New Black Box Warnings: FDA

I have a hell of a toothache.  A couple of months ago I broke a tooth, and went to a franchise-type dentist who took emergency cases.  One of the down sides of being a professional vagrant is I don’t have a regular dentist. 

For a little over $1000 I walked out with a new crown and instructions to call if I had any problems.

I did have a problem, before I even left the office.

I felt that I should have had a root canal before the crown went on.  I know my teeth.  They are ornery, pesky things.  They operate in strict accordance with Murphy’s Law:  anything that can go wrong, will go wrong. 

The dentist assured me that the nerve looked fine, and he hated to mess up a basically healthy tooth.

A couple days later, the thing started hurting like a sonovabitch.  I called the dentist, who immediately assumed I was a drug seeker and blew me off, saying that it might take a few weeks to settle down.

It hasn’t.  In fact, it’s getting worse.  Now I have to look for a dentist who will…but wait, it’s Labor Day Weekend!  No dentist till next week, when I have to run up to Michigan to get some warrantee work done on the old brand new RV.  Maybe I’ll find a dentist there, with a lot of luck.

So, in order to buy some time and have at least a few hours out of misery, I took two of my hoarded tramadol tabs.  Now I have maybe 20 left.

Then I opened my email, to find a bulletin regarding a new FDA policy, intended to protect ourselves from ourselves:  black box warnings on both opioids and benzodiazepines, warning that they must not…Black Box MUST NOT…be taken together, because of the potential of respiratory depression leading to death.

A Black Box warning is the strongest labeling there is.  This means that in a time when even being prescribed pain medicine is becoming a remote possibility, those of us who take benzos for anxiety disorders and/or movement disorders, seizure disorders, or insomnia, will have an even more difficult time obtaining effective pain management.  Doctors who prescribe both meds at the same time will open themselves up for censure and lawsuits.  Pharmacists are being given increasing power to simply refuse to fill prescriptions.  They don’t have to, and if the FDA issues black box warnings, they are fully within their rights to refuse to fill prescription A if the patient is known to be taking prescription B.  In fact, if they do fill it and the patient has an adverse effect, the pharmacist is liable, can lose their license, and can be sued.

This is of direct concern to me.  My neurosychiatrist, who unfortunately has retired due to failed back surgery, hammered out a drug cocktail during the course of our 12 year clinical relationship, that effectively treats my bipolar, PTSD, and social phobia.  It includes 3 types of benzos.  All at once.

It also helps with the muscle spasms that cripple me day and night.

Now I fear that when my prescriptions run low, I won’t be able to find anyone to prescribe these lifesaving medicines because they are “too much.”

Worse, the degeneration of my spine is getting to a critical point.  One of the bones in my neck is rotating in such a way that it is pressing against my spinal cord.  I’m going to need surgery soon.  Major surgery, to fuse three of my cervical vertebrae and lift them up off the nerves they’re pressing on.

I won’t describe the surgery, because it makes me sick even to think about it.  I’ll just say that it involves lots of chopping up bone and remodeling.  Very, very painful stuff.

So…in today’s anti-pain med climate, what’ll it be?  Black Box Warning ahead!  Do I get to continue my benzo regimen so I can maintain a semblance of normalcy, and not be a hypervigilant mess, or do I get a modicum of pain relief after having this spinal carpentry fest?  Do I have any say in this matter?

Last time I had spine surgery, I got sent home with zero pain meds.  None.  And that was in 1987!

Why on earth did this happen?

Because I happened to joke to the pre-op nurse who was taking down my then very short med list (one med!) that I took Xanax for the three days before my periods, and that I was addicted to not having PMS.  She wrote down that I was addicted to Xanax!  It was recorded in my chart that I had admitted to being a drug addict.  So when I called the hospital to ask for some kind of postoperative pain relief, the neurosurgery intern scolded me about being a drug addict seeking drugs.  No pain meds.  And that was a relatively minor procedure, compared to the one I’m facing.

I really don’t know what to do.  Sometimes I wish I’d just die in my sleep, so I wouldn’t have to face this surgery and the prospect of being helpless, in agony, without the possibility of comfort.

How Stigma Compromises My Medical Care

I don’t know what to do.

I can bet that most of you will say, “Just be yourself, Laura.  Fuck ’em if they can’t relate to you as the awesome human being you are.”

Well, yeah.  I appreciate that.

However.

I have this service dog, see, and she’s neither little nor cute.  Well, she’s cute to me, but a 75 pound Belgian Malinois is automatically not cute to most people, especially the uptight assholes that tend to go into “the medical field” these days.  Even my therapist does not think she’s cute.  Even when Atina climbed into her lap and gave her kisses, because she could see that the dear lady was clearly in distress, it did not help.  My poor therapist could do nothing except beg me to get the monster off of her, which I did, and Atina reluctantly obeyed but was still of the opinion that the lady needed her attention.

On the flip side, if Atina perceives that someone is potentially a threat to me, she stations herself sideways in front of me, giving the unsafe party the hard-eye, which is dog language for “come over here and make my day.”

This is why I have a Service Dog:

I have a perfect storm of Asperger Syndrome, PTSD, and Bipolar illness.  My judgement about people is shot to hell.  I lost it on April 22, 1970, the very first Earth Day, when I was drugged, dragged into a dark basement, and brutally robbed of my virginity.  That, and the prolonged months and years of running from one frying pan into another fire, robbed me of my ability to read people’s intentions.  I think it’s because I simply dissociate every time I have to interact with other people.  So now that I’m on the far side of sixty and no longer give a shit, I’ve stopped making myself do painful things, and aside from the inconveniences of not having friends, family, or a partner when I have a medical emergency, I feel much better.

Have you noticed that sometimes your fridge, washing machine, microwave, computer, and automobile all crash at the same time?  So now you have to get a ride to the Big Box store, to the bank to get quarters for the laundromat, and a ride back and forth to the laundromat, to the convenience store for ice until the new fridge comes, and while you’re on the phone with Tech Support your phone is giving your ear a second degree burn and probably giving you brain cancer as well….

This is what I call a Wear Cycle.  When everything wears out at once.  It generally falls out when you’re between jobs, or just before those gift-giving occasions, or your wedding.

So as some of you are aware, I am in the throes of a Wear Cycle of the most annoying sort.  My body is falling apart.  I thought it just needed a tune-up and maybe a brake job, but it turns out to be the transmission, the universal joints, the head gasket; and every time they fix one thing, another one turns up bad.

The result is a seemingly endless procession of doctors, PAs, Nurse Practitioners, lab techs, snotty Front Office People, sadistic MRI techs who put me in Positions Of Stress for upwards of twenty minutes while further damaging my hearing with the various hammerings and clangings of that infernal magnetic tube, being told that I need surgery for this, surgery for that, and they all worry about my blood pressure.  Surely not!

You must understand that my relationship with The Medical Field is a mine field.  The minute I leave my van in the parking lot of the doctors’ building, the hospital, the lab, I dissociate.  I am terrified.

But you’re a doctor, you say.  How could you not be comfortable in this oh-so-familiar milieu?

That’s just it.  I’m all too familiar with it.  I know exactly what goes on behind the scenes, and it disgusted me while I was in it, and it terrifies me now.

Because I am…one of those patients.

You know, the aging female with so many complaints it throws your schedule off, and she’s slight dotty, and might be amusing if you weren’t running so far behind, and of course–of course, she has to be a doctor, at least she says she is, and she does know the lingo…and she has Medicare and doesn’t seem to have a job, so she must be disabled, but for what?  She’s not saying, and if you ask, she’ll say something vague.

I know this, because I’ve been on their side of the white coat.

So imagine what the reaction would be if they walked into the exam room and there I was with my Service Wolf Dog.

The entire visit would revolve around whether the person who Works In The Medical Field was comfortable with the Doggess, and whether she thought they were Safe.

And of course she would pick up on my instant dissociation because I dissociate whenever I run into One Of Those People, because of the abuse I suffered when I was working In The Medical Field, and the abuse I have suffered as a patient dependent upon these people’s power.

And the shame of being disabled, which is, according to the ancient tenets of The Medical Field, weak; and even worse, crazy.

I just rediscovered a former mentor who was hugely influential to me when I was a medical student.  She was my supervisor in the Public Health Clinic.  We became good friends, and she helped me crystallize my medical practice world view, which is based on compassion and empowerment of the patient to take charge of her own health and well-being.

It turns out that this amazing woman had a terrible crisis, which lead to a suicide attempt.

Rather than supporting her and helping her to rebuild her life, the medical establishment brought criminal charges against her for lowering the esteem of the medical profession in the eyes of the public.

They drove her out of the profession.  It didn’t matter to them that this heinous act might push her over that very precipice she had dragged herself back from.

It didn’t matter that they were persecuting one of the finest physicians on the face of the earth, for the crime of being human.

All that mattered was that she had “failed” to complete her suicide.  If she had died, she would have been another tragic physician suicide; but since she managed to survive, she was pronounced a disgrace to the profession.

Fortunately she is a strong and resourceful woman.  She cleaned houses in order to feed her children.  She struggled her way back onto her feet, and reinvented herself.  Blessed be.

So I know very well what the result would be, even if the Doggess didn’t bite the Assistant (you hardly ever get to see The Doctor anymore):  “Did you get a load of that lady with the dog?  What a crock!”

Yes, fuck ’em.  They’ve no right, legally or otherwise, to prevent me from having my dog with me.  She’s Durable Medical Equipment, just like a wheelchair.

The only thing is…being mentally ill automatically discredits anything I say.  I’ve tried it both ways.  And unfortunately, whenever I’m honest and disclose that I have DSM diagnoses, I get my case dismissed.  No contest.  No service.  Goodbye, and put some ice on that.  It will feel better in seven to ten days.  No need for follow-up.

In awful contrast, when I have withheld my diagnoses, it’s all sympathy and MRIs.

Hell, I even got a few tramadol tablets for my torn shoulder, when I begged the doctor because my left wrist is in a brace awaiting surgery and my right shoulder is so painful that I can’t even get out of bed without fainting if I forget and try to push myself up with my right arm.  (How do I get out of bed?  By wriggling on my tummy until my feet touch the floor.)

You think she would have given me that prescription for thirty, no refills, if she knew that I’m bipolar?

Nope.  Bipolar people are categorically drug seekers.  Even though I asked for tramadol and not Percocet.  Drug seeker, no way.

I’m stuck.

I’m terrified of those places, and I need my dog.  But the presence of my dog would set off such alarms in the mind of The Medical Field Person that my actual medical issues would be eclipsed by Prejudice.  Stigma.

If I showed up in an electric wheelchair, they would be all ears.

But a crazy person with a dog?

Sonovabitch

Went downstairs
Getta glassa cider
There I saw the bedbug
Foolin’ around with the spider
And then
Went down agin
Getta glassa gin
Sonovabitchin bedbug
Doin’ it agin

One of these days I’ll figure out how to put sound files (like, me singing, eek) on these posts.

Sonofabitch.  Two weeks ago, or maybe three, I don’t know, time is all mashed up these days–I had steroid injections in both shoulders.  Hurt like a sonofabitch, but what to do, my xrays look just like those mace things the barbarians used to swing on chains, in order to bash people’s heads in.  I mean, they have these bumps and stickers growing out of the ball part oft the joint, diving into my ligaments and muscles and cartilage and whatever else they could stick into.

My left shoulder felt real good after a couple of days.  Right one, not so much, but better, I’ll take better.

No pain meds, we don’t do pain meds anymore, don’tcha know.

Imagine my surprise when I woke up this morning to find that I couldn’t get out of bed the normal way. 

I sure started to, but the pain in my left shoulder gave me those black spots in my eyes and I had to lie back down and contemplate for a while.

After a suitable interval, and largely because my dog was standing by the door with her legs crossed, looking sad, I hove around and slid out of the sack, grabbing onto the towel rack (remember I live in a tiny RV where things are all squashed together) with my right hand YOW! 

Sonofabitch.  The right one too.

As if the cortisone wore off of both of them, synchronized, just like that.

I guess that is what happened.

So now what the fuck am I supposed to do?

This was my second set of injections.  So I did a little reading on the topic, and found that each injection can poke little holes in the shoulder cartilage, until eventually you need a joint replacement.

Uh, no.

But even worse, doing nothing will eventually lead to a joint replacement.

Mmmmm…..no, no likee.

Gotta find me a good acupuncturist.  I know one in Tucson.

Hell, I am a good acupuncturist, just real hard to hit those points on the upper back.

But sonofabitch, I’m stuck in Western North Carolina.

I had big plans to start heading West last week, but being a weather buff, I looked at the maps and said “nope.”

Good thing, because I would have headed right into that bad line of tornados and mayhem.

Driving around doing random errands, I scraped the bottom of my RV on a sharply angled driveway, and next place I camped I noticed nasty stuff pouring out the bottom of the rig.

Shit.

That’s what it was.

Somehow that minor scrape opened up a pipe joint (hey, that sounds good) in the sewage system.  All well and good, since I was parked at an RV repair joint..rollll another one…

But no.  It was a couple days before Christmas, and nobody was working.

I called RV repair joints all the way to Florida and the Midwest.  Same story.

But good news!  I got an appointment for this coming Wednesday!  Only eight days I will have been hanging around here.

But bad news, if they can’t fix it on the spot…it’s my home, you know…And if they take out stuff in the sewer system, that’s real bad, because I use it…a lot…between the fucking lithium that causes me to pee every five minutes to the Crohn’s that goes in cycles, but when it goes, it GOES…

Well, my full-timers rider on my RV insurance will pay for a rental car and a hotel room if my rig is out of service, but sonofabitch, I don’t even have a single one of my vast suitcase collection with me.

Why would I?  I live like a turtle.  All my stuff goes with me, wherever I go. 

Just another small conundrum.  The RV life is never dull.

In the meantime I’m stuck here in beautiful (not) Marion, North Carolina, where there isn’t even a Cracker Barrel.  That’s how small it is.

But it does have a rental car place, which got me all excited till I called them up, and the rental agent told me sadly that they don’t have any cars at the moment.

Oh, and there isn’t any lodging here, either, not even a Motel 6.

Oh well, something will turn up.

My mother, who lives 45 minutes from here in a place that makes Marion look like a booming metropolis, offered to come and get me.

Noooooooooooo!   I’ll sleep in the woods first.  Have done so before.

In the meantime, I’m back in bed, writing this on my phone with one finger and trying to keep from moving, so I don’t hurt my shoulders.

Atina the Malligator has her 70 pound self draped across my legs, warm and heavy, sweetly sleeping, but still scanning the environment with her ears: they are always on duty.

She is a sweet treasure, my Atina.  Living in close quarters, we grow more and more in sync with each other.  She doesn’t like to let me out of her sight, so I just tie her leash around my waist, and she is content to go where I go, do what I do.

I think that’s the way dogs and their people are meant to be.  Together all the time.

If I’m somewhere safe, without cars or people or other dogs, I let her off the leash.  She still sticks close, but the difference is, she carries a toy around with her and bugs the shit out of me to throw it for her.

Which I have no problem with, except my bum shoulders don’t allow for long throws; which means in two seconds she is back with the blasted toy, wanting me to throw it again.

Where is the ten year old kid when I need one?  They could throw the damn ball while I’m busy, then disappear till I need them again.

But I’m happy to see her all waggy and full of doggie joy, so I throw and curse, throw and curse, until I see she’s had enough.

Sonofabitchin bedbug
Doin’ it agin

The Power of Unconditional Love

Listen, I don’t pretend to be a perfect practitioner of unconditional love. I wish I was. My loved ones would have had such better lives, had I had any notion of what unconditional love could do.

For example, on July 20 I bought a skinny, sick, fearful dog, for a ridiculous sum of money. I was in a terrifically needy state, having lost my beloved dog Aress to a freak accident. I looked into this pitiful sick doggie’s soft brown eyes, paid the sum, and took her home.

It was clear that she had never been in a real house before. OK, I don’t really live in a “real house,” since I make my home in a fancy van. But it is undeniably a home, and it was clear that she had never been in one. She lived in a kennel outdoors, was taken out to train, and put back in her kennel. From her lamentable condition, it was also clear that nobody had ever paid much attention to her.

In the six or so weeks that I’ve had her, she’s become a sleek, happy pup who loves almost everybody except people she deems untrustworthy. This is her job, and she does it well. She’s affectionate to the point of occasional annoyance, since there are things that must be done (according to me), like writing, doing chores, paying bills…but to Atina, these are annoyances to her, for damn the torpedoes, the play must go on!

An old buddy of mine stopped by to camp for a few days (hi, pal, in case you’re reading this!). I showed him the picture of Atina when I first got her. You could count her ribs and all her vertebrae, and the bones of her pelvis stood out like a sick cow’s. Her coat was dull and ratty: so much so that I had her tested for mange.

My friend asked me how I had managed to rehabilitate her into the sleek, happy girl she is today. I shrugged.

“Love,” he said quietly. I nodded, tears stinging.

Although he gets furious when I bring up the topic and vigorously denies it, my son is a very high functioning autistic. He learned to speak before the age of one, and before that, he developed his own version of sign language. By 19 months he could count to 19, and by three he could tell you the names of every dinosaur known to man, where they had been discovered, and what they did, their diets, their habitats, and what era they lived in. By four he had taught himself to read and do basic arithmetic via “Reader Rabbit” and “Math Blaster” on our desktop Mac.

On the other hand, he hated anything to do with other children, refused to participate in preschool, and whenever possible isolated himself in corners, absorbed in a book or playing with his plastic dinosaurs or action figures. At three, he was already seeing a child psychologist. We managed to get through private kindergarten in five-minute segments. If he cooperated and sat in the circle with the rest of the children for five minutes, he got to go to his corner and be alone for fifteen minutes. Later in the year he discovered the school office and became enamored with the laminating machine, so he became more motivated to sit for five minutes so that he could run to the office and laminate for fifteen.

First grade was a bust, as far as the teacher was concerned. We enrolled him in a progressive Quaker school: small class size, emphasis on art and music, compassionate teachers–what could be better? Nothing, I guess. Literally nothing. My son staidly refused to cooperate with anything whatsoever. His teacher, a caring and earnest young man, could not get him to do anything. He retreated to a corner and refused to come out. Somehow he managed to ace all the tests, though. But he would not come out of his corner, nor would he speak a word. The teacher called me on a weekly basis.

“He refuses to participate. What shall I do?”

I was busy, harried, frustrated and sleep deprived, so my stock answer was, “You’re his teacher. YOU find a way.”

This did not work.

Finally I had a brainstorm: “Make him the class scribe. Give him a tape recorder, and have him sit just outside the class circle and record everything. This way he’ll feel like he’s got an important job and is not simply one of the (muggles, but that word had not yet been coined by Rowling).”

It worked. We managed to make it through first grade without any further conflict.

In later years, I experienced what happened when I tried to force my son into anxiety-producing behaviors using negative consequences. He either withdrew, or else he simply sat down on the floor and crossed his arms, earning him the nickname “Sitting Bull”. When he got older, he became threatening and intimidating. I was not about to knuckle under, so I upped the ante, and so did he. Soon a full-blown war was in progress.

Now, I don’t believe in accepting bad behavior, not even from a “special” child. But there are ways, and then there are ways.

My moment of epiphany dawned upon reading Karen Pryor’s amazing book, Don’t Shoot the Dog. Pryor was the head porpoise and Killer Whale trainer at Sea World for many years. Now, you can’t make a large sea mammal do anything it doesn’t want to do. You have to make doing the desired behavior so attractive, that said mammal would rather do it than just swim around and play, like porpoises like to do. You have to make it fun to do what you want them to do.

Pryor’s book, as its title implies, carries this philosophy over to dog training. At the time her book was published, most dog training was based on negative reinforcement: You don’t do what I want, you get your neck jerked, you get yelled at, you might even get hit with a rolled-up newspaper for doing your business where you’re not supposed to.

Pryor applied what she had learned as a sea-mammal trainer to dog training. Thus, lucky dogs found out that doing the desired behavior resulted in treats and praise, while negative behaviors got them…nothing. Ignored. Exactly what a social mammal desperately does not want.

Of course, psychology students already knew this from getting rats to do things that humans had a hard time with, by simply having a tasty treat at the end of the maze. But applying methods that worked with “lower life forms” to humans? How insulting. Humans ought to just know that what they were doing was good or bad. Adam and Eve, right? Tree of knowledge of Good and Evil, and stuff like that.

The Behaviorist School of Psychology, pioneered by B.F. Skinner, showed that positive behaviors rewarded with positive reinforcement produced more positive behaviors, while negative reinforcement inhibited negative behaviors. A third strategy was called “extinguishment.” You do what I want, you get left alone to do what you want. You don’t do what I want…nothing. The behavior “extinguishes,” for want of reaction. In many cases this worked better than negative consequences such as electric shocks. (N.B.: a rumor somehow began that Skinner experimented on his own child by placing her in a “sensory deprivation” cage. This is not true.)

Pryor capitalized on Skinner’s Behaviorist School of psychology and its “behavior shaping” model in her sea mammal training program. She then morphed it over to dog training…and concluded her book with a chapter on shaping the behavior of humans.

I can’t say that I ever mastered behavior shaping, either in dogs or in humans, but I have tried to incorporate it, when I remember.

What I’ve learned through the years, though, is to assimilate and practice the art of “Love the person, even if you hate the behavior.”

I have always loved my son, completely and passionately, even when I was dodging head-butts when bear-hugging him through an autistic melt-down, or once again leaving a cart full of groceries in the checkout line when all those people were just too much for him, or agonizing through the time he was in and out of countless outpatient and inpatient addiction programs as a teenager, or sitting up nights worrying when his stepmother threw him out and he lived in a drug house, on the street, in a homeless shelter, in a psychiatric ward zombied out on legal drugs.

Finally he got arrested, and this was my chance to save his life. I called the judge, whom I knew from my work with the court system (yes, this was taking advantage of my position), and begged him to remand my son to long-term inpatient care. The judge reprimanded me for calling him, but honored my request.

After a long period of searching, we found the perfect place. The students were held to a strict policy of personal accountability. Positive behaviors were rewarded with increased privileges; breaches of the rules resulted in suspension of free time, which was instead spent writing a paper examining the undesirable behavior, why the kid did it, what the internal meaning of the behavior was, and why this was counterproductive to the kid’s development as a productive, independent, successful individual. The student then presented the paper to a mentor, who helped process the ideas and helped the kid internalize them. There was still a consequence in terms of loss of privileges for a finite period, and a defined way to regain the lost privileges.

In this way the teens learned that self-determined productive behaviors resulted in more freedoms. In addition to these interventions, the kids had daily group therapy, thrice-weekly individual therapy, a staff mentor who was always available for processing issues, family therapy monthly, and many other interventions. It turned many lives around. It gave my son tools that he is still using, ten years later.

For me, it reinforced that the power of unconditional love moves mountains and saves lives.

Amen.

Turn the Lights On, Will You?

Hey everybody, this is Chattery the Chipmunk here with an Arctic News Blast from Canada.  No, really!  Some of you may know that I’ve been down in the Black Hole for a long, long, long, long…..time.  I keep going to my psychiatrist and he manages to make me laugh somehow, so he knows I’m not hospital material yet.  But since I’m maxed out on the meds, there really hasn’t been anything to do except for hang on tight and think about my son and my dog and some other people who might be seriously bummed if I checked out.

Last week, though, Shrink-O-Matic had a brilliant idea!  Light therapy!  He gave me a “prescription” for a 10,000 Lux blue spectrum light made in Canada, where they really know from Seasonal Affective Disorder.  It mimics the light of a beautiful blue sky!

Now, I am so sensitive to light that my mood changes for the worse if a cloud even covers the sun for a few seconds.  I think one of the reasons I love to be in Israel (one of the many, many reasons) is that if I’m feeling down all I have to do is step outside into the Mediterranean Middle East blue sunny skies and I’m much better.

The instructions that came with the lamp say to use it for 20-30 minutes once a day in the morning.  So I’ve been doing that, and it has been helping some.  Then my therapist on Thursday had the bright idea that I should try using it twice a day.

So today I used it first thing in the morning, and again around 2 pm.  So far I have gone for a long walk with The Dog, swept and vacuumed the entire house (if you can call this a house–it’s actually an unimproved barn-like structure, but it keeps the rain out and has heat), and redid my fan page on ReverbNation, and tried to learn something about investing in stocks, and…I am not at all tired, and it’s 10 pm, and I don’t think I’ll do that again.

It feels something like being on steroids, which is why I hated being on steroids when I had to take them because of inflammation.  I think it could definitely lead to mania if continued.

So, tomorrow will be a one-dose day.  Nevertheless, it is such a relief to NOT be depressed–you know what I mean–that I’ll take a hypomanic episode every now and then if that’s the way it has to work.  I just have to write it on the inside of my eyelids: don’t buy stocks when hypomanic!!! 

Breaking The Silence of Stigma: Laura P. Schulman

alien woman headThis Wednesday’s Breaking The Silence of Stigma interviewee is….me!  So, without further ado, let’s jump right into the shark pool!

BSS: How long have you known that you are living with a mental illness?

LPS: When I was putting myself through a very expensive college, scrambling for every dime I could earn, I saw an ad in the campus newspaper recruiting paid volunteers for a pharmaceutical study, for some kind of psychoactive drug.  Get paid to take drugs?   Oh boy!  Pennies from heaven!  So I applied.

I had to take a whole day’s worth of psychological screening tests to determine if I was suitable for the study.  I’ve always been good at tests!  I aced ‘em all!  Or so I thought.

The following evening I got a call from somebody in the psychology department.  He told me that the tests indicated that I was suffering from Major Depressive Disorder, and he ordered me to appear at Student Mental Health the following day.  And, oh my, I was disappointed to hear that I would not be accepted for the drug study.  Rats.

I couldn’t really figure out what all the fuss was: Major Depressive Disorder?  Hell, I didn’t feel any different than I always felt.  I mean, I’ve got an artistic soul, and those are always tormented, aren’t they?  If I didn’t feel intensely sad and/or elated all the time, how could I make my art, write my poetry, go without sleep for virtually days at a time….certainly there had to be some mistake.

But I showed up at Student Mental Health at the appointed hour.  A nice poufy lady welcomed me into her office and sat down on the other side of the desk, gesturing me into the chair on my side.  She perused a chart.  It was my chart.  This is significant, because I had never had a chart before.

She looked up at me and smiled.  She looked down at my chart and frowned.

“It says here that you’re depressed.  My goodness, you’re a straight-A student.  You have a good job in a lab.  You’re good looking.”

She looked up at me again and smiled again.

“So why are you depressed?”

I got up, thanked the nice lady, and walked out.

 BSS: Can you share with us your diagnosis/diagnoses?  When were you diagnosed with these?  How were they diagnosed?  Did you have any special testing?

LPS: I have Bipolar Disorder, Post Traumatic Stress Disorder, Dysthymia, and a touch of OCD.  And I’m an Aspie, as in Asperger Syndrome.  In 1996, I had a battery of tests at the University of Utah in Salt Lake City.  They totally missed the Bipolar and came up with Major Depressive Disorder, probably because I still didn’t think any of the hypomanic things I was doing were abnormal.  In 2005 I had the tests repeated at the University of Washington in Seattle, and they nailed the BP, the PTSD, the Dysthymia, and told me I scored pretty high on the OCD scale.  The Aspie-ness was diagnosed collaboratively with my Ph.D. psychologist, along with some testing.

BSS: Was your illness diagnosed correctly the first time, or did it take time before the right diagnosis was arrived at?  Do you feel that you do indeed have the correct diagnosis now?

LPS: As I said above, the diagnostic process was pretty choppy, until I arrived at the University of Washington Mood Disorders Center, and got what I consider to be a very comprehensive and correct work-up.  I feel confident that my diagnoses are definitive and correct.  This has helped immensely.

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

LPS: I have been hospitalized twice.  The first time was because I was off meds for fear of being “discovered” by my hospital administrator.  I know, right?  The second was because of wrong medication from a terrible psychiatrist, combined with an over-the-top relationship with another poorly medicated Bipolar.  They definitely helped, because they kept me away from lethal things long enough for my suicidality to blow over.  The second hospitalization was great in another way.  My then-psychiatrist, who was terrible, was on vacation, and my current shrink-o-matic, who is wonderful, was covering for her.  I loved him immediately and begged him to let me be his patient.  That was in 2002.  He’s still my shrink-o.

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

LPS: Oh yes. I’m currently on six different medications.  Yes, they certainly help.  My symptoms are, thank God, mostly under control.  I think.  Side effects….lots.  The worst is from the Lithium, which causes me balance problems (I took a bad fall just a couple of days ago, got a nice concussion), and a tremor that is sometimes so bad that I can’t type!  My handwriting has become deplorable due to the tremor, too, especially my Hebrew!

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

LPS: No. I have had nearly 100 rTMS (repetitive transcranial magnetic stimulation) treatments, which literally saved my life. I have had lasting (and I hope, permanent) positive results.

BSS: What other things do you do to help with your illness?  Do you go to individual therapy?

LPS: I have a really wonderful therapist whom I have seen on and off for fourteen years.  She really hits me where I live, and, in a compassionate way, kicks my butt regularly.  In addition, I’m a compulsive blogger and am blessed to have an ever-expanding group of wonderful fellow Mental Illness bloggers, who are a huge support to me.  Thank you, Mental Bloggies!  I find that being a Mental Health advocate gives me direction and a great deal of satisfaction.  I also have a Psychiatric Service Dog, who helps me in many ways.  She helps me to stay grounded, on task, provides structure to my otherwise fairly aimless life, and she is invaluable when I have a PTSD episode.  If I dissociate she licks me till I come back.  And if I am having a flashback that someone is in the room, all I have to do is look at her, because if someone was really trying to enter my house she would go off like a barking bomb.  So if she’s quiet, I know that I can be sure it’s “just” a flashback and will go away eventually.

BSS: How has your illness impacted your life (jobs, education, relationships, children, alcohol, drug abuse….._)

LPS: Ugh.  Can’t you ask me something else?  Damn me.  OK, here’s your answer:  Yes.  Everything.  I have never held a job for more than two years, because I eventually get manic and fired, or depressed and fired….Now I’ve been certified by a Federal judge to be 100% disabled.  That has taken some getting used to, and I still get weepy when I think about my lost dreams.  I was born to be a doctor, fought through thick and thin to be one, was a really good one, and now allthat is gone…it’s rough.

Education has not been a problem because I am an Aspie and I get straight A’s.

My relationships have been very typically Bipolar:  elation, crash, elation, crash…and then my paranoia sets in, and I’m out of there.  I recently took a seven-year break from relationships, consciously.  Then I opened myself to someone who showed up in my life, and….turned out to be waaaaaay crazier than I am, so….I’m really happy with my life as a single person, and I don’t really trust myself with relationships.  So I might just stay single, except for my dog!

Alcohol—I have tried and tried to become an alcoholic, but it never took.  I’m only half kidding about that.  I hung out with alcoholics much of my life, and drank right along with them, but in reality I can’t handle more than half a beer, so I got disqualified.  Drugs, now, that’s something different.  I did a lot of psychedelics when I was young.  And I smoked a lot of pot.  But thank goodness I never took pills (other than acid or mescaline LOL), and I never shot up.  I did have a cocaine addiction though, which lasted for years.  Cocaine cured my depression, until it wore off and the crash was terrible.  I’ve been clean from that for over 30 years.

BSS: Have you ever felt discriminated against because of your illness, or had to deal with disparaging comments, denied a job or other opportunities?

LPS: Yes, yes, and yes.  As a doctor, having a mental illness is tricky business.  First of all, there’s the terrible schedule: being on-call overnight two or three times a week, which is horrible for stability in general and for medication schedule in particular.  Secondly, if one discloses one’s mental illness, one gets one’s license limited and one must have a supervisor, even if one is a senior physician who has never had a mishap of any kind in terms of patient care, clinical judgment, or even paperwork.  It’s humiliating.  I tried to go back into medicine after taking a break to get stable, and the licensing system made me go to a rehab program—even though I am not a drug addict (they never knew about the long-ago cocaine), because they lump mental illness in with addiction in what they call “behavioral medicine.”  They made me show up for a drug test once a week.  I was to do that for a year, before they would even give me a supervised position.  I was so humiliated that I gave it up and went back to my disability status.

In addition, one’s colleagues do not like to hear about one’s illness.  They tend to do things like turn around and walk away if one shares one’s mood or diagnosis.  So one learns to suffer in silence.

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

LPS: Get the best psychiatrist and psychologist you possibly can, and keep them.  Do what they say, and if something doesn’t add up and you feel uncomfortable with their assessment or treatment, say so.  And if they get haughty about it, fire them and find a better one.  Your life is precious.

Find a genuine support network, in whatever way speaks to you.  I, for instance, relate better online, because face-to-face human contact makes my teeth itch (Aspie).  Others find great satisfaction and validation in volunteering.  Seek out a peer group.  Loneliness kills.  Get an emotional support animal, or a Psychiatric Service Dog if you need one.  If you are in a long-term relationship or marriage, and if you have children, be sure to keep everybody in the loop.  Don’t keep your illness a secret.  Secrets kill.  Open and honest relationships, including couples and family counseling if needed, are life-saving.  And don’t forget the kids!  They need help dealing with their feelings too.  My own experience has taught me that it’s tough being the child of a mentally ill person.  Get the kid(s) their own counselor.  It’s a great investment in your children’s future.

And when things get really dark and scary…..get help!  Reach out!  Don’t be embarrassed!  Get help!

Good News and Bad News

First of all I gotta say that I am really proud of Rhonda Elkins for her bravery in allowing me to post the letter that she wrote shortly after her 23 year old daughter’s suicide, on my Wednesday feature “Breaking the Silence of Stigma.”  That letter touched a lot of hearts and did a lot of good.  And I’m proud of my readers for rallying around Rhonda with their words of support, and some frank and open discussion of their own struggles with suicidal thoughts.

And I’m really proud of ME for writing a great review for David Henry Sterry’s new book, Mort Morte.  He’s honored me by using my review as the copy on his web page.  Kinda makes me think about going back to copy writing.  I wrote copy for an online store for a while, then ditched it because they started carrying shit  stuff I didn’t like, so there went my low-paying writing job. I can’t write copy for stuff I can’t get excited about.  Like “Wow, look at these tacky rhinestone-studded chartreuse earrings in the shape of a bunch of bananas.  Carmen Miranda would have put them on her head!  Only $1,200 on sale now!”  Ugh.  Now if someone would pay me to write fun stuff I’d be on it like white on rice.

That’s the good news.

And here’s the windup, now the pitch….oh come on, just get it out.  Er, I mean over with.  Well, I really don’t want to.  I want to stay sunk in denial forever.

I had to go see my shrink yesterday to get a form filled out so that I can take Noga, my service dog, on the plane when I go to Israel twelve days from now.  Eek.  Time is running short, and it’s running like hell.  Anyway.  So I go and see Tony my shrink, and he’s a good egg.  The man really loves crazy people.  He’s crazy himself, freely admits it, and also admits that the reason he’s a good shrink is that he’s crazy.

Anyway.  So he likes to talk for a long time, both because he likes the company of other crazy people, and because that’s how he sizes you up and figures out what brand of crazy you are and if you need your meds tweaked or anything else like that.  So we’re talking and he’s really paying attention to me and not just goofing around like he normally does.  So at some point I lose not just a single word, as has been happening a lot lately, but an entire phrase that I needed to have, in order to express what I was trying to, well, express.  I wanted to describe something but lacked a whole phrase and was trying to find alternative ways of saying it.

“How often is this happening to you?”

“Oh, several times a day.  Even when I’m writing, sometimes I can’t think of a word and just have to put a parenthesis and go back and fill it in later when I remember the word.”

He raises an eyebrow.  Not a good sign.  Tony is almost always upbeat and goofing around, because if he can’t make you laugh then he knows you’re really depressed.  Or if he annoys the shit out of you then he knows you’re irritable and wants to know what’s up with that.  But if he raises an eyebrow….that ain’t good.

“You know the meds that they’re using to preserve cognitive function in Alzheimer’s?  They’re using them now to treat cognitive dysfunction in Bipolar.”

My heart fell out and hit me on the toe.  I winced.

Last year I felt like my brain was misbehaving, so I had a battery of neuropsychiatric testing that showed a big hole in one part of my central information processing.  I freaked on out and called Tony, who talked me down from my freakout and told me it was a known phenomenon in Bipolar, the older you get.  Great.

So yesterday he gently suggested that since the cognitive issues (he did not say “dementia,” thank God) seem to be progressing, he recommended I try one of these cognitive function preserving drugs.  Far fucking out.

And he also suggested that I go back on the stimulants that I hate and had previously refused to take because they make me feel like shit.  He looked up what I had before and it was Adderal.  He said that sometimes people who hate Adderal like plain ol’ Dexadrine.  He said it might give my brain some clarity and help the cognition to cognate.  So I said all right, and now I have two fucking more pill bottles in my pharmacy.  Why me, Lord, why me?  Oh stop with that whiny shit, Laura, you know very well there are much worse things in the world than being crazy.  Don’t even go there.

The Beginning of the End, Part 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Breaking the Silence of Stigma: Ruth Jacobs

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

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

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

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

Ruth:  Over twenty years.

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

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

BSS:  When were you diagnosed with these?

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

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

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

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

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

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

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

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

Ruth: Thankfully, I have never had that.

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

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

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

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

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

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

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

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

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

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

Ruth’s recommended links:

Don’t Do What I Did

Warning: Trip Trigger.  You might get stoned reading this, or just confused….this is a story of my confusion.

Yup, I did it.  Did what I have taken meticulous precautions not to do for the last two-and-a-half years, since I’ve been taking the heavy meds.  The fail-safe system failed, because I simply paid no attention to it, and I did it, and it blew my day away.

I took my night-time meds in the morning.

Night-time meds: Ativan, Clonapine, Zolpidem, Seroquel, Lithium.  I took all that, by accident, in the morning.  And not just any morning:  it was the morning of the day I closed on the lease of the most adorable tiny apartment in the most amazing neighborhood in Jerusalem.  Yep.  That morning.  The morning before I got on a plane for a 14-hour flight back to the States.  That morning.

Nighttime Knockout Pills

Nighttime Knockout Pills

I didn’t realize what I had done until the effects started coming on.  At first I was puzzled and thought I might be coming down with something.  I  had the whirly-heads: perhaps an inner-ear infection, my rational brain reasoned.  Then my vision started going double.  Not a good sign.  And finally the side effect I dread every night when I have to get up to go to the bathroom:  the floor seems to move and roll around, so that I never know where my body is in space.  Since I had never had this happen in broad daylight, I had not noticed that when I try to walk anywhere in this condition, I weave and stumble like a drunk.  That’s when I realized what had happened.

And then there was the issue of trying to stay awake.  Actually, since what I was experiencing was all the side effects that I normally don’t notice because I have been drugged to sleep by a combination of all that plus a shot or two of hard liquor (yes I know, don’t waste your breath), I found it hard to actually relax enough to fall asleep.  And yet I wasn’t quite awake, either.

I admit that I often forget to take my morning meds, which is not a good thing since my Lamictal is in there.  But I never forget my bedtime meds, because they are the means by which I sleep.  At all.  Ever.

So I checked my med box, and as well as I could make out through my double vision, it looked suspiciously like the little compartment for tonight’s bedtime dose was empty.  Shit.  Now what am I going to do?

Med Box

Roll with it.  What else is there to do about it?  Suck it up.  Live through it.  Fuck, what am I going to do about the lease and the landlord?  Can’t put that off, because just to make things even more fun, I am leaving the country at midnight tonight.  Shit.  Double shit.  Good thing my OCD demanded that I pack yesterday, so at least I didn’t have that to obsess about in this deplorable condition.

You know, this is the only time I can remember being glad I did so much acid as a youngster.  It trained me to “maintain.”  I don’t know if that term is still in service, but I’ll explain anyway, in case it isn’t.  To “maintain” means to act normal even when you’re tripping your ass off, the walls are melting in psychedelic flashing colors, and the floor has become like one of those funhouse rollercoaster tipping floors, which by the way is how the floors started feeling about mid-day.  Add to that trying to navigate the uneven cobblestone streets of Jerusalem, and the crooked ancient stone steps, and the gaping holes that appear without warning due to the recent construction boom, and you can bet I wished I had  a pair of crutches, or at least a walking stick to keep from stumbling from one side of the narrow alleys to the other, like a green sailor without sea legs on a rolling deck.  Oy gevalt.

The landlord called and wanted to meet in a place called Givat Shaul, which would have been two bus rides away from where I was staying.  I don’t recall what I said to him.  I think I just said “Ee efshar,” which means in Hebrew, “that is not possible.”  Then he suggested somewhere else, which I also nixed.   He finally got the idea that I wanted him to come to my place, and since he wanted to sign a lease, he consented.  I have mastered the  concept that if someone wants something from you that involves money, it is a good time to maximize your negotiating power.

By the time he showed up at my place with the lease in hand, I was feeling miserably sick.  We filled out the form and then had a sudden moment of joint panic when we realized that we each needed a copy of the lease, and we only had one.  He would go and get another form, he said, and we would fill it out again from scratch.  My head was pounding and I wasn’t sure if I could get through another lease form without throwing up.  No need, I said; the friend with whom I am staying has a copier.  He answers one of his three cell phones.  Most Israelis have at least two: one for business, one for friends and family.  I guess he has more than one business, or more than one family, or something.  None of my business.

Gotta go, he says.  You make a copy of the lease, and I’ll meet you at the Betzalel stairs at about three. (You don’t really need to know what the Betzalel stairs are, except that they are made of wavy, slippery Jerusalem limestone and require navigating several narrow alleys to arrive at them.)  OK, I say merrily, happy to have him out of my space for a while. Maybe I can take a nap and wake up feeling peachy.

No dice: lying down just increases my nausea quotient.  I grab the oil of peppermint bottle and stick my nose deeply into it.  My stomach quiets a bit.  Exhale.

I totter over to the copier with the lease.  At least I can get this simple task done.  Fuck, out of toner.  Shit.

Good thing I still remember where that copy shop is, in the Binyan Clal, which is a great big building full of random shops, locksmiths, seedy restaurants and a pool hall, about five blocks away.  The sun is blazing.  It has to be a hundred out there, at least.  Where’s my big floppy hat?  Oh god, please don’t tell me it’s anywhere where I might have to bend down to get it.  I’ll puke for sure.  Oh there it is, on that chair.  Sigh of relief.

Desperately wishing not to be apprehended as a potential terror suspect by Israeli police for acting weird, I adopt the strategy of  hanging onto the walls of the stone buildings as I navigate to the Binyan Clal. That’s pretty normal, isn’t it?  I got across Agrippas Street without being run over by a passing bus. Small victory, but still.

After passing through security, just like at the airport (we have to do this when entering any public building),  I got to the copy shop.  A sweet lady copied my lease for me, for two shekels (about fifty cents).  I wove my way back to my friend’s apartment and waited for the call from the landlord, which came none too soon.  I wanted to get this overwith.

The landlord called at three exactly: American time.  If I had been an Israeli it wound have been four or five, but I’m American and he wanted to get this deal closed, and collect his checks.  This was duly accomplished, along with an agonizing half-hour of small talk, obligatory when doing business.

After being released from that exhausting ritual, I wove my way home from the Betzalel Stairs (remember them?) and had a blessed half-hour to myself, before Simha the tree surgeon, who doubles as a real estate agent, showed up wanting his commission for having found me the apartment.

Did I have cash, he wanted to know?  No, I didn’t.  Well, why don’t you go to the Caspomat (ATM) and get some right now, he says amiably.  Because I don’t feel like it, is why.  I’ll write you a check.  No, don’t do that!  I’ll have to pay taxes on it.

I got out of patience and roared, “HONEST BUSINESS PEOPLE PAY THEIR TAXES!!!”  He roared something back; I don’t remember what.  He got a check.  Don’t let the door hit you in the ass, I thought, as my head swam and I fell into the nearest chair.

Evening came and it started to be time to go to the airport.  I wondered what the night flight would be like.  Certainly this shit must wear off at some point.  Is this the reason my brain has stopped working in general?  These awful meds that I take every night?  Could be. But they also keep me from killing myself.  That’s the trade-off, I guess.

The flight came off without incident, thank God.  I took a couple of Ativan just so I wouldn’t have a seizure from skipping my night-time meds, the ones I had taken in the daytime and was damned if I would take them back-to-back, and managed to sleep fitfully through the 14 hour flight.

Moral:  Be really, really vigilant about which meds you’re taking when, unless you want a really, really bad day.