A Thousand Times
It has been a while since I have posted, but today I wanted to share. Things have not been going well for quite a while. Today is Monday, and I am not at work.
Early last week, I woke up and thought, “I can’t do this today.” Then I got up and went to work, because for the past decade whenever I have heard myself say, “I can’t do this today,” I have done it anyway. I would estimate I’ve had that thought a thousand times since I started med school. Not one of those times did I believe me. Every time I would respond with some variation of, “you have to.” Now I see that I was right, though. Even though I did what I said I could not do a thousand times, I was breaking in slow motion. Every time I did not listen to myself, I developed a new hairline crack. It didn’t keep me from functioning, that day. Indeed, I accomplished the often-unstated but always-obvious objective of learning to perform at a very high level while ignoring my every physical and emotional need. But the day would eventually have to arise when all of the cracks would result in collapse. Some part of me could see that, and was telling me very clearly, but the rest of me refused to accept that I have limits. I started out so strong that I couldn’t recognize fragility.
The past year or so has seen an obvious decline in my mental health. Really, moving into my fixer house while simultaneously recovering from major surgery was the beginning, but that anxiety felt very situational and largely related to my dawning realization that I could not rely on solidarity from my partner. Then the delta wave happened, and the traumas at work caused me to start having panic attacks. Those were impossible to ignore, and I knew then that I needed help. I started therapy, and regular meditation, and ultimately meds. I felt I was getting better, and then I watched one of my best friends die; I helped make the decision to extubate her and was alone with her when she took her last breath. In the aftermath of that I continued to struggle with my partner, and every bad day felt worse than the last. I careened into depression like a little plane with its engine on fire, crashing into a forest. Every day became an “I can’t do this today” day. I kept doing it. After months of his attributing all of our problems to my poor mental health, my partner then told me that he thought I was making it all up to manipulate him. I will never forget the abject despair that I felt when he said that. I maxed out my vacation time and went to Montana with three wonderful women, who watched me drag myself through our days with concern. On the drive back home I spent the long, bleak hours trying not to think about suicide. Trying not to think about something feels an awful lot like thinking about it.
On Wednesday I had a dentist appointment for a routine cleaning. I was having an anxious morning and really didn’t want to go, but counterpoint: adult. I have had a lot of painful dental work done in my life and part of why I like my dentist is that they’ll basically give you (well, sell you) nitrous for anything even remotely uncomfortable. She asked if I wanted it for this cleaning and I said no. I did want it, but I felt silly accepting (and paying for) an anesthetic when I knew I was just getting a cleaning. As soon as the dentist started probing I realized I had fucked up. The pain was simultaneously minor and intolerable. I thought about my patients, and how I tell them all the time that anxiety and depression magnify pain. In that chair, I fully understood what I had been talking about.
The dentist noticed that I was jumpy and she asked how I was doing. That question felt impossible to answer, and I began to have the chest pressure that I have come to recognize as the onset of a panic attack. Tears started running down my face and I was breathing hard, and I saw both of them realize that I was now A Whole Situation. I have been the professional on the other side of A Whole Situation, both caring about the person who is struggling and also knowing that I have limited time and resources and that this has the potential to derail my day. They were very kind, and I was very embarrassed. The hygienist suggested that maybe I actually did need the nitrous, and offered to get that going if I wanted to proceed. I should have just rescheduled, but because of my refusal to believe, “I can’t do this today” I stayed and accepted the nitrous. I was congested from crying and the little nose mask was uncomfortable to use, but the nitrous did help and I got through it. As I lay there tripping on residual panic chemistry combined with that silliest of drugs, I recognized that I was losing the ability to function.
The next morning as I climbed into the tub before work, I found that I was dissociating. I hadn’t had a good sleep in I don’t know how long, and I could barely manage the mechanics of showering. I thought about my full clinic schedule and started to panic again. I tried to imagine getting through the day, and wondered if I could avoid making any decisions about medications, because doing even the most basic math seemed impossible. In that moment, it was very clear that I was no longer safe to practice medicine. I had been monitoring for that, and was certain I would be able to recognize if I had crossed that line. On Thursday, I crossed it, and now I’m out on FMLA. A thousand mornings later, I couldn’t do it.
Today, four days after that, I am contemplating kintsugi. I don’t know if this pile of dust can be reassembled into something whole. It may have to be kneaded into fresh clay and made into something new. For now, my primary task is to listen to my whole self and believe what I am saying.
