The Carrot and the Stick

My life hangs by a frayed thread.

I am a donkey who lives by the carrot and the stick.

The carrot hangs in front of me, just out of reach.  This gives me a reason to keep reaching.  It is valuable, because it means that someone else’s life depends on mine.

I had two carrots; now I only have one.  That one is my dog, Atina.  She cannot live without me, for she is sick and depends on my care to stay alive.

Actually some other benefactor could care for her, but I love her, and she gives me the only joy I have now.  So she is my carrot.

Then there is the stick that follows me, threatening to whack me if I don’t keep trudging along under my load.

The stick is the fear that there might actually be an afterlife, reincarnation, some consequence for taking my death into my own hands.

My life has always hung by this thread, and I have clung to the thread as a mountain climber clings to the fixed ropes, the lifelines that prevent the fall into the unknown, or rather, the certainty of death.

Before the doctor rescued me by cutting me out of my mother’s hostile womb, my tiny organism was flooded by the amphetamines she took to keep from gaining weight while pregnant.

My organism did not tolerate her labor.  My heart began to fail from lack of oxygen.  No doubt my attachment to her womb, my lifeline, was marginal because of the drug that caused constriction of the blood vessels.

I was “small for dates,” four pounds, and struggling to breath, so they took me away and stuck me in an incubator with plenty of oxygen.

My lungs were bad, I suffered withdrawal from the amphetamines, I was unstable, and in those days no one was allowed to touch a fragile newborn except for feeding and changing, so I sucked my thumb and watched the white forms padding on silent feet through the dim space that surrounded my plastic bubble.  This I remember clearly.

Childhood was searing pain, alien to everything, clothes tearing at my skin, terror of my mother, clinging to my father who always had somewhere to go or something to do, only my animals for companionship and love.

Teenage hopelessness, violent rape, runaway, street life, rape, rape, rape, pregnancy, abortion, alone, alone, alone.

Finally mentors, self esteem, push push push degree degree degree, marriage, baby, fell off the balance beam, paralyzing depression, no support, head of my class, medical honor society, residency, depression, mania, no support, ruptured discs, surgery, body jacket, divorce.

Son’s father refused to see him “because it was too emotionally hard” on father.  Really?  Your son cries for you every night and day.  How can you sleep at night?  How can you look at yourself in the mirror and say, “My emotional pain is more important than my five year old son’s”?

We went on, my son and I.  Life was rough, life was rocky.  He was angry, I was numb, except for the pain always there.  Work, the drug.  Work hard, work long, work better.  A nanny in place of a father.  Angry boy, angry boy.  Can you blame him?

Angrier angrier angrier.  Treatment treatment treatment.  Drugs, legal and not.  Go and live with father finally, maybe that will help.  Bribe father to take the boy.  Father likes money, I have plenty.  Used to.

Disaster.  Thrown away, street life, homeless shelter.

Mother now disabled by mental illness, bankrupt.

Son needs help, NOW!

Therapeutic boarding school, but how to pay?  Father and his family refuse to help.  I borrow money from my parents.  They get it by mortgaging their home, to save their grandson.

I leave my career behind, to help my son, no turning back after too much time away.  I am disabled, that’s who I am, new identity.  But I helped my son to save himself, so that’s who I am now, what, a sacrifice?  No, just a disabled person.  It would have happened anyway, in my downward spiral.

Now he is a big shot, finishing his Ph.D., and his father and his father’s family have taken him back, so proud.

His first scientific paper published in the world’s premiere scientific journal.  I am so proud.

But.

We “do” Thanksgiving together, he and I, and every year has been a blast.

This year, something different.

He invites me to his apartment.  Just the two of us.  Why?

Don’t you want to invite some friends who don’t have somewhere to go?  You remember, when you were a kid, we always had students over who couldn’t go home, or were Chinese, or for some reason would be alone.

No, he said.  Everyone already has a place.

I wondered.

The night before Thanksgiving I was invited, with great pomp and circumstance, to go out with he and his friends to a bar.  I was thrilled to be included.

But when I arrived, a five hour drive from where I stay, I had a migraine and felt sick, and just wanted to smoke some flower and curl up in my van with Atina, my dog.  I would feel better tomorrow.

So I said, you guys go ahead, I’m going to sleep off this migraine.

OK, he says, eager and relieved.  And ran out the door.  I’ll leave it unlocked he says, in case you need anything.

Morning late, I feel better, he’s hung over.  Coffee, cartoons on the big screen, I’m content.  He starts cooking.  Always happy when he’s cooking!

Dinner: a roast duck, fried rice, greens, cranberry sauce.

Not much to say, and it’s getting weird.  I feel a void, ghosts at the table, who are they and why don’t they come out and play?

So the pipe goes back and forth, and he is drinking more beer and more beer.  I go to bed early, he goes out with friends.  I wonder ?

Friday morning, coffee, and I am served a spoonful of leftover rice.  He gives himself a plate, not a lot, but a plate. ?

He goes to lab to feed his cells, I shower and try to get this migraine to go away.  I’m hungry.  I take a bit more duck, rice, a bit of everything.  Thanksgiving leftovers are the best.  I wish son was here to share, but I’m hungry and my head is pounding, so I eat.

He returns from lab.  I tell him I’m sorry I couldn’t wait for him, I had to eat.  He looks angry.  I feel the old ominous storm clouds.  Why?

I guess I’d better go now.

But I feel like crap, I don’t want to drive.

He’s already holding the door open for me to go out.

Um, listen, I don’t feel so well, do you think I could hang out for a while longer?

Um, sorry Mom, I need my space, he says, with irony face.

Oh, OK, I understand.

Beggar at the door, no place for you here.

What did I do?  Did I eat too much?  Am I too burned out?

I’m not successful like his father, the famous scientist, or his father’s father, the famous whatever.

I’m just a mentally ill disabled person, a failure at life, an embarrassment.

I’m skinny, I look ill, my hair is grey and frizzy, my clothes hang loose, my dog is nervous…

Can I at least use your internet to find a place to camp?

Oh sure, Mom.  Come in.  But please leave Atina in the van.

I thought he liked dogs.  Maybe now that he’s got new clothes and new furniture, he’s afraid she will…

I find a place, guess this is it, he’s holding the door….

Love you, honey….

Love you too, Mom…mechanical doll voice.  Grim.

I drive off, numb.  Can’t feel yet, I have to get there, too much traffic.

Get there, hook up, walk dog, collapse, convulsed with grief.

There goes my carrot.

Now I know that my leaving won’t make much of a dent in his life.

I stay here for him, thinking my exit would destroy him, but not so.

He has his father now, and his father’s father, and he is their prestigious prodigal son.

In some way, relief, that cord is cut, that fixed line down.

The plan has been in place for some time, yet I have held my hand because of Carrot #1.  Now Carrot #1 has shown me the door, out of his life and into ?

Carrot #2 snuggles against me as I write.  Precious baby.  But she is sick.

She may last months, or a year or a few.

When she goes, I go too.

Will I be punished?  Will I have to come back and do it over till I get suffering “right”?  Or, to quote Lewis Carroll, do we just go “poof” like a candle, when we go?

Already I am losing the use of my body.  My shoulders are too full of arthritis to throw a ball.  My left hand no longer works well enough to play my music, which has carried me through so much suffering all my life.

Something has happened to my blood vessels.  They break and bleed under my skin so that I go around with blue lumps simply from the trauma of living.

My skin comes off in sheets if I brush up against anything harder than a pillow.  The wounds take months to heal and leave hideous scars.

The cancer that I had in the 90’s once again inhabits my innards.  I hope it grows faster this time.  No, I’m not going to treat it.  That would hasten my death, and I don’t want to leave my dog.

But some days I can’t move, my bloated belly pushes down like a rock.  Other days, not so bad.  Some days only liquids, others, soup and rice.

I had this one carrot that kept the juice of life running through my broken veins.  Now that carrot is gone, eaten up by some other entity, and the sick carrot and the stick remain.

The stick doesn’t frighten me.  I can’t do anything about the stick.

My sweet Atina will drag me along until her own candle gutters and goes out, and I will follow after, poof, and at least this life will be done with.

I can only hope that the cancer takes me before I have to take myself.

That way I don’t have to worry about the stick.

 

 

When Is Enough Enough?

I lived with my father as he slowly died in increasingly excruciating pain over years and years.  When my mother was home, she forbid him to say, “I hurt,” and she withheld his pain medication “because it made him sleep all the time.”

He slept all the time anyway, because that was the only way he could reduce his pain level.  He groaned in his sleep, though.

Unfortunately, I have inherited the disease that caused his pain: degenerative joint disease, with the added agony of degenerative disc disease.

For the past few weeks the combination of mental and physical pain has me close to the breaking point.  I can’t take opiates because they make me itch, and my skin condition makes it impossible to scratch without tearing off pieces of myself, leaving a wound that takes a month to heal.  In addition, the docs in this part of the country are so afraid of opiates that they refuse to prescribe.  So I’m stuck with using mj, which is somewhat illegal here.  But I have things to do, so I can’t use enough to really relieve the pain, because that would put me in bed.  So I’m screwed.

The psychic pain–there are no words to describe. 

Part of it is endogenous.  Part is environmental–the part of the country I’m stuck in at the moment is grey and damp, two things I can’t stand.  The sun came out for five minutes today and it was balm to my soul.  I’m out of here just as soon as my task is done.

My task is to clean my stuff out of my father’s old studio, where I lived for the last four years of his life.  It took me four days just to clear the spiders out.  Now I’m sorting  through things, making three piles: throw out, because of damage from humidity; give away, because I’m not going to use anymore; keep.

Just to to the situational depression off, Atina is not doing well.  This week her labs were worse.  Her kidneys are getting leakier.  They’re no longer holding her blood proteins in her blood.  They were leaking protein before, but her serum proteins were holding their own; now her kidneys are leaking more than her body can produce to keep up with the loss.

Today we took a short walk in the woods.  It’s been raining for weeks, and since it had stopped this morning (but is back now) I thought it would do us both good to take a walk.  But she wasn’t interested in playing in the creek, and although she carried her ball, she didn’t want to play with it.  And she simply collapsed halfway through where I wanted to go, which is only half a mile on flat ground.  I had to sit down and wait for her to recover.

Now she has fallen off the driver’s seat, which is where she normally sleeps, and is passed out on the floor where she landed.  It looks like she’s nearing the end of her sweet life.

When will my misery end?

I want to stay alive until my son finishes his Ph.D in May.  I want to see him off on the next part of his journey.

He and I have talked about what we lived through with his grandpa, and that I have the same illness, with the added fun of bipolar.  We have had the talk about what will happen when I can’t stand the pain any longer.

It’s one thing to talk about it, and another thing to live it.  I know he’ll survive.  But losing one’s mother is a terrible thing.  And living in agony is a terrible thing.

There will come a tipping point.  I keep on living for others: for my son, for my dog…should I get another dog?  Can I live that long?

In three years my income will be drastically reduced, to the point where I literally can’t live.  I guess that will be the end of the line, if it doesn’t come sooner.

The Tipping Point: So Long, Able Body

It’s not here yet.  I’m not there yet.  But it’s getting closer.  I have to stay alert, lest it overtake me like it did to Dad, and leave me too crippled to decide my own fate.

That’s what happened to Dad.  It happened over a period of years.  I could see it because I lived far away, and when came to visit every 3 or 4 months, I could see the changes.  But one day, or so it seems, he was frozen in thin air.  His body had just frozen.  He could walk, for a while, with a cane.  His hands would not cooperate enough to operate a wheelchair, so he shuffled it around using his feet.  It was good exercise, I thought.

He tried to keep writing–he was a wonderful man of letters–but his pinched nerves refused to work his hands.  It cost his soul a lot, not to be able to write his memoirs.  (No, he wouldn’t do all the alternative things to physical writing.)

Then one day his legs stopped working.  I think he had a stroke.  He had lots of them, and caused him to have difficulty speaking, kind of like Moses, only different.

These few words about Dad serve as a preface for what I am about to tell you.

I have been having excruciating pain in my neck, due to arthritic vertebrae.  The holes in your spine where your nerves branch off your spinal cord and end up moving everything and feeling pain and whatnot–those holes that belong to me are getting calcium deposits on them, which is squishing and poking into the nerves in my neck.  Plus, the spinal canal (you know, the canal your spinal cord runs in–helpful, ain’t I) in my neck is getting narrowed, squishing the spinal cord itself.  I guess that’s why my arms ache and tingle all the time.

Today I drove the hour-and-a-half to see a nurse practitioner at the spine clinic where I get things that so far have not helped, like an injection of steroid stuff into my neck (that was fun) to medicines that allow me to sleep for three days at a time between doses.  Who needs pain meds when you’re fucking asleep?

For the past month or so my neck has been killing me to the point where bending over to pick up something on the floor gives me a jolt of pain, 8-9, sometimes 10 on a 1 to 10 pain scale.  It’s all I can do to hurry over to the bed and pack myself in pillows so I can’t move.  After a while the pain lets up, but not all the way–enough so I can get up and take some acetaminophen.  I don’t do opiates like Percocet, because they make me itch.  Every once in a while if nothing is helping–immobilization, hot packs, arnica oil, CBD oil–I’ll take one of my carefully hoarded Tramadol, a semi-synthetic opiate that relieves my pain just down to the barely tolerable level without making me dizzy or itchy.

So I saw the nurse practitioner at the spine clinic, and unlike the actual doctor of the clinic, the nurse practitioner had some very good and practical suggestions, like physical therapy with massage and electrostimulation, and a hardshell neck brace for when I have to do anything.

Since she seemed to know what she is doing, I asked her point-blank: what is the natural history of my disease?  Us medical people call the usual course of an illness to be its “natural history.”  I like that, because I have always loved Nature, and have been an avid Naturist–no. no, I mean Naturalist–all of my life.  So I asked her about the natural history of my disease, and she said “Not good.”

“What do you mean, “not good”?

Well there was a point where surgery–

“Surgery?  What, they take a Dremmel (an all-purpose engraving and grinding tool) and ream out the foramina (holes where the nerves pass though)?”

Yes, in fact.

“How good is the surgery?  What’s the success rate?”

She shakes her head.  Not good at all, she says.  About like lower back surgery…….which stinks.

But, she says, you might consider it when your hands get too numb to work.

My whole body, including my mind and soul, was numb as I walked out to the parking lot.  “When,” she had said.  Not if.  When.  I kind of thought that’s what’s in store.  My left arm, the one where the nerves are more severely damaged, “goes to sleep” quite a lot, and it aches and tingles pretty much all of the time.  It’s definitely progressing.

And then we come to my right shoulder.  The end of my collarbone that attaches to another bone in the shoulder is so gnarly with arthritis that my last steroid shot not only did nothing, but the difficulty of getting the needle into the joint (because the joint is almost closed up) has made the whole thing worse.  I have constant pain and limited mobility, and probably will end up having the end of that bone sawed off, which is supposed to restore mobility.

I have firmly and completely decided that I am not, God willing, going to let myself go the route my father went, completely dependent on others for years.  And unlike Dad, I don’t even have anyone to care for me should I be suddenly a body with arms that don’t work.  I would be in a nursing home until I died.

I’m watching very carefully for that tipping point, the one between independence and dependence, and praying it doesn’t sneak up on me.

As one of my Physical Medicine professors used to say–he was in a wheelchair due to MS–everyone is TAB–Temporarily Able Bodied.  And so it is, with me, anyway.

I used to love to swing an axe and split wood all day long, or take on an unruly horse, change a tire on my 3/4 ton Dodge Cummins Diesel truck…no more of that for me.  I had to trade the truck in for an easy-to-drive car.  My hands only hold out for so long at the keyboard before they seize up and I have to stop.  I can’t play my banjo anymore.

This is me playing my 1897 Fairbanks & Coles fretless banjo in 2005:

 

Life is getting less and less attractive to this formerly physically active person.  I spend virtually all of my time in my recliner, which is the only place my body doesn’t scream at me.  Hell, my place has not been vacuumed for over a year, because I can’t look down or look up or lift anything over two pounds.

It’s getting closer.  I have to be careful not to miss the tipping point.

 

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.”

Today Is Another Day: Rapid Cycling

As you may remember, yesterday I was painting my toenails in the middle of the night.

Alas, that was not to last.  I woke up this morning with a feeling of dread in the pit of my stomach.

After I finally went to sleep last night, with the aid of more Seroquel, I woke up a bunch of times because my arms were numb and tingling.

Fuck, you know, this has been going on in one form or another for several years.   I’ve been writing it off as probably due to my arthritic collar bone, but this is different.

My medical experience gives me all kinds of terrible fears.  MS is the main one these days.

I remember the day in medical school when they taught us all the bad things that can possibly happen to breasts.

My then-husband came home to find me huddled in the bed hysterically crying.

“What’s wrong?” he asks.

“My breasts!  They’re a ticking time bomb!  I want them off right now!”

“There there,” he said, not knowing what else to say.

The next day I ran to the Student Gynecology Service to get a pre-operative exam.  The kind Nurse Midwife examined me and assured me that at the moment my breasts were not explosive, and offered to re-check them whenever I started feeling breast-anxious.

I felt rather foolish, but relieved that at the age of 29, nothing was wrong with my breasts.

Why do I make these digressions when I’m depressed?

Maybe it’s because I don’t really want to engage with the depression.  I know it will pass, and something else will take its place, but when it’s on me, it’s literally on me, and all over me, and in me, and I can’t shake it off.  All that happens is I start crying and feeling like someone is trying to rip out my guts, and doing a pretty good job at it.

Then it passes, just as quickly as it came.  What follows might be a period of “normality,” meaning, neither hot nor cold, and this is heavenly.  But it never lasts.

Hypomania, or frank mania with psychosis, tends to raise its ugly head at night, about bedtime; which for me is at 9 pm because my meds take 12 hours to wear off.  Actually they take 13 hours, but that is an embarrassing amount of time to sleep, so I actually set an alarm for 9 am.

I can tell the (hypo)mania is on its way because my bedtime knockout cocktail doesn’t do a thing.  I’m awake playing Solitaire on my iPad, which usually bores me to sleep, except now I’m totally awake: uncomfortable in my skin, twitching, restless.  I don’t want to look up because sometimes my wallpaper turns into ugly faces.

I follow the protocol my shrink and I developed for these very occasions: more Seroquel.  Another 50 mg till it knocks me out.  And a double dose of my benzos for good measure.

Sometimes it takes a couple hundred more milligrams of Seroquel to do the job.  I have an incredibly low tolerance for Seroquel, so my maintenance dose is only 100 mg.  I know, I know, some of you take 600-800.  That would put me to sleep for several days.  I usually get to 300 before it’s knock-down time.

The good thing about hypo/mania is that it can be controlled, if recognized early enough.  Depression, though…that’s another beast.

Bipolar depression is different from “regular” depression for reasons I don’t know.  I was treated with regular antidepressants for years, and was pretty much suicidally depressed the whole time.  Vitamins “L” (Lithium and Lamictal) saved my life, quite literally.  Blessings upon the quirky head of my neuropsychiatrist, who was on call when I was hospitalized the first time, and got my bipolar figured out.

The only adjustment we can do for the depression part of the roller-coaster is to up the Lamictal by 50 mg, which puts me at 200.  More than that pops me over into mania.  It’s a delicate balance, as you can see.

So the only thing I can really do with this depression is to wait it out.  Sometimes it does get suicidally bad, and then I have to think about my dog and my son, and what my suicide would mean for them.

I put them in that order, because my dog is helpless without me (although yes, I could put her in Rescue, but that thought makes me cry harder) and my son second, because even though it would tear him to pieces, he is at least able to provide for himself, unlike my dog.  I know that makes no sense but that is how it happens to fall out in my brain.

I’m starting to feel tired now, which means this part of the wave is coming to a close–I don’t know exactly when–and what happens next I cannot guess.

OH NO!!!!

Hello, dear readers.  I think I have flipped.

I caught myself giving me a pedicure at 11:45 PM.  And really enjoying getting artistic about it.  It came out brilliantly, if I may be so obnoxious.

Hm.  Something does not feel quite right.

So I smoked half a joint, meditatively.

That’s when I got it.

I have been a slump since last Wednesday.  Well, not exactly a slump.  I would call it a triggered, dissociated, PTSD’d mess.  But it seems that under that pile of oozing slime, the Black Dog was lying relaxed, head up, tongue hanging out and dripping, waiting.

As I was enjoying my joint it hit me:  Silly silly, you have been depressed all week.  I mean, you have felt terrible, am I wrong?

But now have no fear, because Hypomania has made her entrance.  What fun!  Actually it is, if I don’t ruin anything important in the process.

Who knows how long I could stay up tonight, answering mail since last fall and calling Israel to check on the abysmal state of my bank account, since I haven’t been back in almost a year.  I could, in fact, put away the unspeakable piles of **stuf** that has collected on every flat surface.  I have to push objects away on the table in order to have space to eat.

No, not really that bad, most of the time.  Just during the down spells, where I have no interest whatsoever in that big envelope that promises instant gazillionair-hood.  I throw it all on the table.

Then if I’m lucky I’ll have a nice productive flip.  If I can stand still enough I can get all sorts of things done.  But **sigh** there is little danger of that.  Plenty to do in the big world!  Now, if I can just find a way to stay in this pleasant condition and not get into a mixed episode (shudder) or pop all the way into mania–not fun……..but now for the extra dose of Seroquel so I can get some sleep tonight….

Vascular Surgery

WARNING:  NOT FOR THE FAINT OF HEART!

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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 minuscule 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.

Frantically 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.

 

The Best Christmas Gift of All

Everybody knows I’m Jewish.  But.  I grew up being the only Jew in a world of Christians.  My teenage years were mostly in New England, in Southeast Massachusetts where people really do trace their family lineages back to the Mayflower, the ship that landed at Plymouth Rock in 1620.  I have been to Plymouth Rock and it is a disappointment.  All this hubbub about Plymouth Rock This and Plymouth Rock That, and all it is is a medium size boulder sticking out of the sand, with no distinguishing features save a bronze plaque:The Pilgrims Landed Here.  No mention of the Indians, turkeys, Indian corn, nothing.

With the exception of my parents, I had no other Jews to celebrate Jewish holidays with; and since my parents themselves did not have much exposure to Judaism, we bumbled through the two Jewish holidays we knew about (Hanukah and Passover) by rote: did the things we knew to do, ate the foods we knew to eat, but otherwise did not have any particular understanding of the significance of the festivals.  Since it was only the three of us, none of it lasted very long.

We moved to New England when I was twelve.  The other children were quick to let me know that “their ancestors got off the Mayflower,” meaning, “and you will never belong here or be one of us.”‘

On the other hand, since I had never belonged anywhere anyway, being from another planet etc., I got used to it and poked around to find families that would tolerate me crashing their Christmas traditions.

With the exception of Old England, I doubt there is any place on earth that takes Christmas so seriously as New England.  By “seriously,” I mean Serious Fun.  In those days you could count on two or three feet of snow on the ground and often more coming down, the night turned blue by the refraction of the snow so that the fields looked like vast undulating blue bosoms.

Over these blue bosoms we would tramp on Christmas Eve, freezing in galoshes, boiled-wool pea coats, and hand-knitted hats, gloves, and mittens, the latter so caked with snow from snowball fights that the wet wool threatened frostbitten fingers.

On arrival to our destination we would stand outside the two or three hundred year old clapboarded or shake-shingled house and sing our hearts out: the standards, O Holy Night, O Come All Ye Faithful, Joy To The World, like that.  The family would come to the door , backlit from the roaring Yule log in the great open fireplace.  After grinning through our performance, they would invite us in to warm up around the fire.  Mittens came off and steamed on the hearth while we were immersed in great mugs of hot chocolate floating with marshmallows.  The cookies went ’round, inquiries made after the health of Aunt Bessie, and after we were warm, dry, and refreshed, we said our “thank-you’s” and “Merry Christmases” and set off across the fields to our next destination.

Most families did not put up their tree until Christmas Eve, unlike the current trend that used to begin with after Thanksgiving and now seems to be encroaching on Halloween.  The suspense leading up to that joyous hour when the big Balsam fir (no one used anything else, for the Balsam’s delicious fragrance permeates the house and no potpourri is needed) was hauled upright in the bay window.  There really is no better place for a Christmas tree than a bay window, because there’s plenty of room to move all around the tree to decorate, and the window seats make great places to sit while opening presents.  And of course, anyone happening by gets a spectacular view of the tree!

I don’t know about today’s decorations, but in those days there were two kinds: home-made, and heirlooms.  The home-made kind ranged from little felt Santas, elves, and angels made by first-graders, to paper chains made by us, to popcorn-and-cranberry swags that we made on the spot with a felting needle and a lot of popcorn and fresh cranberries (being New England, where cranberries come from, and all), to gingerbread cookies made of a special recipe that hardens and you wouldn’t want to really eat them but they look great, and of course the candy canes, which we did eat.

Then the box of heirloom decorations was opened, and a hush fell on the room, succeeded by excited exclamations as each precious piece was unveiled from its tissue wrapping, where it had slept, dormant, since last Christmas.

The Star, of course, came out first.  New England Stars are often made of hand-crafted tin with whirly things and tinkly things.  Some of them are lanterns that you put a candle in, if your ceiling is high enough.  Getting it on the tip of the tree involved ladders and gymnastics and usually brothers.

The icicles were of drawn crystal.  Real crystal, that danced with light.

The balls included clear ones with snow scenes inside, and ones with red-cheeked Santa faces hand-painted on, and each one had its own story: who it had belonged to, to whom it had been passed down to, and how it came to be in this box.  There was a reverence to hanging each and every memory, connecting generations, on the fragrant branches.

Nothing was done without a rich egg nog, or a wassail, to cheer along the festivities; and the cookies that were meant for eating came out.  Every year someone made pfefferneuse, those abominable pepper cookies that look deceptively delicious, but taste so evil that one is forced to seek out a discreet trash can to spit them out.  Likewise the obligatory fruit cake, made at least a year ago and packed away soaking in rum.  Does anybody really like fruitcake?  Please.  I want to know.  And please send me your address.

In my experience, fruitcakes are a great gift to receive, because you can pack them up in a different tin and give them right straight to somebody else–just make sure you don’t give it back to the person who made it–which can be a little tricky in a small town like ours.

Now.  New England Brown Bread.  THAT is a horse of a different color.  Who has had it?  It is a moist, molasses-filled cake spiced with cloves and cinnamon, bristling with raisins, baked inside a number-something (I forget, but I think it might be twelve) tin can, in a water bath.  That makes it officially a pudding, I think, according to English culinary nomenclature, but in New England we just call it Brown Bread, and it is the most delicious thing of all, especially eaten warm, splashed with brandy and dolloped with vanilla ice cream or heavy whipped cream (not the kind in a can), or both.  And it is BROWN.  Whenever I have been the lucky recipient of a can of Brown Bread I have never recycled it like I do the fruit cakes, but hoarded it until I could enjoy it properly.

Roll forward many years, and I am in Seattle.  How I got there is another story, but let’s just say I was alone, without family or friends.  I was exploring my Jewish roots at the time, and bit by bit learning the how’s and why’s, but really between the worlds, and terribly lonely and depressed.

As everybody knows, the holidays can turn a normal everyday depression into a catastrophic one, so I did some advance planning and came up with a solution: rather than stay home and entertain myself by running movies in my head about the brilliant and elegant ways I would off myself, I would go to the mission food kitchen and take my mind off my troubles by running my ass off serving meals to people who didn’t have the luxury of a home in which to sit and contemplate suicide.

I showed up on Christmas morning.  Even though dinner wasn’t to be served till noon, the dining room was packed with people holding down their seats, eagerly awaiting one of the few real meals they would get this year.  It was cold outside, too, and of course raining, being Seattle, so they got to wait in a warm, dry place.  My heart opened to all these souls: there but for the grace of God go I.

Tables were set, the dinner gong “went” at noon, and we waiters began to scurry with heavy plates steaming full of turkey, dressing, mashed potatoes, canned yams, canned green beans, cranberry sauce….there was a bit of confusion when some of the guests decided to “help” with the table-waiting in order to procure seconds for themselves….an announcement was made that seconds would be available after everybody had “firsts,” providing we didn’t run out of food.  Everyone sat down again.

A sudden wave of panic broke out in the kitchen: the cook had fallen ill–now what to do?  I mentioned that I had been a chef some years back, and was instantly drafted and in fact, shoved physically into the huge stainless steel institutional kitchen.

To tell you the truth, it wasn’t a difficult job to fall into, since much of the food was already prepared and just needed to be heated up.  But there was a herd of turkeys sizzling in gigantic ovens, and pots of mashed potatoes that I needed  a ladder to even see into, and such pans of dressing, that needed two people to hoist out of their oven compartments!  And oceans of gravy hot enough to scald to death the unfortunate who fell into the gargantuan pots.

I was very fortunate to have a small army of kitchen assistants who knew what they were doing, so all I had to do was ask questions and do what they said.  In two sweat-drenched hours we fed well over 400 souls.

I helped to serve the pumpkin pie, since by that time there was no further chef-ing to be done.  I could barely make it from one diner to another, due to the fervent hand-squeezings and embraces and blessings from people I would not have previously thought of getting that close to, but somehow, and I think you’ll understand, a blessing from someone who lives in the cold, wet, filthy, dangerous, hungry world of the streets is worth more than a blessing from the Pope.  It is a blessing from a fallen angel.

That Christmas, I felt that (even though I am not a Christian in the conventional sense) if someone had asked Baby Jesus what he wanted for Christmas, he would have said: Take care of the poor, the destitute, the hungry, the sick, the outcast, the prostituted.  This is what I want for my birthday….for Christmas!

Feeling Suicidal? Change the Channel.

Things have been going in a dismal spiral that has been threatening to turn into a full-blown tailspin.  For the last three days I have ruminated night and day about death: fervent wishes for a speedy natural death, and in the absence of that, turning to my old faithful suicide plan, painless, tidy, nothing to clean up and nobody’s trauma.

There is no good reason for this, if you discount the deep spell of depression.  Here I am in the Holy City of Jerusalem at the holiest time of year, and especially now that it’s sukkot:  the happiest time of the year for us Jews.  So what’s the deal?

OK, so I have had to move twice in two months because of the bedbug plague that is sweeping the city.  Bedbugs get me down.  They give me more than the creeps, little bastards sucking your blood all night and hiding out in your underwear drawer during the day!  Chutzpeh!

I had the second apartment exterminated three times, each time involving leaving for 10 hours, then scrubbing the floors and all the surfaces multiple times so as not to poison myself and my dog.  Nevertheless I have had a nasty headache for weeks, which has gone away after moving to the third apartment which so far (please G-d) does not have bedbugs like the first two.

Along with all the other bedbug mitigation work, I have to wash and dry everything over and over.  Right now everything I own is on the roof baking in the sun (they can’t stand heat and drying), which was fine until it rained the other night.  I have not had the strength or ambition to climb back up on the roof and undertake damage control.

So circumstances are getting me down, yes.  It’s an overlay on the bipolar depressive phase.  But it could be deadly, because just a few hours ago I was planning when and where.

And then I broke my policy of strict isolation (because when I’m like this I am such a zombie, flat affect, flat voice, no reactions) that it freaks people out and is very unpleasant for me.  And if they’re people I like, I might just burst out crying and that just makes things worse.  So isolation it is, and yeah, I know, it’s not good.

So this evening a very special event was planned in my congregation in honor of this day being the passing of Rebbe Nachman of Breslov, in the year 1810, who was a revered spiritual leader, and is the guiding spirit of many members of our congregation.  I had to go.  I wanted to see everybody, hear what the rabbi had to say (even though I only understand about every third word of his Hebrew) and generally be with my peeps.  I did not set myself a time limit: if I got uncomfortable, I gave myself permission to leave at any time.

Not only that: since my Hebrew birthday falls out tomorrow, I booked myself a massage tonight.  Yeah.

When I got to the party I was feeling pretty low and didn’t know if I would be able to handle it.  But there was singing and someone was playing a djembe (African hand drum) badly, and I saw another djembe that didn’t have anyone playing it.  Now, I happen to have studied djembe for four or five years, and played with an African dance troupe.   I have stopped playing because of severe issues with my hands, but since I was planning to die I didn’t care if I fucked up my hands more so I picked up the free djembe and warmed up quietly, getting the feel, and then the old feeling came back and I popped right back into the common West African dance rhythm BADA bada BADA bam, working the bass and the slaps and tones and rim shots just like old times.  And for some reason, I didn’t break blood vessels in my hands or hurt my two bad wrists or any of that.  And feeling the groove of the people singing and getting underneath the inexperienced drummer and giving him a boost so he could ride my wave was intoxicating.

I forgot all about suicide.

Then I went and had a 90 minute massage.

Now I’ve taken my meds and am going to bed, with a lot to think about.

I’ll think about it in the morning.  At Tara.  Or maybe in the Old City.

Suicide Prevention is Everyone’s Business| American Association of Suicidology

Suicide Prevention is Everyone’s Business| American Association of Suicidology.