Wow.

Just...wow.

I opened my email box yesterday afternoon, about an hour and a half after posting "Gee, Officer Krupke!" and found more than two dozen emails. Some were comments on the blog postings about my brain; others were just emails, sent to say "hang in there" or "throwing yourself under a bus is a bad idea" or "look at me; I'm stable and healthy and have been doing this for thirty years".

I can't thank you all enough. It's a relief to know, of course, that you're not alone, but it's also a relief to know that there are people in the world who are nutjobs like me but who can also use paragraph breaks and spell correctly.

A couple of points I need to clear up: I am not going to toss myself off a high building, or even a low one. Suicide is not attractive in the least.

Also, I'm feeling better. Either I have the fastest chemical-reaction time known to man or this is the placebo effect; either way, I'm not arguing. This happened the first time I upped my dosage of Effexor, from 37.5 to 75, even though "everybody says" that it takes a week or two. I'm a little speedy yet, but feeling much better.

Too, I think I figured out what Doc Pedro meant by "rapid cycling". The last time I saw him was March of 2005, and he didn't get the date right. He thought I'd gone from peachy to miserable in three months, not in fourteen. Regardless, I'm still going to find a shrink. I got a little grumpy when I realized Pedro hadn't read my chart right, for Chrissake, but that just reinforces my next two points:

Doctors are human and can screw up, especially in minor ways, especially when they're stressed out; and,

It's never a bad idea to hold up a hand and say "Wait. Stop. I don't understand." If *I* can fail to do that, as somebody who's used to dealing with doctors all the time, *anybody* can.

Still, shrink it is. Brain chemistry is a specialty, and I have some questions about my med that Pedro couldn't answer.

Thank you all again for your emails and comments. It was really and truly like being borne up on a huge wave.

Cue "Gee, Officer Krupke!"

"You--take him to a headshrinker!"

So I saw my pal Pedro, also known as Doc Pedro, PCP, today.

Doc Pedro wasn't having the best of days. Somebody's grandchild was trying to systematically dismantle his waiting room as somebody's grandchild's grandmother made a big stink about nothing, and in walks his primo, pure-dee, brass-plated Headcase Du Jour.

Poor Doc Pedro. He's sending me to a headshrinker. On accounta, she says, channelling Action and Riff, I'm depraved. And on account of the "cyclical nature of my depression." Yes, he really talks like that.

Never mind that four years of good control on Effexor is the longest damn cycle I've ever seen, Jack, and maybe he got me mixed up with somebody else; I'm headed off to find a psychiatrist.

All joking aside, there's a definite period of adjustment when you come to terms with the fact that you need medication to function like a normal person. Then your medication gets doubled on the same day that your PCP tells you he can't really manage your care any more, and you're forced to look at yourself in the sunshade mirror of your car and say,

I am mentally ill.

I have a chronic condition that is not curable, but is manageable with lifestyle changes and medication.

I will be doing this the rest of my life.

Whereupon, driving up the street, it suddenly made sense to me why some people actually kill themselves.

I, of course, not wanting to deprive the Reading Public of my thoughts, did not drive my car under a bus. Instead, I went out and got an order of nachos with extra guacamole and drank a beer. Then I considered my plight.

I am mentally ill. I will be doing this the rest of my life. I will be managing, with any luck, my illness with lifestyle changes and medication. Forever.

Then I swallowed another Effexor. Doc Pedro doubled my dosage today, given that all my symptoms are those of somebody whose body has grown accustomed to Effexor. He wasn't willing to change my meds, fearing that that would merely confuse any other practitioner I consulted.

So, here I am. I'm depraved, not on account of I'm deprived (unless it's some intrinsic genetic failing), but I'm depraved. Just knowing that I have some problem that he can't help me fix makes me feel better. You know those questionnaires that you take, where the max score is 21? I got 18. I think anything over 15, for him, merits a referral.

I swear to Frog I'll find the silver lining in this. (See? My mood's improving already.) It might take a while, but I'll find it.

Meanwhile, I have to find a shrink I can handle. Good thing I work on the Brain Unit, eh?

Reflections of a Nutjob

It has come to my attention that I am a nutjob. Not a hard-core nutjob (meaning, I take only one medication, and the lowest effective dosage of that one), nor an unmedicated nutjob, but a nutjob nonetheless.

Please. I am not "depressed" or "differently serotonined". Euphemisms are for the differently brained. I am nutso. A whackjob, if you prefer that terminology. A crazy. Whoo-whoo-whoo, a la Moe of the Three Stooges. I have a shopping list of things that gets me through the day, most of them mind-altering substances of varying availability (Caffeine, Effexor, Caffeine, Simple Carbohydrates, Norepinephrine, Effexor, Scotch, and venlafexine for dessert). I have been known to have anxiety attacks for no particular reason, and in fact had one today.

So. In the spirit of past Things To Do lists, here's:

What To Do If You Know A Whackjob, Version One-point-Zero

1. Do not, under any circumstances, indulge their desire to talk about nuclear holocaust or other forms of apolcalypse. See, whackjobs get anxiety in weird ways, and this is one of them. Steer them away from the David Brin and onto the Spider Robinson, where everything turns out okay.

2. Do indulge their desires for simple carbohydrates and alcohol, within reason. Carbs raise serotonin levels while alcohol in moderation can keep the garden-variety nutcase from jumping off a bridge. Make sure it tastes good, and you'll have accomplished another goal: showing the loonie in question that tomorrow is indeed another day.

4. Crazymeds dot org (thanks, Anon, for the correction!) is an excellent resource website for both the interestingly-brained and their friends and relations. True, there are some postings on the site what will make you say "Wooo. Buh?", but overall, it's a nutjob presenting what it's like to be a candidate for the whackshack with grace and humor.

5. If your crazy pal needs a warm body around, be that warm body. I cannot tell you what a difference it makes from the loonie perspective to have somebody around who can quote Bloom County and make coffee. It's invaluable.

6. If you work with even one other person, do not make denigrating comments about crazy folk at work. That one other person might be me, and I might be on a short leash due to my antidepressants not working all that well, and then there might be a lot of mess to clean up. Crazy people *are* different from you, yes: we're often smarter and more creative. We're certainly posessed of a well of nastiness that you can't even conceive of. So be nice.

7. Answer the phone at 3 am.

8. Don't pressure the nutcase in question to go out in public with you. Often, nutcases such as myself can't muster the energy to go to the bar or a restaurant. It's simply too overwhelming. Bring by a clamshell of Chinese instead if you really want to see me.

9. Make sure the nutcase keeps their doctor's appointments. This is not such a problem with the minorly-medicated, but can be a real issue with those of the brotherhood who take multiple meds or meds in major doses.

10. If in doubt, call 911. I am not saying here that this has ever been an issue for me. I have been blessed up to this point with having not had any serious thoughts of self harm....but I can certainly see how some people might.

If you work with, live with, or love a moderately- to severely-depressed person, or a person who deals with bipolar disorder, keep in mind that calling the fuzz in might someday be necessary. This does not mean that you or the other person has failed; it's a modern response to an age-old problem that used to drag the median lifespan down. Think of it as your way of boosting our national life expectancy.

Tomorrow I see my Muppet-like doctor. We'll talk about how to regulate this pinkish lump of neural tissue behind my eyes. I'll certainly, since everything is fair game here, keep things updated.

Frog Soup

I feel like the guy in the cartoon who brings his car into the shop, complaining that it's running rough, only to have the mechanic point out that he's missing two wheels on one side of the vehicle. *There's* yer trouble, with the understood "dipwad" coming as a modifier.

My antidepressants aren't keeping up with changes in my brain chemistry. Oh, boy. It took me a while to realize this, but now I'm on board.

Funny thing, depression: it's a lot like that old wives' tale about putting the frog into a slowly-heating pot of water. By the time you realize there's a problem, you're nearly Froggy Consomme. There's a long history of Frog Soup on the female side of our family; the previous generations mostly self-medicated with alcohol and charity work, but the women of my generation and Beloved Mom's generation have pharmaceuticals.

However, even modern medical miracles can sometimes lag behind when it comes to the Wonder That Is The Jo-Brain, so I'm snarkier and less energetic than usual. (Comments about how this makes me a super-snarky three-toed sloth will not be approved, people.) And in that nonenergetic, snarky mode, I bring you....

Rules for Stupid People, Some Of Them Residents, Part Three Thousand and Sixty-Five

1. If I page you post-call, it's not because I like playing with the pretty buttons on the phone. It's because you've written the prescription wrong, failed to include your DEA number, and written for over the maximum allowable dispensation of narcotics. So don't snark when you call me back.

2. If you don't call me back, even after I've paged you 911, don't snark when I get your attending to deal with it. I *will* start removing your digits if that happens.

3. Stamp your fucking H & Ps, okay? I can't let an unmarked H & P, lacking any indication of who it's on, just sort of migrate into a chart somewhere. Digit removal, people, digit removal.

4. I don't date residents. Ever. Stop asking already.

5. Pathologists are not allowed to turf. If you attempt to turf over a biopsy that should've been in my lab five days ago, things will get nasty indeed. I don't care who you are or who you work for; I have a guy whose brain is turning to mush, probably because of something infectious, and we needed that biopsy last week. You think I'm snarky with the residents? You should see me with attendings, who *ought* to know better.

6. Don't drive 45 in the left lane. Even if you're in a Prius. Thank you.

7. Don't ever, ever tell me that I need to have more information, or a better grasp of the information available, before I come to you with a question. I might then be forced to point out (in front of either your attending or your fellow, whichever is there) that you haven't left a note in the chart in, oh, three or four days. That will suck. And not for me.

8. I don't care how much of a genius you are: if you start to jack around in somebody's spine without wearing a mask and gown in addition to your sterile gloves, I'll stop you. And if you snark at me, one of us will be sad later. Hint: it will not be the nurse who had to reinforce proper sterile technique.

9. If I've ordered a scan with and without contrast, I really do mean "with and without", regardless of whether you think the contrast will be helpful. Trust us on this one, okay? Thanks.

10. Dictation can be fun! Really! They offer a free lunch every Tuesday and Thursday down in the dictation cave so that you can dictate what you should've dictated ten days ago and eat at the same time! It's great! You should try it!

It struck me about a year ago that the life of a nurse goes like this: Know All, See All, Fix All. It also struck me that we really, as a professional group, ought to agitate for better ways to get other people to do their jobs better. I'm thinking either a mass issuing of Super Soakers or some slingshots and M & M's as ammo.

MBTs and my MCL: Not Quite a Love Story

I have strained my right MCL. That's apparently a ligament in my knee (I don't remember; I was drunk that day in A & P, I guess) that does something like keep one's knee from bending at some crazy angle toward one's other leg. Mine is strained, not torn, which is a good thing. It means that I can still shop for groceries and do laundry and work, though I do all those things with a limp and a pronounced disinclination to squat, and it also means that I won't need surgery.

It happened like this: I had just gotten out of a nice, hard 30-minute workout on the treadmill and exercise bike, and spotted my buddy Bunsen. Bunsen's half Golden Retriever and half Traveling Salesman, as Mom would say, and is about a year old and about 80 pounds. He's also enthusiastic about playing Chase The Ball And Then Tackle The Human. We played Try To Tackle The Human for about twenty minutes, during which time I had to feint repeatedly to each side...while wearing my MBTs.

When you buy the things, they come with a little booklet that cautions you to be careful of doing things that require lots of feinting to each side. They also caution you against doing things that require a combination of balance and weight, like lunges. What they don't caution you against is being a blasted idiot, so of course I went out and was a blasted idiot.

The chief of the ortho department's reaction was this: "Dude. Bummer. A week or two. Ice. Bummer." (Yes, he really talks that way.) Chef Boy's reaction was this: "Wow, that was stupid." (Yes, he's really that supportive and gentle.) Chef Boy did provide me with an ice pack and some ibuprofen last night, though, and I was able to head out and pick up coffee and bread today. I'm going to spend the rest of the day icing this dadratted knee off and on and reading fashion magazines.

Tomorrow starts a week of intensive upper-body training and, I guess, very little in the way of aerobic exercise. I suppose I'll have to wrap my leg, or something, to provide extra stability while I'm wandering around work.

Take-home from this experience: Do not, under any circumstances, no matter how happy he is to see you, play with a puppy pal while wearing your MBTs. Run home and change your shoes first.

Huzzah. Nnnng.

This is post #350. Huzzah. Nnnng.

Meh. That's all I have to say today: meh.

This morning's workout didn't go all that well, and then Chef Boy added insult to injury by guilting me about not wanting to go to the pool with his kids. Never mind that I was surrounded by pots, pans, half-empty jars of spices I've not used in a couple of years, and a few plastic and Pyrex containers I'd never seen before. I was cleaning out the kitchen cabinets, obviously, and not in any shape to trot into a swimsuit and go to an indoor pool.

Meh.

The crazies have come out of the darkness at work. They're all lined up in the chairs in the family waiting room: from the person who wants gait training for her semi-vegetative daughter (who's been like that for, oh, about twelve years now) to the family member who insists that she *will* read her husband's chart *whenever* she likes, they're all there. If they're not there, they're getting underfoot, attempting to 'help' with things like moving people, changing dressings, or (I kid you not) inserting central lines.

Note to crazies: your daughter hasn't bothered to open her eyes except to pain for twelve years. Gait training is not a possibility. Also, you may *not* read the chart, it's against the rules. And finally, if a resident is putting in a central line or lumbar drain, or if I'm putting in a Foley catheter, the last thing we need is your grimy little paw in our way.

To those of you nice enough to send me links and do your own trackbacks: I promise, promise, *promise* I will get to blogrolling you either tomorrow afternoon or this weekend, whichever can provide more coffee and chocolate. I'm terrible about updating things, I know, and I plan to do a major update...sometime soon. Promise. Really.

Nnnng. Meh. Blar.

I think I'll cook today. That'll make me feel better, having a clean and well-organized kitchen with good and happy and well-cooked food in the fridge.

But first I'm going to go chew my cuticles and say "meh" some more.

This is the coin.

They sat her up every morning at eight, put makeup on her face, and dressed her in a sweet pink bedjacket with lace around the collar. They begged her to eat, to get into a chair, to walk around the floor and go to the gift shop, even after she had a pathological fracture from the cancer that was eating her body from the inside out.

Her daughter dressed her in clothing that wouldn't reveal the mass that was growing on her side, a mark of the cancer that had come back, or the tubes that came out of each side of her chest to drain the fluid that was accumulating there.

We'd talked about hospice, but they wouldn't hear of it. Mom was going to get better, by God, and she'd have surgery to fix that arm, even after the orthopedic surgeon told them there was no chance of it healing.

Finally, after admissions at three different hospitals, they took her home. They'd heard the same thing at three different places. It was obvious there wasn't any hope, that her best chance at comfort was morphine in her own bed. All they'd let her have with us was ibuprofen. She hurt all the time.

She died the day after they left our floor.

***

They were both shocked when the doctors came in with the news: tests showed that he had, at most, a few hours to live. Life expectancy is funny that way: you can go from weeks to live to hours to live in almost no time.

Still, he wouldn't take morphine. Not because she wouldn't let him, but because (his words) he didn't want to lose the hours he had left. They'd been married forty years, and she'd been with him through all the important times, so he wanted to be with her now, when he was dying.

He lasted four and a half hours. They lay together on the bed, holding hands, talking about how wonderful their lives together had been. At the end, he got sleepy, so she cuddled his head into her shoulder and held him even after he'd stopped breathing.

This is the same coin, the coin that has hard-won, painful life on one side and a gentle death on the other. The one side is selfishness and pain, the other is acceptance and love.

These are the coins that we pay the ferryman with.