This one came out a bit long-ish, but the bulleted description of my arc & failed treatments since 2005 might be interesting to some of my readers. Hugs.
So I decided I was magically mad a month ago and started this blog (on another page) after a visit to a new psychiatrist. When my long-time psych fell ill and retired I bounced from clinician to clinician, hospital to hospital, until I finally did what I did when I landed my original psych to begin with, which was to explicitly state what I wanted and needed in a psychiatrist. This was my original blog post:
My attempts to secure a strong mental health professional over the past year were something akin to trying to beat a rigged carnival game. In the past I’d had the luxury of approaching my treatment as a game of skill, in which I determined through a profile how experienced a clinician was, how broad their styles might be in terms of frequency of visits, willingness to prescribe, comfort zone with a high-risk patient. But 2011 was a killer, a game of chance I didn’t even know I was playing, and with every loss –
- ”Valium is evil, Jim Jones used it to kill all those people!” – really? You lack even the verbal sophistication to refer to the victims of the Ministers ill-famed affair as his ‘congregation’ – they were “all those people?” Oh, and that was CYANIDE! Did you used to prescribe that?
- “You self-hospitalized last week? Sorry, our Center Director considers you a high risk, but here’s a list of qualified practices.” – because his PSYCHIATRIC practice isn’t qualified to deal with individuals who are struggling emotionally?
- ”How many clonazepam do you have at home? Five? I won’t prescribe anything to you.“ – and your job title is? Oh right – Waste of My Goddamned Time.
I wondered at the legitimacy of the entire field. What the hell was wrong with these people? How could psychiatric professionals be afraid of the foundation of anxiety pharmacology? Be terrified of suicidal tendencies? The unwillingness to prescribe was a matter of orientation, but given that it was with someone in the same practice where I had been treated for going on 15 years, it was exceedingly irrational.
So when I called the practice’s fourth location, close to where I recently moved, I was frustrated and explicit.
“Hi, I used to see Dr. J for about 10 years at the Boston office, he retired in 2010 and since then I’ve had singled visits with about 10 clinicians and no one is clicking. I need someone with experience with complex cases, who is not skittish about suicide or hospitalization, and who prescribes freely.”
“I have the perfect person for you.”
The appointment was booked a month out. When I woke up that morning, after feeding the babies and checking in with the office, I quickly drafted a summary – I was so tired of explaining the sequence and context of events, all of the hospitalizations, doctors, treatment avenues and medications.
I showered and drove to the appointment, playing a 70′s mix of Gerry Rafferty, The Rolling Stones, Tom Petty, Badfinger – singing along and trying to relax. I had mixed expectations. I was early and after a half an hour the doctor was seven minutes late in calling me and my anxiety was ratcheting up from the patients in the waiting area – one woman sucking on a piece of hard candy, a manic older man talking at breakneck speed. I asked the receptionist to confirm that my appointment had been scheduled for 3pm. She said the doctor was on a call and would be right out.
And he was. He held the door as I brushed past him, my head down. His office was practically a greenhouse, with plants mounted on the walls, orchids of all colors, accented by vibrant framed photographs of exotic birds and rainforest creatures. And I knew.
“I’ve reviewed your history, but could you tell me in your own words-”
I had pulled the stapled sheets of paper from my handbag and raised my hand – STOP.
“Here, I typed this up his morning, I’ve sat and explained this so many times and I can’t do it again. Also, I never remember all of the different medications I’ve been prescribed when prompted, so this may be the best thing, I hope you don’t mind.”
He was delighted. I was relieved at not having to run through the convoluted litany of the past six years. He quickly read this:
“2005 (preparing to leave spouse of 15 years)
- .5 clonazepam (prescribed by primary)
2006 (left spouse of 15 years)
- 1mg clonazepam (prescribed by Dr. J)
- Gabapentin no-to-negative impact on symptoms
2007 (ex stalking me, my 2 daughters; started new job with big firm, met new boyfriend/2nd husband)
- 1mg clonazepam x 2 (am & pm)
- .5 mg Ativan, switching out with 5/10 mg Valium when potency wore down (as needed)
- 20mg Prozac (no impact)
- topiramate (no-to-negative impact) (all prescribed Dr. J)
2008 (ex choked to death 12/07; pregnant as of 1/1/08; married 7/08; had baby 8/08; bought house & relocated to Dallas 11/08)
- Stress level extraordinary, OB recommended I see a women’s specialist (former-mid-wife, current RN w MGH psych unit). She prescribed a battery of meds I cannot entirely recall
- Lithium (I stopped taking when I read bad for kidneys – I have renal artery stenosis)
- Doubled Prozac to 40mg (no impact)
- Added Abilify (?mg) (no-to-negative impact)
- Lamictal (no-to-negative impact)
- Depakote (no-to-negative impact)
- Lopressor (no-to-negative impact)
- Other anti-convulsant & blood pressure meds that I cannot recall (no-to-negative impacts)
- Added clonazepam & lorazepam halfway through pregnancy
2009 (in Dallas, when I arrived for work on 12/1 I was told my full-time job was gone, looked for work but spouse refused to take jobs my bosses were able to arrange for him – good jobs with full-health insurance. I also became pregnant with our second baby. My husband essentially demonstrated that he cared less about providing for his family than he did about passive-aggressively punishing me for moving to Dallas to begin with. I had to go on state insurance later in the pregnancy & finally sold my house when it became apparent that we weren’t going to be able to come up with the $10k property tx & 2 HOA dues in the fall. I officially fell into the black hole that is MD)
- 1mg clonazepam
- 1mg Ativan – both prescribed remotely by Dr. J as a courtesy while I was uninsured in Dallas
2010 (after disaster in Texas, moved to the Berkshires, hoping for peace. I shifted from immigration legal to human services, working as a residential counselor with severely retarded adults, thought it would be therapeutic. Instead I tried to kill myself.) This year so much happens that a summary will not suffice and events earn bullets:
- Diagnosed w MD, AD, BPD & Complex PTSD at BIDMC, 2-week stay 1/10 following suicide attempt – self-hospitalized
- DBT therapy in Northampton for 6 months (individual therapy was good, group a horror, apathy towards life continued throughout – no impact)
- Feeling suicidal – Self-hospitalized again 7/10 – McLean/Belmont – diagnoses confirmed
- Trilafon (only mental changes we terror and paranoia – neither of which I’d ever had)
- Seroquel (no-to-negative impact)
- 1mg clonazepam (am & pm as preventative)
- 1mg Ativan/5mg valium (as needed, switched between the 2 depending on resistance building up)
- 8/10 discovered new pregnancy AND moved to NYC for big job – saw therapist & prescriber – he pushed Xanax on me – gave me headaches
- 10/10 planned suicide attempt via Verrazano Bridge at 3am without realizing it wasn’t a pedestrian bridge like the Brooklyn Bridge – removed from bridge by police, forced hospitalization for weekend. Think to myself, next time in a snow storm I can pick my way up and over the labyrinthine Brooklyn Bridge and jump unseen.
- 11/10 went into labor at 25 weeks, baby born via emergency C-section after 8 days inpatient bedrest, he had emergency intestinal surgery for Nec at 6 days (weighed 1.5 pounds and was translucent), doctors would not commit to an opinion that he would live until years end, he would remain in Neonatal Intensive Care unit until February 2011
- 12/10 was e-mailed by my firm that I was being fired as the client I served was a “demanding” client and my position could not be held. I sent them a carefully LEGALLY worded e-mail back, addressing the fact that I had been assured I was supported by the firm and that all of my absences were for medically documented or documentable reasons. Initial response from firm’s general counsel is to go away. A week later there is a second response – from the Partner who I worked for – fully reinstating me as of January. I decline when she says I will not be able to take time off when my son is eventually released from the the hospital and she says she will be happy to give me a recommendation if ever I apply at one of the firms other offices (there are a least 25 globally, biggest immigration law firm in the world).
- STRESS LEVEL EXTRAORDINARY
2011 (See bullets)
- January – Husband got a position with old firm in Boston, moved back – I am in a $3,350 a month apartment in Park Slope with 4 daughters and a son in the NICU
- Mid-February – teens took bus back to Mass to spend February vacation with friends, 1 arrested for her 1st and -to date – only underage drinking party, I could not get her as I was 300 miles away, decided with husband to “send a message” and leave her in custody over the weekend. Instead she was assigned to the state, I was labelled “unfit” and “neglectful” for leaving her with Mass Department of Children and Families, and she was released after a week into the custody of my sister who lived in Boston – an alcoholic – who proceeded to send her back to spend the weekend with the same kids she was arrested with the 1st weekend in her custody. My daughter decided I didn’t love her so she would fight to be emancipated or have her aunt granted permanent custody. Hearings in Mass scheduled for 2nd week in March.
- Late February – baby released from hospital. Massachusetts DSS calls NYC DSS and I am immediately visited with follow-ups scheduled. As if things weren’t bad enough, with no health coverage to cover my mental care, DSS is in itself a trigger for me, having been removed from my mother’s care at 9 by DSS & never seeing her again, until she was in a coffin, and I am barely holding it together in front of this case worker.
- Early March – delicate baby goes limp, the Infant CPR course I took at NYU Medical nets only 2 breaths from him, my oldest daughter dials 911 and within 3 min FDNY is in my apartment, at first failing to revive him manually, succeeding upon bagging him. He is rushed to a hospital 2 blocks away, stabilized, diagnosed with RSV. I am scheduled to be in court for my daughter in Mass in 2 days. The next morning he is rushed into Manhattan, having declined – I ride in the ambulance from Brooklyn and once he is stable I catch a taxi to LaGuardia and take a 45 min plane ride back to Boston. The child my son is rooming with is about 5 and must have Leukemia and I am deeply unsettled. I collect my daughter from the court the next day and she refuses to speak until she gets into the apartment in Park Slope, when she sees her siblings, particularly the baby girls.
- Late March – baby released from PICU at NYU Medical and we move to the apartment my husband has secured for us the next day. My depression & all symptoms of its co-morbidities fall away within a month or so, inexplicably, except for the anxiety, and I hate the apartment and am reminded again how important my sensory comfort levels in my living space are to my mental health. My anxiety abides and I am very angry, my husband is working alot and is distant, from me and everyone else in the house. I wonder if my mental relief and his new mental distance isn’t the result of our switching of the Breadwinner status.
- April – I start to see a CNP with a practice on the South Shore that I visited just before the New York move and want to be treated for the anger and anxiety. She prescribes whatever anxiety meds I want but also wants to try some mood stabilizers. I am game. We try:
- Trazodone (sleep all day)
- Saphris (sleep all day, then cut in half – I had been given a sample – it is off-label only for mental health and when I find that the half works a bit she writes the script – my pharmacy calls me and tells me my insurance won’t cover it and it’s $600. No thanks.)
- Wellbutrin (no impact)
- Cymbalta (no-to-negative impact)
- Lamictal (no-to-negative impact)
- Abilify (no-to-negative impact)
- Depakote (revisited by depression)
- Ativan (PEACE)
- Clonazepam (PEACE)
- Valium (PEACE)
- Prozac (revisited by depression)
- July – suicide attempt with pills (I have been prescribed SO many over the past few years) and vodka – everyone supposed to be out for the day but teens come home early and call 911 when they cannot revive me. Back to McLean for forced hospitalization.
I have struck out over the past 6 -9 months with practitioners – they either want to prescribe everything on the shelves or nothing at all. Most recently I have tried Prozac again (DIRECTLY back into milder depression – sleeping all day, etc.) & then used trazodone to help with sleep. It didn’t help with sleep but seemed to make my days less stressful. However, I am not taking it right now.
I am looking to manage my anxiety, erratic sleep patterns & inability to concentrate fully. I telecommute as a paralegal, have 2 teenage daughters (16, 17) & 3 babies at home (1,2,3). I work 30 hours a week, 1 day in the city, & my husband works regular business hours in town. Our marriage is poor.”
I had written, on the worksheet I filled out while checking in, that my current concerns were erratic sleep, anxiety and concentration. I was having difficulty focusing, particularly on work, but I also was starting projects and not completing them, defrosting meat with the intent to cook and letting it rot, making plans to take the kids out and opting to nap with them instead.
He noted that I had been chemically resistant but that if trazodone was paying even minor dividends then we may as well stick with that. He asked if I was having active panic attacks and I said yes, in fact I’d awoken in a state of full-blown panic one morning that past week and that it had taken minutes to unlock my fingers and knead the pain out. We agreed to stick to the clonazepam, if only to avoid withdrawal.
Then he asked about the concentration.
“In what ways is it manifesting?”
“Mostly when I’m working or driving. It took me a week just to log on to the Labor Department’s website to simply hit ‘Submit’ on a case recently. I have no idea why it took me so long, it took five minutes to get it done.”
“Do you remember if you daydreamed in class as a student?”
“Hmmm. I don’t recall, but I was a good student so I don’t think so.”
“Has anyone ever suggested or explored ADD with you?”
Of course no one had. He explained that the notion that only less intelligent folks have Attention Deficit Disorder was a myth and described the way the disorder manifests in highly functioning adults, and I was very surprised that most of what he said was more than familiar. Academic or professional cramming was actually a symptom. The brain often asserted an unwillingness to shift from the frivolous to the important, thus a person missed appointments, lost track of finances, procrastinated on important tasks.
We discussed eastern philosophy and mental techniques a bit and he urged me to employ these techniques as fully as I could. He prescribed Adderall and recommended I book his next available appointment. We shook hands and he handed the paper prescription to me.
“It was a pleasure meeting you.”
We had run 15 minutes over schedule.
Anyway, after I started taking the Adderall (see entry “Adderall what the fuck is your problem?”), I got tired of my pencils and my custom journals that always took my artist friend in the Czech Republic months to get to me, my elbow and hand started to hurt way too quickly after writing, long before I was out of words, and I figured I would try an online format – blank Word documents leave me creatively and mentally blank myself, so I figured I could choose a layout, an “environment” where I could record all of this bullshit. And it’s actually worked out really well for me.
I am really happy to find myself around so many fellow-sufferers, writers, poets, even clinicians. I had no idea there was a real online mental health community, but it is a wonderful place to retreat to. Even if my babies don’t often agree. So thanks to anyone who took the time to read this, to my new regular cyber-pals, for keeping me company, for sharing your thoughts and experiences and for providing such hospitality for a new blogger.