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addicted

12 Tuesday Apr 2022

Posted by in addiction, autism, Catholicism, christianity, empathy, kids, residency, Sin

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all of my patients are physically dependent on opioids. ICD 10 F11.20. some of them are addicted to opioids. a lot of them aren’t.

maybe you’re physically dependent on something. for which there is no ICD 10 code. caffeine, zoloft, dopamine, adrenaline. maybe you’re addicted. coffee, zoloft, social media, shopping, toxic relationships, speeding, gossip, little debbie Christmas tree cakes, work, success, sex, HGTV.

maybe you think I’m being cute. or metaphorical. just making a point. no one goes to rehab for gossip addiction (maybe they should). no one goes to jail for possession of little debbie Christmas tree cakes (maybe no one should go to jail for possession of anything. maybe the jails are a crime)

addiction is an escape from the pain of being human. being human is more painful for some than others. but it is painful for all of us. and if someone tells you it isn’t, that is because they are so deep in their addiction, they have lost touch entirely.

eve and adam ate that apple and it all went to shit, you see. our eyes were opened and sickness and pain and toil entered the stage. we all fell down, down, down. and ever since, we have very logically sought to numb the pain of it. because there is no way up, up, up. not in this life anyway.

we are afraid. to hope, to love, to ask for love, to speak our truth, to share our pain, to need or be needed, to want or be wanted. we are afraid to take up space and that we might disappear, to be silenced and to be heard, to be alone and that we might make a genuine connection. we are afraid we are unlovable and that to be loved would be the most unbearable pain imaginable. or perhaps, worse than that, ecstasy.

in addiction we connect with other people. no we don’t. we are with people and we are less lonely and so we think we are connecting. logical. understandable. but let me tell you a story about the time my friends let G die when he overdosed because they were high too and didn’t want to get in trouble and i knew they loved drugs more than they loved me or each other. and the time i went back to my dopamine adrenaline filled emotional intimacy free relationship because right at that moment i loved it more than my kids and i do not want to tell you that but how else can we do better?

and they told me my son played next to other children but not with other children and that he was too old for parallel play. but tell me how much time adults spend engaging with other people and not engaging next to other people? are we connecting spiritually or are we churching next to one another? and those residents we work 90 hours a week with that we save and lose lives with, do we know them at all? and so pass the pipe and hand me that spoon and we will share a hit of Netflix and yoga and pumpkin spice latte next to one another in this Fallen World.

there is no ICD 10 code for the unbearable lightness of being but maybe there should be

Drip, drip, drip (better times up round the bend)

25 Friday Jun 2021

Posted by in empathy, Evil, kids, love, marriage, my awesome husband, narcissism, PTSD, Rape, romance, Sin, Uncategorized

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Water torture encompasses a variety of techniques using water to inflict physical or psychological harm on a victim as a form of torture or execution

I’d like to start this post by pointing out the term “Chinese water torture” is racist and nonsensical actually. When this torture technique has been used, it has been mainly by Europeans and there’s no recorded instances of the Chinese ever having used it.

Ok, onward and upward.

There’s this book by Lundy Bancroft I bought years ago titled “Why Does He Do That?” It’s about abusive partners and the many myths that surround our ideas of abuse. He’s a counselor that works with abusive men who either want to change or have been forced by the courts to undergo counseling. We often say abusive men need to learn to manage their anger but Bancroft argues that abuse isn’t an issue of out of control anger. Rather, it is a systemic, deliberate process used to control for the benefit of the abuser. They don’t need to learn to control themselves; they need to learn to stop controlling their partner (and everyone else in their lives they’re controlling).

In the book, he details ten different categories of abusers. The one I am going to talk (err-write) about today is the Water Torturer.

We’re all familiar with the idea of water torture. Not the waterboarding done by the US government. Rather, this idea of tying someone down and dripping water down onto their forehead slowly, drip by drip. The drops come randomly and it induces a psychological breakdown.

Lundy uses this as a metaphor for the kind of abuser who doesn’t yell or hit. He is always calm and appears to the outside world to be a great guy. He rarely slips up and lets anyone see what he’s really like. He knows how to push his partner’s buttons and get *her* to scream and get emotional. Then he says “why are you getting so worked up?” “you really need to work on your mental health problems” “stop abusing me.” He doesn’t punch or kick but he engages in subtle physical abuse such as blocking her from leaving the room or following her around the house arguing when she tries to get away. He doesn’t engage in blatant sexual abuse such as rape but rather makes degrading comments about her sexual interests, her appearance or withholds sex. He makes extensive use of sarcasm, put downs, controlling where she goes, controlling money, undermining her sense of self worth, isolating her from friends and family, badmouthing her to other people and gaslighting. Lots and lots of gaslighting.

Because you see, like Harry Houdini who helped popularize the idea of water torture, he depends upon an illusion to keep her with him. He depends on creating distractions so neither she nor the outside world can see what he really is and what he’s really doing.

The good news, friends, is that you don’t have to remain strapped down to that table. The damage done by this abuse is extensive, but most definitely something you can heal from.

You just have to keep in mind the Wizard of Oz is not real and keep your eyes on the little man behind the curtain. It’s hard to do, but you’re a badass so you got this.

I see this a lot in my practice. I have women who come in with black eyes and broken ribs, but more often they come in telling me stories of emotional abuse like this. They’ve been so worn down by it, like a pebble in a stream that becomes small and smooth over time from the water flowing over it. They are too tired and broken to leave. And they’re in love. And they’re addicted to the chemicals our brains grow to crave when we’ve been in toxic, tumultuous relationships for so long.

The University of Illinois did some research and noticed there are 5 stages to leaving an abusive relationship. The first two stages encompass the very beginning of the abused partner noticing there is something very wrong, something that goes beyond normal relationship issues. She’s nowhere close to leaving, but the spell has started to wear off. Stage three, women start to notice the effect of the abuse on their children. They start viewing the abuser’s behavior as abuse on a regular basis. And they start preparing to leave. Maybe they tell a friend what’s going on. Start stashing away cash in case they need to run. Call a domestic violence line. Stage four is an interesting one.

Stage four is the yo yo stage. You leave but then you come back. You might end up yo yo-ing several times before you truly leave. Why? Because he says he’ll change. Because being on your own is hard, financially, logistically (with kids), emotionally. Because he gets other people to guilt trip you. Because he won’t “give up on you.” Because you’re addicted to the brain chemicals. Because this dynamic is comfortable to you. Because you love him.

Stage five is the final one. You have left and you have stayed away and aren’t going back. The researchers define this as having left and stayed away 6 months or more. The abuse can continue if there are children involved and you are forced to have continue contact with your abuser, but it’s much less than before and you can begin to heal and move on.

It’s hard as doctor to have patients in those first four stages. Hard for friends and family too. But you can’t skip stages and you can’t rush someone through them. They have to make the choice to leave and stay left. You can support them by listening without judgement and validating their feelings. If you’re a friend or family, offering help with kids and other logistics can help too. And if they yo yo back, be there for them. They may be afraid to tell you. They may avoid you. Don’t give up on them. The abuser will likely make even greater attempts to isolate his partner if she goes back, so stay in her life whatever way you safely can and let her know you’re there is she ever needs you.

A lot of doctors shy away from dealing with the issue of intimate partner violence because they find it so frustrating to have a patient that won’t leave or who goes back. There are a lot of reasons women stay or return. And the sad reality is, sometimes it’s safer or necessary for her to stay. Being there to keep her as safe and supported as possible is hard, but it can be life changing for her. If you abandon her because she won’t leave, you’re just continuing the patten of the abuser, seeking to control her.

The longer you stay, the harder it is to leave. So, if you’re in a relationship with a water torturer, don’t put off considering leaving. A lot of times the reasons we come up with to stay aren’t as convincing if we discuss them with someone outside the relationship like a therapist, domestic help line or friend. Once you’re down in his world of gaslighting, isolation and control, your sense of reality is skewed. You need someone who isn’t riding that Tilt-A-Whirl.

Once you are out, the healing is not necessarily the most fun process. It’s kind of like when someone is getting over opiate addiction. There’s a lot they need to dig out from. A lot of pain and sadness and the practical part of rebuilding your life. But there’s also joy. And as the months pass, there is less and less pain and more and more joy. And you will look back and say, how did I do that all those years? How did I survive? And you’ll see what a badass you are. And that there are far better things at the carnival than the broken Tilt-A-Whirl. And you and your kids will eat cotton candy and laugh and sleep soundly at the end of the day cozy in your warm, safe beds.

America we’ve given you all and that’s not nothing (or Narcissus needs a drink)

11 Wednesday Mar 2020

Posted by in empathy, Evil, love, medicine, narcissism, Uncategorized

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America
I’m addressing you.
Are you going to let your emotional life be run by Time Magazine?
I’m obsessed by Time Magazine.
I read it every week.
Its cover stares at me every time I slink past the corner candystore.
I read it in the basement of the Berkeley Public Library.
It’s always telling me about responsibility. Businessmen are serious. Movie producers are serious. Everybody’s serious but me.
It occurs to me that I am America.
I am talking to myself again.
*
*
*

I have spent a lot of time reading about narcissism lately. I have my reasons I won’t go into here. An unexpected outcome of this research is the realization almost every politician in the Democratic primary is above average on the naricissim spectrum, some just as high as Trump. One in particular. The one who had to drop his bid in 1988 because he was exposed as a pathological liar and plagiarist. The one whose toxic masculinity led him to challenge someone to a fist fight recently. The one who has assured the billionaires “nothing will change.” And a relationship with a narcissist, my dear reader, only ends one of two ways: you wake up and leave or they suck the life out of you. The Democratic electorate has chosen the latter. It is narcissist versus narcissist in 2020 (it has been before, to be fair) . We will all lose no matter which one wins. If Biden wins, we are left with an America still under the conditions that created Trump and we will either get another Trump or …. Trump. Do you really think leaving the White House will make Trump go away? He has created a movement and they will follow him where he leads. The presidency,  my dear reader, may become significantly less relevant. The question is, will the movement Bernie is driving remain intact to counter it?

 

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I think of the people most affected by all this and I cry. My addiction patients in rural Pennsylvania, their children. They don’t even realize just how different much of America is living. And most of America doesn’t realize how they’re living. If they did, I’d like to think things would be different. But narcissists are very good at gaslighting and projecting and lying. Lying especially. Lots of lying. And if you’re a decent, feeling, empathetic human being, it is hard to resist. It is hard for for you to conceive that such a person could exist. Someone with no empathy and no remorse. Entirely self serving with nothing to limit what they’ll do to get it. Try to imagine. It should scare you. Terrify you.

I believe most Americans are decent people trying to get by in the face of a lot of hardship. I see it in my office everyday. Not just my most vulnerable patients, my middle class medical marijuana patients too. The cop with PTSD who had to retire because of it and now has no insurance or income to pay for the therapy he so badly needs. The single mom of an adult son with autism, trying to get services that aren’t there, trapped in her house. Chronic pain patients that were abruptly kicked off their pain meds once doctors started facing consequences for over-prescribing, not offered any help for withdrawal or to manage their pain. And I see the upper middle class patients who benefit from the system but have so much anxiety and depression, the money does them no good. And still they hold onto it tightly, unwilling to see letting some of it go would not only save so many struggling; it would save them too.

Greed is an illness. An ugly dark emptiness that cannot be filled and will not stop making you hunger for more. Like any addiction. Are the heads of the pharmaceutical companieds just projecting then? Turning so many into addicts so they can see themselves? And Trump, who will never have enough cheering angry supporters or enough money. He pulls the worst from us, feeding off negative emotions and chaos as narcissists do. Projecting onto America the darkness inside of him.

care-bears-movie-care-bears-stare-power

I do not mean for this post to sadden you or leave you feeling hopeless. Indeed, that is exactly what a narcissist wants. I want you to see that once you know you’re dealing with a narcissist, you begin your steps towards recovery. Leaving is not easy. They will try to suck you back in. They will love bomb you, bring you flowers and tell you how wonderful you are. But if you stay strong, it gets easier in time. And the best part? The thing narcissists hate most is someone who heals and is happy and strong. Our revenge would be a healthcare system that takes care of us, universal childcare, a Green New Deal, a living wage, an end to mass incarceration. Our revenge would be joy. Like an army of Care Bears shooting out beams of love and kindness and hope from our chests. They would keep trying, but with no one to reflect their image back to them, narcissists wither. Like Narcissist himself, when the reflecting pool they’re so addicted to dries up, so do they. And we, America, will have won.

***

America, by Allen Ginsburg

America I’ve given you all and now I’m nothing.
America two dollars and twentyseven cents January 17, 1956.
I can’t stand my own mind.
America when will we end the human war?
Go fuck yourself with your atom bomb.
I don’t feel good don’t bother me.
I won’t write my poem till I’m in my right mind.
America when will you be angelic?
When will you take off your clothes?
When will you look at yourself through the grave?
When will you be worthy of your million Trotskyites?
America why are your libraries full of tears?
America when will you send your eggs to India?
I’m sick of your insane demands.
When can I go into the supermarket and buy what I need with my good looks?
America after all it is you and I who are perfect not the next world.
Your machinery is too much for me.
You made me want to be a saint.
There must be some other way to settle this argument.
Burroughs is in Tangiers I don’t think he’ll come back it’s sinister.
Are you being sinister or is this some form of practical joke?
I’m trying to come to the point.
I refuse to give up my obsession.
America stop pushing I know what I’m doing.
America the plum blossoms are falling.
I haven’t read the newspapers for months, everyday somebody goes on trial for murder.
America I feel sentimental about the Wobblies.
America I used to be a communist when I was a kid I’m not sorry.
I smoke marijuana every chance I get.
I sit in my house for days on end and stare at the roses in the closet.
When I go to Chinatown I get drunk and never get laid.
My mind is made up there’s going to be trouble.
You should have seen me reading Marx.
My psychoanalyst thinks I’m perfectly right.
I won’t say the Lord’s Prayer.
I have mystical visions and cosmic vibrations.
America I still haven’t told you what you did to Uncle Max after he came over from Russia.
I’m addressing you.
Are you going to let your emotional life be run by Time Magazine?
I’m obsessed by Time Magazine.
I read it every week.
Its cover stares at me every time I slink past the corner candystore.
I read it in the basement of the Berkeley Public Library.
It’s always telling me about responsibility. Businessmen are serious. Movie producers are serious. Everybody’s serious but me.
It occurs to me that I am America.
I am talking to myself again.
Asia is rising against me.
I haven’t got a chinaman’s chance.
I’d better consider my national resources.
My national resources consist of two joints of marijuana millions of genitals an unpublishable private literature that jetplanes 1400 miles an hour and twentyfive-thousand mental institutions.
I say nothing about my prisons nor the millions of underprivileged who live in my flowerpots under the light of five hundred suns.
I have abolished the whorehouses of France, Tangiers is the next to go.
My ambition is to be President despite the fact that I’m a Catholic.
America how can I write a holy litany in your silly mood?
I will continue like Henry Ford my strophes are as individual as his automobiles more so they’re all different sexes.
America I will sell you strophes $2500 apiece $500 down on your old strophe
America free Tom Mooney
America save the Spanish Loyalists
America Sacco & Vanzetti must not die
America I am the Scottsboro boys.
America when I was seven momma took me to Communist Cell meetings they sold us garbanzos a handful per ticket a ticket costs a nickel and the speeches were free everybody was angelic and sentimental about the workers it was all so sincere you have no idea what a good thing the party was in 1835 Scott Nearing was a grand old man a real mensch Mother Bloor the Silk-strikers’ Ewig-Weibliche made me cry I once saw the Yiddish orator Israel Amter plain. Everybody must have been a spy.
America you don’t really want to go to war.
America its them bad Russians.
Them Russians them Russians and them Chinamen. And them Russians.
The Russia wants to eat us alive. The Russia’s power mad. She wants to take our cars from out our garages.
Her wants to grab Chicago. Her needs a Red Reader’s Digest. Her wants our auto plants in Siberia. Him big bureaucracy running our fillingstations.
That no good. Ugh. Him make Indians learn read. Him need big black niggers. Hah. Her make us all work sixteen hours a day. Help.
America this is quite serious.
America this is the impression I get from looking in the television set.
America is this correct?
I’d better get right down to the job.
It’s true I don’t want to join the Army or turn lathes in precision parts factories, I’m nearsighted and psychopathic anyway.
America I’m putting my queer shoulder to the wheel.
Berkeley, January 17, 1956

June 19, 2008 (or, Tequila!)

19 Tuesday Jun 2018

Posted by in kids, love, marriage, medicine, my awesome husband, PTSD, Rape, Uncategorized

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It was raining this morning as I headed out for my run. Ten years ago on this day, though, it was hot and sunny. I know this because I can remember the beads of sweat rolling down the back of my legs as I sat in my green minivan in that long, heavy, black Land’s End skirt I’d bought on clearance a few weeks before. My air conditioner was broken and the van churned out warm air as I sat staring down at my phone.

I’d programmed the phone number for the Pittsburgh field office of the FBI into it a couple months before under the name “Hope.” It was finally time to call. I knew he might kill me. Knew he might kill my two boys. Mies had just turned 4. Max was 2 1/2. I asked God to please protect them but told Him if something happened to them, I knew it just was what it had to be. I had to turn him in. I could never face my babies again if I didn’t. I didn’t want them to live in that kind of world. Abraham, I am feeling you, brother.

I operated purely through adrenaline at that time. Until he was arrested in August. And released on bail to a local podiatrist. And jailed again since he, ya know, had threatened to kill me and my kids and all. And then as I fought to stay in school as my med school slut shamed me and tried to get rid of me. Once the adrenaline stopped flowing continuously later that Fall, the real hell began. PTSD.

I wanted to give up but I somehow got to a place where I told myself, this isn’t it. Someday things will get better. You will watch your babies grow up. You will become a doctor and take care of your patients. You might even get married and have more babies. Maybe a daughter. Maybe. I fought off the hopelessness. I convinced myself there was possibility.

Here I am ten years later. With five beautiful kids (including a sassy-sweet daughter). With a handsome, devoted husband. With a practice of my own, complete with amazing patients I care about more than I knew I could. Healed of my PTSD. Having forgiven Jeremy and even Sylvia, the head of my med school, and all those professors who betrayed me. Training for a semi-impossible obstacle course race with my husband and a trainer, for goodness sake. A trainer. More than I dreamed possible.

I am so grateful to God my babies are alive. That I am alive. That I am a doctor. That I have the husband and kids I do.

I skipped work today and drove through the country to Deer Lakes park to go running. The rain and grey gave way to fluffy white clouds and sunshine in a beautiful blue sky. I held my hand out the sunroof as I drove. I felt the sweat run down my legs from my run as I drove.I sang along to Tequila! like a fool. I’m sure I looked and sounded ridiculous.

I pray the little girls he hurt find the peace I have. I pray he does too.

I am so grateful for today. I am alive, I am free. Thank you God.

Tequila!

joy is a choice

19 Monday Dec 2016

Posted by in kids

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I have been on a diet for a few months now. I’ve lost 30 pounds. Losing steadily week by week. And then a few weeks ago I began to struggle. I stepped on the scale fo r my weekly weigh-in the day after Thanksgiving and had only lost 0.8 pounds. I was upset. I was pissed. This was not acceptable.

I decided I was going to show my diet who was boss. So, I began a fast. I wasn’t not eating at all, I reasoned. And really, Advent is a time you’re supposed to fast anyway, I reasoned. I was, of course, full of shit. I ate very very little for a week and, not surprisingly, when I stepped on that scale a week later I had lost 8 pounds. Eight pounds! In a week! Woo hoo! I’ll be at fighting weight in a few weeks!

I imagine you can guess what comes next.

I continued my oh-so-religious-not-unhealthy-at-all “fast” a few more days and then I crashed. As happens. I ate a whole lotta junk. So, I told myself, well, I’ll just go back to the weight watchers. 30 points a day. fruits and veggies are 0 points. I’ll just go back to that and then I won’t regain the 8 pounds. Still dreaming of the holy grail of being at Goal Weight.  I reasoned that since I don’t have any clothes that fit me right now and since I can’t justify buying any new clothes until I am at my end weight, why it only made sense that I really *needed* to lost 3-5 pounds a week instead of that BS “1-2 pounds a week for healthy weight loss” they were always selling.

I imagine you can guess what comes next.

I didn’t stick to my 30 points. I bargained with myself further: okay, self, if you must eat more than the allotted 30 points a day, then at least *record* everything eaten. At least stay on track *that* much.

I imagine you can guess what comes next.

It’s been two weeks of my Angel making various bargains with my Devil. And the Devil laughing as she inhales candied nuts and dairy free egg nog.

I raised the white flag last night and decided to sit down and journal it out and see what’s going on. There are a lot of factors at play: my hormones are out of whack because I’m weaning my son, it’s THE HOLIDAYS and yummy comfort food is EVERYWHERE, being on a diet for 12 weeks is really hard and gets a little old after a while, I worked six days straight right as this downfall was starting (I work 12 hour urgent care shifts so this is no small thing. Honestly, working more than 3 in a row is pretty awful), and I’m pretty damned stressed since this is my first Christmas without my family. Also, my son with autism starts getting a little… shall we say, difficult this time of year because routines are getting out of whack with the holidays. Also, we’ve all been sick with colds (#UrgentCareLife).

But it isn’t just that I’ve been eating a bit more than I should or saying Yes to more cookies passed my way than I’d planned. I’ve returned to an old pattern of eating I’ve had since I was ten. (See this entry for more on that). So, I journaled away.

It’s this feeling that I have this hunger in me that will never be filled. Like I could consume the whole universe and I would still not be satisfied. It would still not be enough. I try and try to fill it. It’s exhausting. It’s a big black hole that won’t go away.

Because it is not something that can be filled with food. It’s trite but it’s true.

It is a hunger so wide and so deep. An ocean. No land in sight. And I am alone on a little boat. You can scream all you want but no one will hear.

It is something that must be filled with love and joy and speaking your truth and having someone hear and knowing you’re resilient and having faith it’s going to be okay. all of it. Filled with my son’s drawings and my daughter’s songs and my other son finally learning addition and my baby saying Uh oh! Filled with God and his saints and Hebrew prayers and oplatka and incense and chanting. Filled with the rhythm of the year and laughing when you really want to cry and doing what’s right even when it’s hard. Because life brings pain but we decide how much we suffer. And joy is a choice.

I am blessed with four beautiful children. I am blessed to be a physician. I am blessed to have been called to Catholicism. I am blessed to live in a warm home and drive a safe car and to be able to buy my children the things they need and some of the things they want. I am blessed to have grit. I am blessed because I am not alone. And it is not an endless ocean. Just puddles we’re jumping through. And in between, we laugh.

 

That choice is gone (or, This is hell. get walking)

06 Thursday Oct 2016

Posted by in christianity, Evil, kids, love, residency, Sin

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Mental illness kills.

It kills with heroin overdoses and self-inflicted gunshot wounds and anorexia induced cardiomyopathy and obesity induced sleep apnea and girls who take risks they shouldn’t with dangerous boys.

And when it does, there are usually kids left behind. And that is the worst tragedy.

When I was a resident, we would admit patients overnight who had failed at killing themselves with drugs. We needed to make sure they were medically stable before being sent to inpatient psych. The ER  had saved them but we were the ones to run fluids and monitor them and fill out the paperwork once the psychiatric hospital was ready for them.

It was the job of the residents to go see these patients at two in the morning and complete an H&P, a history and physical exam. We would ask the questions we asked all patients: chief complaint, onset, duration, intensity, chronology, exacerbating and remitting factors, associated symptoms. In this case, the chief complaint was not shortness of breath or fever. In this case, the chief complaint was, I wanted to die. So I tried.

Sometimes onset was a long time ago, often it was right beforehand. Intensity was of course always a ten. Sometimes they told you their story freely. Sometimes only the bare minimum. (we would write “history limited by non-cooperative historian”)

I remember one patient in particular. She was a mom. She had three kids around the same ages as my three kids at the time.  She told her story of how her boyfriend had hurt her. Hurt her so badly she decided to die. I asked where her kids were when she took the pills. They were home with her. Maybe they’re the ones who found her and called 911. Maybe it was the worst night of their lives after many other bad nights. She didn’t know whether they’d found her or not. She didn’t care. She never asked us where her children were now. Just went on about the boyfriend and how he’d hurt her and how hurt she was. And I tried very hard to have compassion for my patient, but all I could think of was her kids. Of how badly a successful suicide by their mother would have wounded them.

I have never been the type to lack compassion for those so hurt inside they feel killing themselves is the best solution. I have heard good Christians say they will go to hell. I have heard people call them selfish for hurting their families and thought, do you have no grasp of how much pain they must be in?

But by this time, at the age of 34, I’d lived a bit more of life and had a more nuanced view, you could say. I still think its’s awful to say they’d go to hell. But I do not think, when children are involved, we can simply say they were ill, they were in pain, and so it was.

When I was 28, I had a boyfriend too, just like my patient. He broke my heart too, just like my patient. And I decided to die too, just like my patient. I planned out which pills I would take and when. I’d just had pharmacology before Christmas break had begun and knew which ones would be most effective. It was Christmas. The tree was up. I hadn’t given my kids their presents yet. We were alone in Erie for break. I decided I would drop them off with their dad. He would take them to his parents house for several days for New Years as he did each year. No one was expecting to hear from me. It was time to die.

I was in a depression as deep as any I’d been in many times before. But this time was different. I was 28. I’d been battling depression since I was ten. I always held out hope I would get better one day. Life held so much possibility. But at 28, I thought, here I am again. I can’t keep doing this. I can’t. I sat on my floor crying as my three year old and two year old asked what was wrong and brought me Children’s Tylenol to try to make me better. I hate that I did that to them. I am sorry that I did that to them.

I kept pulling presents from the basement and giving them to them one by one to keep them occupied. I fed them leftovers from the Christmas eve party at my family’s house I’d brought back. I suppose I changed their diapers. I don’t remember.

I planned out how to die and thought, they will go live with my parents and be so much better off without a worthless mother like me. But then it happened.

I entered into rational thought long enough to realize they wouldn’t go live with my parents if I died. They would go live with their dad. And their dad, luckily, was a tremendous asshole at that time. And I thought, I’m really worthless, but he’s even worse. Thank you God he was such an asshole. I couldn’t do that to them.

I remembered when my oldest son Soldier Boy was a baby and I didn’t know if he would live because of a genetic disorder they thought he might have. I remembered sitting in the glider in the nursery wailing a gutteral wail from as deep down as a person can, begging God not to take my baby. Put me through the pains of childbirth for all eternity, I said (I’d just finished a 32 hour natural birth so that’s no small statement). Put me through hell, I said. Just save my beautiful baby.

And he did.

And I thought to myself, I am in so much pain. It hurts so much to live. I am in hell. But now it seems I must do what I told God I would. I must walk through hell for my babies. And so I did. One step at a time.

When you are that depressed, finding the will and the energy just to get out of bed in the morning is excruciating and exhausting. But I did. I got out of bed and I took care of my babies. I went to class and studied. I called a psychiatrist’s office and was told they don’t take Medicaid. That about did me in. But I made myself call another. And I got a psychiatrist appointment for a month from then and a therapy appointment in a few weeks.

I kept breathing. I kept living. Every breath hurt. My heart ached. My muscles ached. My soul was not in my eyes if you bothered to look. Luckily no one looked.

I wanted to check myself into inpatient psych but I knew if I did it could ruin my career and I could get my kids taken from me. I was right. I’m glad I didn’t. But it hurt. It hurt so damn much.

It was in this time, this darkness, this exile, waiting to see a psychiatrist that I entered into the relationship with the man who was my trauma, who was my Ordeal. I was in hell, so I laid with a demon. I suppose.

There in the midst of my Ordeal, I made my way through hell. I chose to live each and every day in every decision I made. When I did not feel like getting out of bed,  I would say to myself, you either live or die. If you stay in bed, you are choosing to die. When I didn’t want to go for a walk to get exercise and fresh air, I would say to myself, you have two choices, life or death. If you do not go on this walk, you are choosing to die. And that is not an option. Your babies need you to live. This is hell. Get walking.

I do not know how it is that a part of me found wellness inside the trauma, the Ordeal. Sometimes I think it’s that a part of me, a version of me, broke off and endured the trauma while the rest of me went on with life as usual. Sometimes I think it was the adrenaline. Sometimes I think it was God. Maybe a little of each.

I know that with my therapist and my psychiatrist I got to a point where I could do a load of laundry without exhausting myself. Where I could study and enjoy neuroanatomy and feel proud of myself for rocking the exam. Where I could play with my kids.

Then came PTSD, but that’s another story for another time.

And so this is what flashed through my mind and heart when I stood there collecting this patient’s onset and chronology. For her chief complaint of choosing to die. This is why I could not lend her more compassion.

When we choose to have children, certain choices go away. Dying is one of them. Even when living is hell.

And to not die is not enough. We must choose to live every day in every choice we make. We must fight for our children. Even when we can’t bring ourselves to fight for us.

They are innocent. We are not. The body is weak, but the will is strong. Must be. For them. This body, this mind, this pain, is not endless. It will all fall away. Ending it a little sooner is not worth the price of their innocence.

It is not a choice. That choice is gone.

New Year New You! (How Ima Got Her Groove Back)

10 Saturday Jan 2015

Posted by in empathy, kids, love, medicine, my awesome husband, parenting, PTSD, Rape

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I found this idea on Pinterest for keeping a jar where you write down happy/funny things that happen throughout the year and put them in this jar. I believe it advised a big jar (with the assumption being you’ll have lots of good things happening I suppose). You open the jar up at the end of the year and read over all the little happy moments you otherwise might have forgotten. The woman who’d pinned it had written it was a “super cute idea !!!!” and that she was definitely going to try it.

I pitched the idea to Poobah and he liked it (although he didn’t call it super cute or exclaim). So I took the large clear plastic teddy bear shaped animal cracker jar and dumped the animal crackers out into a bag (they’ve been sitting uneaten in the jar for 3 months so why not keep them uneaten in a different container a little longer) and wrote 2015 on the bear’s tummy with a Sharpy.

As I did so, I thought, why only write down the happy times? Why not the bad times too? It was January first and I was heading to work soon. I wasn’t very cheery.

But it wasn’t just working on a holiday that made me think that. I’d been bogged down in PTSD and working crazy hours and stress and financial problems and family discord. Bogged down for a while.

I felt like there wouldn’t be much to put in the jar.

I said goodbye to my husband and kids and headed to the hospital. Holidays can be slow because people put off going to the hospital on a holiday if they can, but it’s been a particularly busy year for hospital medicine because of all the influenza. I expected I’d be fairly busy and hoped it wouldn’t be any worse than that. I hoped no patients crashed. I hoped for some time to think.

Earlier in the day, Poobah and the kids and I had gathered in the living room around our old school fake Christmas tree (the kind that really do look fake and aren’t “pre-lit” and don’t have green concentrated pine scent aroma sticks discretely hung on a strategically chosen back branch) to continue a tradition my sister Nicci and I had started when I was still in high school. Every New Years we make predictions for the upcoming year and then the following year we read over them and see who got the most right. We also talk about things that happened over the past year that were unexpected.

We’d each made three predictions but I wanted some time before I went and started the admissions to write down a few more and think about the year ahead.

I started writing and this is what came out:
I need to move forward. But these next 6 months are going to be exhausting. I’m not sure what to do. I wish it were a simpler tale. I wish I could figure it out.
Where did it begin? Before I was born? If it did, then what?

We all seek to be an individual with self-esteem
There are those who stand in the way
And so we assert to be ourselves in maladaptive ways
Because of the innate drive towards maturity

Malcolm has something special in him. Malcolm could change the world.
He said he wants to be an astronaut so he can change the world.

Mies has this amazingly unique combination of traits.

They’re extraordinary.

Maybe I am too.

And with those four little words, I got my groove back. I didn’t just get my groove back from before Jeremy Noyes traumatized me seven years ago or before my medical school rubbed salt in the spiritual wound and made it stick. I mean I got my groove back from Way back.

It’s a process, of course, but it is set in motion. It is inevitable. The rate limiting step of the reaction has been overcome and the chemical cascade is in full swing.

I’ve spent most of my precious little free time since then wading through shame and heartache, cleaning out every dark corner of the past 35 years. It’s amazing all the things I’ve been ashamed of over the years. It’s amazing how ashamed I still felt now, decades later, simply writing out the words different people have said to me. I’ve done that sort of thing before, sitting and trying to process bad memories. But the difference this time is that I finally believed that I didn’t deserve any of it. I finally believed I’m extraordinary and so deserving of love and safety and joy, it’s ridiculous.

The words lost their power over me. Those people lost their power over me.

There are things I’ve done in my life I’m ashamed of and I sat with those too. Some of them I reminded myself I had no control over (feeling ashamed I “let” myself be raped, for instance), some I decided are just inevitable mistakes of youth, and some I had to forgive myself for. I regret very little as a general rule, but the things I’ve done that have hurt people, really hurt them, I do regret, and I had to forgive myself and let go of the shame.

Another inevitable piece of it is that I am losing the extra weight I have clung to for many years. It’s time to let it go and so I am. I feel hungry but it doesn’t distress me because it’s what’s supposed to be.

I’ve recovered from political amnesia and am reading feminists and progressives and anarachists again. I’m engaging with people about things that matter. I’m throwing a hundred evolving ideas out to my husband on everything our future holds after we graduate this June.

It’s not that I’m becoming a whole new person. It’s that I’m returning to being myself. I’m doing what we are all made to do: becoming more myself and finding what it is I am supposed to be doing to make the world a better place.

I look at my two year old daughter and see she’s there. She’s got her groove on. She knows what she thinks and wants and feels and she lets you know it. She’s engaged with everything and everyone she comes in contact with. She’s alive. She’s in the flow.

I want to do everything I can to keep her there as much as possible. I want to help all my kids find their flow. And anyone else I can. Because that’s what life is. But I see now, it’s not selfish to enjoy having my own groove on. Quite the opposite. Flow begets flow.

And so, the other day, I took a little green slip of paper next to the empty animal cracker jar and I wrote the first memory of 2015: January 1st Ima got her groove back. (our kids call me Ima. I’ll tell you about it some time)

This is for my husband now: My name is Elizabeth Spaar and 2015 is the year I got my groove back

The Waiting Room at Children’s Hospital

12 Thursday Jun 2014

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I’m sitting in the Children’s Hospital waiting room. Again. I’m here with The Ax this time (usually it’s Soldier Boy). We’re here to see Endocrine because he’s not growing very well. We see the specialist and she listens to our story and tells us that little Ax’s particular eating disorder is very strange. Maybe she doesn’t use the word strange. Maybe she says unusual or uncommon or not typical or not something we see very often. The exact wording is irrelevant. What matters is that I’ve found myself in a familiar place: getting unexpected bad news from a doctor about my child.

I’d been the one to request the endocrine referral from his PCP (my attending at the outpatient clinic my residency runs). He’d been seen by various doctors for his eating issues before. He’d been small for a few years. No one really thought it necessitated a visit to endocrine. I asked for the referral feeling like I must be overreacting, but also feeling I deserved the peace of mind an uneventful trip to the specialist would bring.

Little Ax had always been the healthy Yin to Soldier Boy’s multiple diagnoses Yang. I expected doctor visits for Soldier Boy to yield worrisome news. I’d learned to brace myself for it over the years. But this news, that little Ax might have something more wrong than I’d thought, came as a blow I hadn’t prepared for. My abdominal muscles were relaxed, my jaw slack. The punch landed and I went down like I had in the early days of the Soldier Boy medical saga.

They wanted bloodwork and an X-ray of his hand to assess growth trajectory. The results would take 7-10 days. She would call me herself to discuss them. I didn’t like the idea of the doctor calling personally with the results. Calling with normal results didn’t seem like a doctorly thing to do. Normal results don’t require explanation; there are no questions to field. If she was calling, it seemed like there was no hope of a normal outcome. I did not say any of this. My mind was relatively blank as minds so often are in the presence of physicians. We should come back in three months, she said, so The Ax could be weighed and measured again and she could get a better idea of how he was growing. Any questions? No, thank you for your help. They’ll direct you to the lab when you check out. X-ray is on the second floor.

We sat in the waiting room for the lab for an hour, Ax on his computer and me on my phone, texting all the interested parties awaiting the results of his appointment like it was election night. You hear the moms discussing what diagnosis brought them there. One mom of what appears to be a six month old baby boy relates he has cystic fibrosis to another mom there with her diabetic tween daughter. The life expectancy of those diagnosed with CF had increased significantly in recent years but is still much shorter than the typical person. This always happens in the waiting room at Children’s. You always find someone with a burden greater than yours, right when your pity party is in full swing.

The interesting thing about it that I’ve found out over the years is that a lot of the families I think are worse off than mine, think the same thing about me. There’s no precise hierarchy of the lost dreams we carry for our children. Some of us go into it stronger than others; some of us surprise ourselves with the strength we develop under the tensile stress of it all; some of us, I suppose, fall apart either for a time or completely.

A woman leaves the lab with her tiny newborn baby on her shoulder, her belly still swollen from the birth that couldn’t have place more than a week ago by the look of it. I remember when I was here with Soldier Boy when he was just a few days old. It’s a bad memory. I’d like to put some beautiful spiritual spin on it, but I can’t. Watching them put the needle into your tiny newborn’s arm is just an ugly thing. Having doctors tell you there is something very wrong with your perfect little newborn is heartbreaking. It’s not a break that ever completely mends.

I go to ask why it’s taking so long for us to be called and they tell me they paged us quite a while ago. My pager didn’t go off, I tell them. They offer no apology but tell me he will be called soon. The Ax is calm as the phlebotomist draws his blood, asking her questions about the meaning of the different colored tops on the vials she uses to gather his blood. She says he reminds her of her own son. I think that it’s a nice thing to say, but it’s a thought detached from feeling. My heart is in a sad place from long ago.

We finish and head to radiology for the X-ray of his hand. I remember taking Soldier Boy there for CTs and MRIs of his brain. It doesn’t feel like a memory; it feels like I am there. Is it possible to get PTSD from having a sick kid? This feels like a flashback. I remember how stifling the crowded waiting rooms full of kids and parents felt. That “Max and Ruby” had been playing on the waiting room TV that day of the first CT. I remember looking at the cartoon bunnies and commenting to Soldier Boy’s dad that it would be funny if one bunny began humping the other as our pet bunnies at home often did in their eternal battle for dominance. We laughed. We had to.

I think of it now as I look at the Ax happily chattering to someone he’s introduced himself to in the radiology waiting room. You have to laugh, I remind myself. There are so many more happy times than struggles for my kids. So many happy times ahead for them along with the struggles. Grieving demands our attention but we must make room for laughter too. Laugh now while you bide your time in the waiting room. Tomorrow has enough worries of its own.