you can’t tell me.”  And we would change the subject.

Gentle readers, there will come a time when those two lines intersect: the downward spiral of my health and productivity, and the linear decline of my ability to sustain myself with food, shelter, medicines, and everything else one needs.

No.  I do not want to enter a nursing facility.  Neither do I want to be dependent on others, which is convenient because there ARE no others to be dependent upon.

I do not want to be locked into a crippled body the way my father was, until he died an excruciating death, screaming out his last hours on earth through blood-filled lungs.

I pray that I will know the right moment.  I pray even more that if there is a Deity, that he/she/it will take me out of this life before I have to make that tough decision.

Pray with me now, dear readers.

Pray that I get to dance at my son’s wedding.

Pray that I get to hold my first grandchild.

Pray that I get to have a sweet, gentle kiss of Death, and go Home before I have to make that tough decision.

Frida’s last diary entry, the night before her not-entirely-accidental death, went something like this:  “I hope my end is joyful, and I hope to God never to return.”

My Magic Wand

When I was in active Pediatrics practice, anxious parents used to ask me all the time, “When will this get better?  Will it get worse?  Can you make it go away?”  This, usually in reference to some unpleasant chronic condition like asthma or psoriasis.  My answer to them was always the same:

My Magic Wand is in the shop with my Crystal Ball.”

This usually provoked a crestfallen look.  But I do not lie, I do not dissemble.  I tell the truth even when it is not what anyone wants to hear:

“Your child has leukemia.”

“Your child has meningitis (because you staunchly refused to give him the vaccination against that--but I would never say that.  They will either figure it out or not, but I will not increase the suffering of an already stricken parent.)”

“Although we did everything in our power, we were not able to save your child.”  That was the worst, the one I dreaded the most.  Where there is life, there is hope, is a true statement.  There are conditions which are dangerous, which are usually fatal, but where there is life, there is hope.

But the outcome, in the end, is not in my hands and I cannot foresee the future: my magic wand is in the shop with my crystal ball.

And now that I am the patient, I juggle these things.  Some things about my diseases can be predicted, and some can’t.  I think sometimes the most distressing part of having a disease is the uncertainty of how it will turn out.

Take Ebola, for instance.  The media has whipped the fear-and-paranoia quotient to the moon.  People are starting to fear each other on the streets.  There is talk of people wearing masks in public places, even though it has been proven that in order to pass the virus via the respiratory route, like a sneeze or a cough, someone would have to be so sick that they would be on life support anyway, not likely to be in the subway station or the mall.

Will the virus take hold in other nations, or will it peter out the way Bird Flu did, the way the previous Ebola outbreak did?

Sorry folks, my magic wand is in the shop with my crystal ball.

I am fortunate to live in two countries where one is relatively free to chose one’s own doctors, for many things, anyway, if one’s health plan permits.  If I don’t like my doctor, I simply fire them and get another one.

Very fortunately, my shrink in America, whom I have been in a cordial therapeutic relationship with on and off since 2001, is a funny, pragmatic man, who is just as likely to say “I don’t know” as he is to say “Hello, how are you?”  –which he says in a jovial yet businesslike manner, because he REALLY wants to know how you are.

Thirty minutes later I leave his office both confident and perplexed, which is the way he means for me to feel.  I am not sure our plan of treatment will work.  Neither is he.  His magic wand is in the shop with his crystal ball.

He must be in cahoots with my therapist, whose office is just the other side of his wall.  I give her a hard time, saying, “I could do your job right now.  Right now!  All I would have to do is rotate the following exclamations:  “Really?  No!  You HAVE to be kidding. [silence]”  She did not quite find that funny, but I did and that’s what’s important, especially if your DSM diagnosis was changed, without your permission, from Asperger Syndrome to Autistic Spectrum Disorder NOS.

But in reality she is a really good therapist, because she does indeed give me both space and support, and cognitive feedback, which I truly appreciate.

She DOES have a magic wand in her office, but it’s one of those fake ones, you know what I mean, with some kind of thick fluid and glitter than flutters down through it when you upend it.  But crystal ball, no, she leaves that part up to me.

My family doc in Israel is a one-of-a-kind gem.  He listens to me; he is open-minded yet erudite, and he most certainly owns neither magic wand nor crystal ball, and if he did he would have to lock them away from his kids.

Now.  I want you to know that luck played very little part in my finding my Medical Knights and Ladies.  I fired many a therapist, and several psychiatrists, before I happened upon the ones I have.

The position of Primary Care Physician in America is still open.

My psychiatrist in Israel, bless his heart, had a severe psychotic episode and had to be hospitalized, and I don’t think he’s practicing anymore.  I hope not.

Far be it from me to be anti a mentally ill psychiatrist; my shrink here has Major Depressive Disorder, and he knows how it hurts.

But my Israeli shrink started showing signs of paranoid psychosis while I was in his office, which was in a basement room with no windows and you had to be buzzed both in AND out.  Oh dear.  Nothing short of Magic Wand was going to help him, poor man.  He was kind enough to renew my prescriptions for three months, giving me time to find out there wasn’t anyone else on my health plan who speaks English.

All of this is to say:  We just don’t know.  We don’t know what will happen to us in the next moment, let alone days, weeks, months, or years.

I was in a traffic jam going up a steep hill on a two-lane road once.  When traffic finally got moving it became clear that a huge tree, its roots sodden with the torrential Monsoon rains, had fallen atop a Jeep, crushing both it and its occupant.  She died instantly.

After watching my father wither slowly away over years, months, weeks, days, and moments, it was hammered home to me: I don’t have a crystal ball, and I certainly don’t have a magic wand.  But I want that lady’s tree-falling-on-vehicle sudden death.  I don’t want to fade slowly into more and more and more pain, up till the very last breath.  If only I could have that crystal ball, to see my death, and that magic wand to change it, if it isn’t one I can live with.

Here There Be Monsters

When I was a little girl, the space underneath my bed was rotten with monsters.

I had to take a running start to make the three-foot leap into bed, so that a scaly hand or tentacle would not snake out and snag me, dragging me into the dark waiting maw, where they would all fight over my little body, tearing it to shreds, and that would be the end of me.

Now I’m finding that that leap is impossible; it’s futile; the waiting monsters are licking their chops.

My dad is declining rapidly.  He’s been hallucinating, confusing familiar sights and sounds with threatening nebulous images.  Well, he IS an artist, and my favorite show of his was called “Fantasies and Daydreams.”  And now his imagination creeps up on him from behind, casting veils of illusion over his senses.  He dozes, and sudden terrors trigger his fight-or-flight response: he flails with hands and feet, and today twice pitched forward, and would have launched himself out of his wheelchair face-first on the floor, had I not been right there to lay a reassuring hand on his shoulder and tell him it’s OK, nothing is going to harm him.  He wakes from these fits, thank God, when someone intervenes.

The hospice nurse brought up the possibility of giving him a small dose of Haldol, a major tranquilizer and antipsychotic, but my mother voted it down.  She’s worked with the elderly for most of her life, and seen Haldol used as a way of drugging “problem residents” in nursing homes, so that they cease to be a trouble to the nurses.  I’ve tried to explain that the idea here is not to drug him into a zombie, but to relieve him of horrible experiences that are eroding the little quality of life he has left by transforming the music he loves into threatening voices, and the beautiful forest where they live, which has always been an inspiration to him, into a hall of shifting and changing faces, leering with evil eyes and gaping mouths.

I think she will reconsider the Haldol shortly, if for no other reason than to relieve herself of the exhaustion of constant vigilance.

Last week he even got out of his hospital bed somehow, in the middle of the night, and must have wriggled across the floor–he can no longer walk, and he can’t control his arms and legs enough to crawl–and ended up wedged between the sofa and a chair.  The only reason my mom found him at six in the morning is that the upstairs bathroom was being worked on and she had to go downstairs to use that one.  And she heard him moaning, and there he was on the floor.

The drill now is that when he ends up on the floor, we call Hospice and they decide whether to send over a nurse, or to call the First Responders to look him over and get him back into bed.  That is what happened in this case, and my mom said they were very rough and literally dropped him on the bed, didn’t bother to get him pulled up onto the head of the bed but left him with his feet hanging over the foot of the bed.  Mom tried to shift him up, but couldn’t do it, so there he lay until the morning attendant arrived.  Dad was so worn out by the whole process that he was unable to even sit propped up that whole day, and besides, he had hit his head again and was really “out of it.”

In the past, when those scenarios occurred, we would call the ambulance and he would be taken to the hospital, and we would spend an anxious and exhausting eight hours waiting for the CT scan and all that to be done, and he would either be discharged home or admitted for observation.  Now that we’re on Hospice, we don’t go to the hospital any more.  We’ve all agreed that we are at the end of Dad’s life, and the aim is to make him as comfortable as possible as we wait for the end.

It’s devastating to see the man to whom I have compared all other men, and found them all wanting, wasting away before my eyes.  I know I’m not the only one to have this experience; and compared to many others, his deterioration is blessedly mild.  He is not in some hospital hooked up to machines.  He is in pain, but it’s controllable, and he’s able to sleep most of the time, day or night.  He still recognizes me, and we still have our “le’chaims” every afternoon.

Today was different, somehow.  I think he was exhausted by the hallucinations and terrors.  He had trouble holding his little whiskey cup, one he had made himself (we always have our whiskey out of these cups), and the liquid didn’t always make it exactly into his mouth.  The right side of his mouth droops from a stroke he had early on in this process, and his food and drink often make their way down the resulting crease into his beard.  My little dog Noga loves to clean his face, if the opportunity arises and no one intervenes–just the way she loves babies, because they usually wear most of their meals on their faces and hands.

Mom has been sick for months.  She’s been very short of breath, breathing at a rate of around 30 breaths per minute.  Normal is 12-14 for an adult.  I’ve been hounding her for months to go get a chest x-ray and pulmonary function testing.  Finally she started wheezing badly and her girlfriends began to make comments, so that propelled her to make an appointment with the “doctor.”  I put that word in quotes because the person who wears this particular MD is, in my experience, completely incompetent.

True to form, the “doctor” ignored the fact that my mother told her (at least, she SAID she told her) that this has been going on for months and months, and possibly over a year; that she has lost weight, and has trouble sleeping because of shortness of breath.  She even has to stop halfway up one flight of stairs to catch her breath.

So she did get an x-ray, results to follow, but was denied the pulmonary function testing that I feel is mandatory under these conditions.  Instead she came home with a prescription for an antibiotic and a course of steroids.

The steroids will make her feel better regardless of the cause of the chest issues, but will not address the underlying pathology.  And it will increase her baseline irritability and labile behavior–not good.

In medicine we have this thing called “differential diagnosis.”  It’s a way of sifting through all the things an illness could possibly be, first casting a wide net and then crossing things off the list as they are ruled out, either by the process of logic or by test results, and hopefully a combination of these, along with a dose of clinical know-how, and the faculty of observation.

So in the years that I have been observing the evolution of this process, I have whittled the possibilities down to two:

1. Cancer

2. Cancer

3. Restrictive lung disease

I’ve ruled out COPD (Chronic Obstructive Pulmonary Disease) because that is always accompanied by cough, usually productive of sputum, which she does not have.

She did smoke in the past, approximately 40 pack-years (the number of years smoking times the number of packs per day), but quit about 40 years ago, so smoking-related lung cancer is unlikely.  However, there are lung cancers that have nothing to do with smoking, or are made more likely by a person having been a smoker in the past.  I know the common wisdom is that after a person has stopped smoking for a certain number of years, their risk of cancer is as if they had never smoked, but I have never believed that, having seen otherwise in clinical practice.

Restrictive lung disease happens when, for some reason, the lungs become stiff and cannot move oxygen into the blood.  The late Ralph Nelson, MD, a brilliant physician who devoted himself to medical illustration, dubbed people with restrictive lung disease “Pink Puffers” because they manage to make up for the stiffness of their lungs by breathing faster: therefore they don’t turn blue the way people with other lung diseases do.  My mother is a classic Pink Puffer.

But restrictive lung disease can result from certain cancers that infiltrate the walls of the lung tissue, making the lungs stiff, necessitating an increase in the respiratory rate, and hugely increasing the work of breathing.

I’m feeling sorry for my mom, even though I don’t love her.  I hate to see anyone, any creature, suffer.  I suspect that the process of definitive diagnosis will be a long and unpleasant one.  Believe me, if I were still in medical practice, she’d have her diagnostic workup done, not yesterday, but a year ago.  And then….what would happen to them?  I can’t even take care of my dad alone, due to my own health issues, let alone the two of them.

Tonight I feel as if I’m looking right down the throat of the monster that takes lucky people with two living parents and makes them suddenly into orphans.

 

The Letters After My Name

Laura P. Schulman, MD, MA, FAAP.  What do these letters mean, of themselves, and what do they mean to me?  Why do I use them, here on Bipolar For Life?  What, if anything, do they have to do with bipolar-ness?  And most importantly, why do I insist upon using them when the professional qualifications they symbolize are now meaningless?

MD: Medical Doctor.  A passion since childhood, hard-won.  I put myself through college (oh yes, another set of letters: BA, Bachelor of Arts) by holding down three jobs while taking a full course load.  I know, I know, hypomania.  But it was fun, and I would have graduated with honors except that the required Honors Seminar conflicted with one of my jobs.  Oh well.

The MD turned into a combined degree program in Medicine and Medical Anthropology, six years.  Graduated with a perfect grade point average, 5.0.  Number One in my class (actually shared with my then-husband, who also had a 5.0), inducted into the Alpha Omega Alpha Medical Honor Society.

My first year in practice as a Pediatric Emergency Physician, I was inducted as a Fellow of the American Association of Pediatrics, and added FAAP to the collection.

All that stuff, including the wisdom garnered while cocktail waitressing as an undergraduate:  I used it until that very bad day, April 4, 2000, when I locked my office door for the last time, drove home, and went into a catatonic depression that resulted in my permanent disability.

All those letters, lost.

OK, yes, I did earn them, every one of them.  And it could be argued that in so doing, I earned the right to keep them after my name, forever.  No one can ever take them from me.

On the other hand, I feel lost when I look at them.  It’s as if–no, it isn’t as if–it’s the reality, cold and hard, that I am no longer who I once was.  I no longer go to the ER or the office every day.  I no longer practice Pediatrics, or anything else.  I live moment to moment.  My energy goes into keeping my mind in a reasonably healthy trajectory, and it takes every once of energy I have just to keep living from one moment to the next.

For a long time I used the letters after my name as a reminder of what I have achieved in this life.  But now I feel that they have become a burden.  I look at them and cringe.  This is not what I wanted for a life.  This is not what I worked 20 hours a day during my undergraduate years, who knows how much during my Medical and Graduate School years, 120 hours a week during internship and residency–I did not work all those hours to be sitting around like a bump on a log just trying to keep my shit together so I don’t start screaming and scare the dog.

I look at those letters, and I start to cry.  I think about the people who read this blog, or my comments, and think I am a practicing physician with oodles of money, knowledge, and perhaps power.  And I think I am misleading them.  In fact, I know that’s the case sometimes, from comments I’ve received.

Those letters weigh upon my soul.  They sit on me like an elephant.

It’s not that I don’t want them anymore.  I earned them with my sweat, blood, and tears, dammit.  They’re mine.

It’s just that right now I’m feeling the grief of my lost life, and I don’t want them staring me in the face every time I look at my blog or my email signature.

So I think you will see the letters after my name disappear.  Not today; I don’t have the energy for it.  But soon.  Maybe tomorrow.

In Praise of Invertebrates

No one has ever called me “spineless,” yet there have been times when I’ve sorely envied those creatures without one:

Give praise to the invertebrates, for they shall inherit the Earth.

I don’t know who said that.  Thought I did, but looked up the source and it wasn’t where I thought it would be.  But never mind. For the past, oh, month or so, give or take, I have been limping around on one or another of my limbs.  My knee locked up; my hip hurt; and now my back has eclipsed the rest. My back has been, for me, a symbol of the level of support I am getting from those close to me.  And while some may argue that what’s physical is physical, and that the mental/emotional/psychosocial arenas cannot cross over purely physical lines to cause or worsen structural damage, I disagree.

My point of view lines up with that of the “biopsychosocial model” on which I was nursed and weaned by my Very Special Medical School, the University of Illinois at Champaign Nirvana Urbana, smack in the middle of Corn Country, Illinois, USA.  The biopsychosocial model, as it indicates, teaches that our health and wellbeing are not compartmentalized, but a living organism that is affected by everything in our environment, inside and outside. There is certainly a genetic component to my spinal maladies: my dad started having awful back problems in his early thirties, just as I did.  So I guess I have him to thank for that, along with a lot of other inherited traits, most of them good.

My adventures with Degenerative Disk Disease (DDD), which is a progressive disintegration of the intervertebral disks, started in 1987, in the Big Yellow Truck that carried our little family away from Champaign Nirvana, into the uncharted territory of Rochester, NY, which is even colder than it sounds, being just across the lake from Ontario. I should define terms here, in case there are people reading this who have the good fortune not to know them.  An intervertebral disk is an ingenious structure composed of a thick outer wall of tough yet supple ligament, filled with a gel.  It is in the shape of a hockey puck, and alternates with the vertebrae, insulating them from shock and serving as the means for our spines to be flexible.  Think of gymnasts, or contortionists, or Tango dancers and you’ll get the picture.  Speaking of pictures: Here is an X-ray of a normal lower back.  Note the clean lines and clearly defined spaces between the vertebrae, which look like boxes with little things sticking out of them. Here is a nice comparative image of a normal lower back, top, and its unfortunate cousin on the bottom.  Mine looks like that one, only worse. lumbar_degxray_vertical   All sorts of treatments and non-treatments exist for this extremely painful and often debilitating condition.  I have experienced quite a few of them. When we were driving from Champaign Nirvana in the Big Yellow Truck (or “Big Lellow Truck,” as my son called it, being two at the time and in awe of the Ryder Rental), I noticed that I couldn’t find a comfortable way to sit.  When I was driving, a hot river of molten pain flowed down my right leg into the accelerator.  When I was riding shotgun, the only way I could sit even mildly-to-moderately comfortably was cross-legged, bolt upright.  No sleep on that trip.

When we arrived in Rah-cha-cha, there was far too much to be done to pay attention to a mere case of low back pain, so I forged ahead with helping to unload the van, unpack, set up, and immediately start my internship in Pediatrics. By then I had developed a matching pain in my neck, such that I had to build a set of pillows molded around my neck so that I couldn’t move–or else I would wake up suddenly paralyzed with pain. But I had an internship to start, and my ex had a post-doctoral fellowship to start, so I soldiered on and started my residency.

As is the nature of things, before one starts anything significant, one has to sign all the papers first.  That was a good thing, in the case of the residency, for it gave me something I had been lacking and would be needing shortly: insurance. At that point in my internship/residency program, we were fully staffed, so “call” duty was every third night.  That meant that you came in at your regular time, 5 am, then worked until 5 pm sign-out rounds.  You met with the lucky creatures who were going home, and conferred with them about their patients, whose care you would be assuming until 8 am sign-in rounds the following day.  Then you would continue your work-day till 5 pm, when you “signed out” your patients for the night, went home, and fell on your back in the bed, staring at the ceiling and feebly trying to repel your husband and child, who are trying to greet you after your long absence.

As luck would have it, my first night on call was Night One of my internship.  It was the debut appearance of the infamous “black cloud” that would follow me throughout my medical career.  My neck had been in spasm all day, but I did my best to ignore it and soldiered on.  Sign-out rounds came and went, and I was on my own with my resident.  It was just the two of us to cover all of Pediatrics, Labor and Delivery (the baby part), Newborn Nursery…and admissions from the Emergency Department, which seemed to be a very busy place that night.

My neck felt like it was trying to rip itself off my body and fly away on its own.  I was wishing it would. We admitted a sick little girl with a fever of 104 F (40 C), to the toddler ward for diagnosis and treatment.  Part of the diagnostic work-up involves the collection and subsequent examination of every kind of fluid there is in the body (gas, oil, antifreeze, brake fluid…just kidding).  You have to collect things in a sterile a manner as possible, so as not to introduce germs from the outside of the body into the fluid samples.

Long story short, we needed to get a sterile urine sample from this little girl, and that involved a catheter, and cleaning the “outer parts,” and someone with experience to do that part, and anyone at all to do the all-important Holding The Patient Down part.  I shudder.  I was once Held Down for a medical procedure when I was 5, and I still remember it.

At last we had the hapless little girl spread-eagled and ready for the 30-second procedure.  My job was to keep her in that position, so that 30 seconds would remain 30 seconds and not, say, 20 minutes, which is what might happen if we messed up the first try and had a furiously fighting toddler on our hands. So I got a good grip on the little chubby thighs, and prayed that my superior would get the job done chick-chock, which is Hebrew for “right now.”

She missed.

The outraged little victim jerked her leg away from me, and looking me straight in the eye, kicked me a good one right in the center of my forehead. POP. That was the annular ligament of C5-6 you heard popping, there.  In layman’s terms, the tough outer covering of the disk between the 5th and 6th vertebra in your neck, of which there are seven, gave way and all the gelatin from the center of the disc poured out like fire, compressing the nerves that emanated from my spinal cord at that level.

I was paralyzed with pain.

But I would not give in.

This was my first  on-call night of my internship, dammit, and besides, where would we get a replacement for me at 2 am?  I have always said that the reason more people don’t die during their residencies is that the program does not allow time to attend one’s own funeral.  So I soldiered on, until sign-in rounds, where the Chief Resident noticed that I was in agony and sent me to the Emergency Room.

There I was examined by a medical student, an intern, a resident, the Chief Neurosurgery Resident, and finally, the neurosurgeon himself, who looked at the X-rays and agreed with all the others that I had an acute rupture of C5-6.  They sent me home to rest for a week, with a prescription for Tylenol with Codeine.  I rested, felt absolutely no better, and went back to work.

Another week, and another on-call night, and I truly felt like my head was going to just fall off and roll around on the floor, because my neck could no longer bear its weight.

Another morning in the ER for me.  This time the neurosurgeon just happened to be in the building.  He stopped by and saw me. “What, are you here again?” angrily joking.  “What’s the problem this time?”

I sheepishly explained that I couldn’t move because of the pain in my neck.  I got a terse lecture regarding the subjective nature of pain, that it was “only pain,” and that I really should suck it up and go back to work.  But my hair was all wet from my tears, so in obvious disgust he ordered a CT scan of my neck.  MRIs did not exist yet. He looked at the scan himself, and his attitude flipped 180 degrees.

“I’ve never seen such a huge rupture in someone your age.  The nucleus (gel center) is sitting completely outside of the disc space!  We will schedule surgery.  Until then, you will wear this spiffy hard cervical collar and don’t take it off.” Surgery was a week from then.

I spent the time arranging for child care (my ex was not good at that), and begging for insurance coverage.  My insurance, you see, did not kick in until I had worked a full week in the program.  Somehow, in some office, someone was compassionate, and I got my insurance.  I was kind of eagerly anticipating surgery, hoping that it would get rid of the awful pain that had somehow become my entire life. To be continued…….

Kind Of Freaky, But Necessary to My Sanity

I just blocked somebody from commenting on my blog.  I felt bad doing it, but this person arouses feeling of rage every time I see their comments.  I feel like I shouldn’t feel this way.  I know exactly what they would say if they saw this.  What’s even more aggravating is that they post from multiple locations, resulting in multiple IP addresses that I have to block individually.  I feel like a creep doing it, but I have to save my sanity, what’s left of it, and take care of my high blood pressure.

What I really want is to block this person from even accessing my blog (actually I have a couple of stalkers–yes, really–that I’d like to block) but according to WP  there’s no way to do that other than making it a private blog, and that would mean being invisible to the wonderful world of blogging friends who have found my blog, usually via other mental health bloggers.  So there’s nothing to do about that.

Please know that this is a tiny group of people that I know personally, from the distant past, and have serious issues with, who found my blog through various searches.  It does not apply to my “bloggie” community, at all, at all.

Have any of you had to take measures to prevent unwanted comments or lurkers or stalkers?   What did you do about it?

My Bipolar Life: A Mini-Memoir

My astrologer is in sort of a crisis mode these days, so I don’t really want to bother her with the question: Why is it that I am feeling bombarded by people who feel that bipolar disorder is something to celebrate?  It’s true that if I weren’t bipolar, I couldn’t possibly have accomplished the feat of living several concurrent lives.

I’ve got a lot done.  I’ve created little empires, and lost them.  I’ve made a lot of money, and lost it.  I’ve had bosom friends, and intense relationships, and wonderful marriages–all gone.

I hated being a child.  Children were so…stupid.  Like cattle, running in herds, living their happy little lives, sniveling at trifles, reading Dick and Jane.  Innocent, docile, boring little things.  I refused to associate with them.

I had one friend, and one friend only: Terry Martin, whose father was a carpenter and let Terry use all his hand tools.  There was a creek in the woods behind my house, and Terry and I built bridges over the creek using scrap two-by-fours salvaged from Terry’s father’s scrap pile. We would design a bridge, build it, tear it down, design another one and build it, ad infinitum.  I imagine Terry must have grown up to be a famous architect.  We were seven, eight, nine, in our bridge-building years.

The rest of my childhood was consumed with books.  Grown-up books, not kid books; although I did love Charlotte’s Web and anything else by E. B. White, who is still my literary hero. And of course animals–horses in particular, and any other non-human creature.  I used to take in injured animals, wild bunnies who had been half mangled by the cat, a mouse rescued from the trap, and nurse them back to health.  It was my introduction to healing.

But I suffered terribly from depression–of course it was not known, in the 1950’s and 60’s, that children could be depressed.  But I had frequent bouts of overwhelming sadness and a sense of confusion, not knowing where I was in space or time, dissociation I would call it now.  I would cry for hours over seemingly nothing.  I hated my existence and wanted to be gone.

And then there were episodes of ecstatic heroic fantasy.  Like the time I tied the sleeves of my coat around my neck for a cape, and ran full throttle around the schoolyard shouting that I was going to save the world (it was the Cold War then, and the world needed saving). And the time I lost Terry Martin, by planning out and executing my fantasy of winning his nine-year-old heart to be my forever lover, by singing him a love song I had learned from the radio.  That heralded the end of our bridge-building days, and plunged me into a deep river of remorse.

High school.  Oh dear.  I suppose most high school girls spend their after-school hours writing poetry and drawing diagrams of what would later be called “wave-particle theory.”  It was the 60’s, it was Flower Power, it was Viet Nam, it was smoking pot, it was losing my virginity to a vicious rape and running away from home, all the way from Massachusetts to California. It was wandering, purposeless, homeless, sometimes adventure and sometimes just doing what was necessary to keep alive.

Young adulthood–three different art colleges, no degree, frequent bouts of dissociation, PTSD from the now many rapes and close shaves with abduction and what was then called “White Slavery,” now known as Sex Trafficking.  Paralyzing depressions, then marathon painting sessions, up all night listening to WGBH Boston and working on three or four canvasses at once–hanging them on the otherwise bare walls of my bedroom and moving from one to the other until 3 am when the fishermen’s coffee shop (Mike’s) opened and I could go down the hill for espresso and listen to the hushed conversation of the Gloucester fishermen, getting their coffees and Italian pastries to warm their bellies before heading out on their boats for the day.

And then it was back up the hill for me, to get ready to hitchhike to art school, take my chances with whatever creep pulled over to pick me up–would he be manageable or would I have a fight on my hands first thing in the morning–who knew? Left art school one quarter shy of graduating–I had to go play in my boyfriend’s band.  Granted, it was a good Irish band but couldn’t I have just stuck it out three more months and graduated?  No.

Everything was a blur.  I could not concentrate.  They told me I was good, if I could only get it together–but I couldn’t get it together, because I didn’t know what together was.  So I quit to join the band. We had a good roll with the band, and I was painfully in love.  He told me flat out he wished he could tell me that he loved me, but he didn’t.  I kept on hoping…and lapsing into states where I would go far, far away and no one could reach me, so they just went on and left me to my own devices, and I would wake up crying, feeling lost and abandoned.

Decided I’d better be a doctor, because that’s where my heart was–and is.  Talked my way into University of Chicago without a high school diploma–how did I do that?  I was on a high and nothing could stop me.  I blazed through the interview, charmed the interviewers, and got in.

My parents had had enough of paying for schools, so they refused to help with this one.  So I worked three jobs–from 6 am to 8 am blood rounds as a phlebotomist at the hospital.  Ten to three, classes.  Three to eight, nap and homework.  Nine pm to 2 am, cocktail waitress at a downtown disco.  3 am to 6 am, lab tech.  On nights I didn’t work the disco, I went out Latin dancing with the South American grad student crowd.  And at 9 am I ran three miles with Sunny, the girl I was in love with and didn’t find out she was also bi until after college. Sure I got depressed.  I just thought that was normal, since I’d always felt that way.

Let’s fast forward, because this is a blog post and not a book.  This is the interesting part anyway. After a dual degree in medicine and Medical Anthropology, I went on to a residency in Pediatrics and Adolescent Medicine.  I was a very poor resident, partly because I had begun to have episodes of deep depression triggered by sleep deprivation.  Instead of recognizing that I was having a health problem, the administration punished me for my lethargy and crying spells by assigning me to more and more rigorous rotations–extra stints in the Neonatal Intensive Care Unit, which I loathed, and extra time in the Pediatric Emergency Department in the Gulag, which is what we called the hospital in the northern reaches of Rochester, NY, also fondly known as the Knife-and-Gun Club, since it was situated in the heart of Gang War Territory.

I loved the Gulag, for some reason.  It was rough and tough and you never knew when there was going to be a lockdown because some gangs got in and were shooting it out in the stairwell.  It was my kind of  place. I ended up working nights there and becoming the Acting Director when the previous one quit.  I took the place from being a skunk works with one intern to a fully-staffed professional department.

Then the boss hired an old girlfriend over me.  She had no emergency medicine experience, was a developmental pediatrician.  I put on my cape and went into Superhero mode and wrote letters to every bigwig in the medical school.  I got fired.

I got a better job, developing a brand new pediatric emergency department in another part of the country.  I used what was turning into boundless energy to create a top-notch state-of-the-art facility. But that wasn’t all. I got married, bought a 32 horse boarding stable with 40 acres of land, 20 acres of prime alfalfa that we baled 5 times a year, and an asphalt hauling business.  We had one employee, a stable girl.  Otherwise, we did it all ourselves: my husband, my son, and his son.  And I worked 60 hours a week at the hospital. Not unpredictably, I got irritable and contentious.  I didn’t get partnership.

I quit and got another job.  I quit and got another job. I quit and went into practice for myself, which was heaven on a stick, except that now I was having to go into my private office between patients to cry. Disaster hit.  A church-based organization bought out my hospital, which owned my building, and I was suddenly practice-less.  The blow was too much.  It sent me to the hospital, the first time out of twice. I have never been the same since.

Yes, I did create mini-empires with my bipolar.  I could never have done all that stuff, and I haven’t even told you the rest.  But the price was too high.  I’m totally disabled now.  At sixty, I have little to look forward to. I think now, in these days, when there is so much more consciousness about mental health in general and bipolar in particular, there might be hope for consciously channeling that super-hero energy while somehow mitigating the crushing depressions.  I certainly hope so.

For me, it’s a day late and a dollar short.