Route Out: A Variation on A Theme

Dear Readers,

It's been a busy day editing some earlier blogs in my drafts folder. I'm struck that I had more to say during week one in recovery than anything I wrote in subsequent weeks. The schedule was grueling, zapped much of my energy by early evening. I went to bed very early. I steadily began to feel some strength return. I discovered I wrote several other blogs in draft but they precede the summer. Maybe I'll finish them soon or store them away for future posting. Their titles are snappy. I

There is an original story spinning in my head about ghosts, set in a Gothic background, where life and death does not seem so black and white. Everyone loves a good ghost story and I have one to share that is immensely entertaining. But before I undertake writing it, I want to leave you with my impressions of my mid-summer dream. 

Much of the following blog is contained in today's other postings. You'll may find many repetitions on the same theme. They're important and need repeating. Nothing like a teacher to drive a point home. I must learn how to organize these blogs better, categorize or tag them and hopefully list them in an easy to access fashion. Blogger must have more functionality than I'm using. I'll learn. Your comments are welcome. Remember tea is always a dialogue. Drop in any time and spread the word.

Peace to you all,

Dee

_____________________________________________________________________________

While friends and family enjoy and plan their summer vacations, I embarked on a summertime journey. This severe depressive episode has weakened my body, mind, and spirit thus my social life. So off to the partial hospitalization program I go. In hindsight, I should have done this a year ago. This is a courageous decision as my good friends tell me that I'm brave. This is true.

Each day, we are asked what our goal for the day is and my response is "A good cry". The cry I long for though, escapes me. Although, the first day I feel the well inside me begin to leak while I am walking alone. I refer to this as my daily exercise because it is a good five minute walk from one end of the hospital to the other. Naturally, the cafeteria is located at the other end of the hospital. I'm off to meet the smokers who have just inhaled their lunch and have bolted for the fresh air. We're told to walk down to the highway entrance in order to smoke. Yet these young adults have staked a position along a wall far enough away from the formal main entrance of the old building that houses the mental health department. I join them, not proud of the fact, that I'm smoking after quitting for so long. Without the mentally ill, cigarette manufacturers would be without a market in the US. However, smoking is still a social activity among us. A dopamine enhancer. I pull the sunglasses over my wet eyes and join them. Our conversations flow smoothly as I follow them around learning the timing and ropes of the program. Day one passes, no tears are shed.

A sense of routine is being established as I rise at 6 am to be in Salem by 9. It takes that long to shower, iron, dress to have the morning coffee and breakfast before the drive. I'm trying different routes to the hospital, convinced that I will find a quicker commute avoiding the local traffic snarls. By the end of day two, I settle on the fastest route home. The highlight of the day is when I meet the psychiatrist assigned to my case. Let's just call her Dr. Michelle. Her quiet, gentle appearance in the room takes me by surprise. She's low key, very attractive, youthful, tall, lean, and fashionably cool wearing jeans. She walks gracefully as I follow her to an office in the Adolescents Day Program. Here about 20 young people under the age of 18 are gathered creatively in an arts program under the careful observance of a handsome pony-tailed man. There are more kids in this program than are in ours. I take this as a hopeful sign. Early detection means early treatment means a higher quality of life. The kids look up from their arts and crafts following me with their eyes as the doctor sits down in her office. She quickly puts me at ease, informing me of her close professional relationship with my trusted psychiatrist. "I understand you are one of his favorite patients. He emailed me about you." The doctor asks me questions. As I'm answering her questions, as I start to speak, tears begin to flow from the deep well inside of me. We discuss my options and a psycho-pharmaceutical strategy is proposed. I agree.

Dr. Michelle speaks about ECT as another option. (Please, read the posting "ECT: Two Women", March 28, 2010. An award-winning animation by Laura Piraino)  I've learned ECT is a viable solution that works. However, it requires a very strong family and personal support system of care to be effective. The logistics of finding available, attentive, dedicated caregivers is insurmountable for an unmarried, middle age woman without children or a significant other. I pass on ECT now.

Personally, I find it distressing that psychiatrists are referred to and are relegated to the role as psycho-pharmacologists today. Though, I never liked the term "Shrink" either. I believe it invalidates their years of training and their enormous educational time and expenses invested in the competitive study of medicine. I feel it invalidates their professional experiences, and their special calling to a branch of medicine little understood or appreciated by their medical colleagues. Psychiatry is the art of listening, hearing, observing, it's part science, based in hypotheses that's standing on firmer ground as neurological and systemic research of the diseased brain becomes better understood. That is if the entire mental health system doesn't collapse under the burden of a growing demand for mental health services.

 

Psychiatry is always the first for budget cuts, it was the first medical branch to be dismantled in the 80's and the 90's, the first to feel the effects of Wall Street's scheme of privatizing medicine, who are forced to deal with insurance companies that on a good day are basically unregulated banks staffed by low paid, uneducated agents intent on denying patient claims that are a matter of life and death. Of course, they're just doing what their high paying executives tell them to do. Depression is a very, very expensive disease for a patient (and their families) as a psychiatric condition. Let's not forget the pharmaceutical companies who are primarily focused on profitability. Most research is government (tax payer) funded with lobbying by drug companies that allows these tax-payer-funded research costs to be passed onto the consumers at exorbitant drug prices. And what's with their advertising? I remember the days when advertisements by drug companies, gambling of all sorts, lawyers, erectile dysfunction and medical institutions were forbidden to advertise to the public. Now they dominate cable, print and internet marketing with budgets in the billions of dollars, filling the void left by cigarette and hard liquor commercials.

In the meantime, medical schools around the country and around the world, are producing fewer and fewer doctors trained in the specialty of psychiatry. So the number of days in-patient (10) is strictly regulated by insurance companies. In-Patients are barely stable when their 10 days in-house hospitalizations are up. They are transferred  to a PHP to be discharged (ready or not) within 10 days. This barely is enough time for the doctors, nurses and social workers to do their job. That they manage is a testament to their commitment. That patients survive this incorrigible system is a testament to their courage. Those patients who talk get better results than those who do not. We bond to support each other with our commitment to get our essence back and to stabilize physically and emotionally.

By the end of the day, I realize that I'm going to have to be very patient with myself, telling the group, I met my objective. I had a little cry. My well is very deep though. Two young 20-somethings are discharged that afternoon.

That evening, Illa, calls in with support that includes a good kick in the ass, too. "You will make this program work for you! You are going to do it. And that's that!" Though I hardly feel like laughing, she has called upon our past experiences, which brings a smile to my face. I go to bed early. I'm exhausted.

Day three starts with the same goal, to have a good cry. One of our group, that includes another new member, quips "May I ask, what does a bad cry mean?" I laugh, a sign my humor may be returning. By now I'm used to the dirty walls, the worn sofas, the clickety-clack of one of the ancient, struggling air conditioners, and the white noise of the fan. It's all designed to reduce the stuffiness of the room. I learn to bring a sweater despite the rising temperatures outside hovering around 90 degrees. The bulletin boards in the hallway are a chaotic collection of fliers focused on domestic violence, rape and substance abuse. There is nothing about depression or bipolar or similar sources of information, or special hot-lines or support groups posted. I take note of this because every person in the program is at some stage of severe depression.

There are two dorm-sized refrigerators in the "kitchenette" that offers bitter decaffeinated coffee. One is for the brown bag lunch you must bring. The other refrigerator is empty but contains an abundance of tiny half and half thimbles. The same two apples sit in a basket untouched. I take note of a list of food stuffs available to the insured guests. Among these are yogurt, OJ, cereal, milk, etc. so I inquire about getting a yogurt and an OJ on this morning. Shortly, thereafter, an office administrator brings me two small yogurts and a cup sized OJ, which she pilfers from the adolescent program next door. She tells me a food supply order will arrive the next morning. I thank her. 

With an increase dosage of a mood stabilizer, three small meals a day and with the series of  45 minute sessions followed by a 15 minute breaks, I begin to stabilize. It's a mystery to me how or why this therapeutic program works because the topics of "conversations" are not unusual. Stress and time management. Dealing with change. Self-esteem. Cognitive strategies. The copy quality of the handouts and the "from memory" presentations of three social workers tells me, the same "curriculum" has been used for a long time. Only one, talks "at" us. This I find to be an annoying style (not a judgment of the worker or content quality) but I mentally redecorate the room and try not to dose off. This is not true of a couple of the other patients in the group. Sleeping or nodding-off is tolerated. By the end of day four, I've calculated how much one-on -one face time with the various professionals I've had. There are apologies, of course. I understand they'll get to me sooner or later as they manage priorities. I believe it was St. Augustine who said, "The reward of patience is patience." I wonder, once again, if my appearance and presence are working against me. I rarely appear publicly like I'm in crisis. But then again, my public appearances are restricted when I'm crisis. Ultimately, I will and do receive a great deal of special attention, time, consideration and powerful support from the all the professionals involved with my case. By the end of nine days, I don't feel very confident about leaving the program because I'm just beginning to feel stable. Therefore, arrangements are made for me to attend another complimentary day program in Lynn.

Thursday night, the night I have a contract to teach, will be a real test of my stamina because the bridge work being done in Lawrence requires a different route into the city. The ESL class goes exceedingly well as we watch YouTube clips and read about the origins of the tango. We continue with reading "Tuesdays With Morrie" that focuses on the importance of family in dealing with a chronic and degenerative disease. Morrie states unequivocally that without his family, he doesn't know if he'd be able to cope. This strikes at the core of my loneliness and fear. My own family knows nothing about the partial hospitalization and for the most part still have an incredibly unresponsive attitude about mental illness. This saddens me because this disease is genetic, like getting blue or brown or hazel eyes. There is no choice involved and one doesn't really know until college or later whether the gene is yours or not.

I do not function well on six hours of sleep so I awake exhausted on day five. It's a Friday and will mark the turning point for me. There are two new members added to the group. The agenda for the day includes a presentation on Spirituality. This catches my attention. Enter the female Chaplin of the hospital. Let's just call her Jane. She is professional and feminine in appearance, beautiful with her chic framed glasses. Her presence, her inner strength is dynamically tangible. She literally lights up the room. They'll be no sleeping during her presentation. She gets it about mental illness, it strikes at the very essence of your being. Your soul, your spirit. Only those who have experienced deep loss know the truth of this.


Later I would learn that Jane would like to meet me the following week. I readily agree and we have an amazing conversation where I left her office felling validated, welcomed, and with a respected, resourceful  woman to remind me, that above all else, I was to find diverse ways to nurture my soul and spirit and to incorporate this into my daily ritual. She reminds me, that God believes I'm awesome, specially designed and I'm magical. He cries because I cry. This simple perspective of being loved for who I am touches me like nothing in recent memory. I'm charting it out, Jane. Getting in touch with those places and spaces to be part of the joy of nature and the works of the divine.

Where do you find peace to witness the glories with God? Do you remember to give thanks when you do?