An Herbalist's Guide To Slowly Going Crazy

The more anonymous version

[sorbussitchensis]

Am I pushing through the hard spots or am I killing myself? Making pennies. Working 70+ hours a week. Doing all the admin shit, most of the marketing shit, constant networking. I was supposed to have 3 days off this week and only managed 1.5.  Never see my partner. Never see my kids.  My heart rate has been 100 or above for a solid month now- a nice solid warning sign that I’m about to dip back into POTS from stress. 

If I took a corporate job with less responsibility than I’m trained for (Like a PA job), I could retire my husband and afford to live in town. And I’d see my family. 

Why do I want this so much? Why am I holding on to a dying style of medicine? Why don’t I just go get recruited by someone with the money to cover my financial responsibilities?

[sorbussitchensis]

Ok I'm back but probably goth for a while so it's totally fine if you don't want to listen to me whine on the internet. 1) my MIL retired from the army yesterday. Now she wants to know when we're flying our family of 5 out. Uh, never? The only day we don't work opposite schedules is Tuesday, and j works Monday nights? Also have you looked at the cost differential of 5 vs 2 people flying cross country? For what it's worth, I am NEVER flying my children, who have seen j's parents for LESS THAN 24 hours over the last 3 (!!!) years, out to Georgia for the summer. It's just not going to happen. You want to hang with family? Maybe you shouldn't have sold your house in Washington and deliberately moved away from all your kids. 2) I think one of the twins is allergic to bees too. Bummer, dude. Benadryl for bedtime tonight. The sleep level they've had is pretty close to the CIA definition of torture. 3) picked up a Fitbit charge HR from a friend. My resting heart rate is like 110. Probably time to go back on the Milner's acetylcholine protocol.

[sorbussitchensis]

I met with a child psych and an EMDR therapist this week to talk cross referrals and the therapist brought a cranial electrotherapy stim unit which 1) what a thing to bring to a networking meeting And 2) I want one. I'd never done that type of neurofeedback before and I'm really in touch with my body, so trying it out was pretty novel. I put on the ear clippy thingies and it only took like, 2 minutes for my brain to try only having one thought at a time. Anxiety is so noisy. I pretty much only think one thing after another on a fair amount of weed or with a lot of sleep and self care on board. A quiet brain is such a beautiful thing. Anyway, the training is only $150 so *grabby hands*

[sorbussitchensis]

Mothering

I was 29 before I realized that my mom was hallucinating instead of talking to God. When you grow up in a deeply religious family, you don’t realize it isn’t normal. The church I grew up in praised my mom for “speaking in tongues” and treated her as a leper for what I would later realize were features of borderline personality disorder. If I had to guess, I would also diagnose my mom as Bipolar 1 with schizoaffective features. She’s never going to see anyone for a real diagnosis, so that’s as good as it gets until she kills herself (active suicidal ideation for 4 years) or gets committed. The …. Part of growing up is realizing that other families do things differently than you do. Part of having your own children is realizing how much everyone is just trying to do their best. I worry, with my depression and anxiety that maybe I’m crazy too. Will my 6 year old have to kiss me before a sleepaway while I hallucinate that my nose is on the side of my face by my ear? Will I have days so bad that remaining in bed is the only thing my kids see for weeks is my bedroom? Will my children have to meet with the sheriff to get permission to drive early because I’m incapacitated? …… Over the last 6 months my partner and I have been questioning what is best for our family, and how much contact with family of origin we need for our children. Whether we should follow old traditions, whether we’re doing the right thing. I’m a part of this beautiful community where many of my own mothering needs are met by other mothers and the earth itself. I’m more likely to look for an herbal hug than to call my mom. …… Honestly, my mom is a good mom. She baked cookies and sent me to shark dissection classes and encouraged me to read and think. She and my sister are very close, the way I wish I had been. Today I feel extra introspective granted the media focus on mothering, the challenge of doing something without an example, the ever widening gap between my mother and myself. I love her…but it’s complicated.

[sorbussitchensis]

Unpacking the weekend

I went to a training on psychiatric prescribing for women in the peripartum years on friday. It was fascinating, useful, and I’m pretty sure after that training that my family is bipolar. 

Well, let me back up. My mom talks to God. She once packed up all of our belongings for 2 years because God told her we were going to move. My mom hears “angels and devils”, cycles between migraines so bad that she wants to kill herself, and absurdly huge projects. Of course she’s bipolar.  But imagine being 7 in an incredibly religious family and just assuming that of course, God talks to mom. So finding out 29 years later after completing medical school, finally seeing my mom on a slide from the presentation, seems like a shock. 

But it shouldn’t have been, not really. I’ve been depressed since my early teens, I’ve been out of touch with reality at least twice, once that I remembered, with postpartum psychosis. I thought I had really bad anxiety, but I saw me on a slide too. And I worry about that, because when you have mental illness, your mind lies to you. I’m an incredibly high functioning wreck, but now I have insight into those darkest times that I can’t really remember- the waking from sleep in a dead panic, sure that my husband was accidentally dropping our son from the 7th story window (which didn’t open), the obsessive research and compulsions to get better, to conquer what I’m working on. I should probably see a psychiatrist. I’m down a lot and I’m not as crazy as my mom, but it would really change my opinion on whether I should taper off of the zoloft in a year or not. 

Then I drove 4.5 hours for a funeral. People typically pause me here and say “I’m so sorry” but look, the dude was 73, a totally uncontrolled DM2, depression, passive aggressive bullshit, a constant stress to my family. I know my dad will miss his uncle, but I just has so totally divorced myself from this side of the family that I had a clinical cynicism when I heard. Of course. Of course he died. That’s what happens when you eat what you want and only halfassedly follow up on your insulin. It was interesting to hear a non-familial, unfamiliar side of my uncle- this generous, giving, excellent educator who was friendly but unassuming, who bought coffee for the ladies at the toyota shop, who had a lifelong best friend. I mean, it all falls apart behind the scenes with a history of the why and the fallout afterwards. But wouldn’t it be nice to just believe in the public face that other people saw?

My extended family is falling apart. It was before, but the election divided us further. I don’t know if I can get any more family gatherings in. I sat at the table (in a pizza parlor, no vegetables to be seen), with my unhealthy physically and emotionally family and I felt like a stranger. I felt invisible. I know my grandmother is proud of me, but I also know that my passionate activism means that most people would rather not see me. It’s a strange thing to see a large family fall apart- and to know that it was falling apart already, that the “tribes had fractured” or something like that. Strange to be a scientist in the den of dogma. Strange to eat car snacks in a pizza parlor. Strange to feel a stranger. Strange to silently plan to not go to another family gathering, to avoid the obligations we’re born into. 

[sorbussitchensis]

Despite clear lab work showing preeclampsia prior to delivery, they continue to follow algorithms that do not fit the patient situation. I am concerned because her abdominal pain is so severe that there may be a surgical complication or continuing liver damage.

I’m getting a little sassy in this chart note. 

[sorbussitchensis]

My preeclampsia case that I talk to my mentor about as "disaster lady" is still ongoing. At 6 week well child she did the "and by the way I can't move and I'm still swollen as hell" thing with one hand on the doorknob. I did labwork to check on her kidneys and liver and such- her liver enzymes are still high. And her BP was 140/100 in office, which wasn't shocking because she hadn't been taking the HCTZ I'd asked her to take. 3/4 ttp on abdominal, so much guarding I can't feel her uterus. And, since she didn't fucking have an appointment with me, I sent her to her MDs up the hill for further workup. They don't know what's going on either- none of the numbers are classic- and they're investigating postpartum cardiomyopathy. Which, whatever, ignores the preeclampsia and the liver enzymes and the fact that she doesn't have a heart murmur or lung crackles and isn't short of breath. Then they have the audacity to tell her that 1) I'm not a real doctor and 2) I shouldn't be managing her blood pressure which was only elevated because she wasn't taking her meds. "It's a different paradigm" they say. As if HCTZ is different when they prescribe it than when I prescribe it. They can fuck all the way off, I have to order the ultrasound that I assumed they'd do in office when they couldn't palpate her uterus due to guarding and they didn't even fucking lay hands on her abdomen. I'm laying odds on an atypical postpartum preeclampsia with a possible surgical complication.

[sorbussitchensis]

-I hate bedtime -the local hospital isn't following guidelines and I'm worried they're going to kill a preeclampsia patient. They told her that I don't know what I'm talking about. Bitch, I personally had preeclampsia twice. I can recognize some pre-e getting ready to head south, even in my first fucking year. Do your job, hospital. -I'm drinking cider while everyone cries about bedtime. I'm 700% done with 3 night waking kids on my own. People tell me "just hire a sleep trainer" or "just hire a night nanny" or "just get a hotel for the night". Fuck them right in their wealthy, non nightworking partnered mouths. I am at my ropes end and I still have to have a business meeting tomorrow morning, even on a third day of less than 3 hours of sleep. I still have to order vaccines. I still have to wrap up classes . I still have to function and I don't have the privilege or space to deal with how awful this non sleeping early childhood thing is. -I know I'm doing the right thing, a good thing, a needed thing by doing the work that I'm doing where I'm doing it. Everyone says it takes 5 years to find your feet, and I'm only 6 months in. I hope it gets better than this. I'm barely surviving.

[sorbussitchensis]

So he told me his heart rate was irregular and that every time he went in for a blood pressure check, people would do an EKG and then send him to the hospital, wherein he would be told he was fine and sent home. He told me all he wanted to work on was anxiety and blood pressure. He's 85 years old, I figure he has a right to decide how much health care he gets. Then I took his blood pressure, which was high, and I could hear how irregular his heart is. Then I hooked him up to a pulse ox with a stethoscope on his chest, and whoa. I can see why every other doctor sends him to the ED immediately. On listening for a minute, his heart rate is probably 58. On watching the monitor, it ranges from 32 to 75. But his oxygen, somehow, is completely fine. I took a minute to decide if his history warranted me doing an EKG or sending him to the hospital and decided that he sounded like a reliable enough historian that I could believe him, and I let him go. Of course I'll check on him today, but his chief complaint was that every time he gets into an algorithm with his doctor, the doctor refuses to believe that he's outside of the bell curve, and that's exactly the sort of patient I end up with. What do you do with a heart rate so irregular that the patient is about a minute from dead, who refuses EKG and hospital admittance? I guess I just treat the things he was actually concerned about. I gave him hawthorn for his heart and lavender for his anxiety. I told him about a food delivery service that would bring healthy food. I always ask about treatment goals. Sometimes it can be hard to remember that at age 85, the patient has a right to stay out of the hospital and to refuse more intense therapy.

[sorbussitchensis]

So I had a patient last week who looked like shit. Not the good "oh this person is going into labor soon" kind of shit, the "oh, this person looks wrong" kind of shit. Anyway. Swollen to hell, epigastric pain, blurry vision. No labs run by their conventional practitioner. I dunno, I prefer to screen predisaster. I ran labs expecting to see pre-preeclampsia with a uric acid over the top and maybe an IHCP. But I get the report back today and it's straight up HELLP. Early HELLP. Not everyone is dead yet HELLP. So I sent them to the hospital to see their midwives and their midwives are like "this doesn't fit strict criteria, her AST isn't quite double" and I'm like, come on. She's gained ten pounds of water weight, 20 mmhg of blood pressure, she can't see, her abdomen hurts, and her labs are clearly demonstrating that her kidneys are tanking and her liver is really sad AND her platelets are below 150,000 by a lot and her ferritin is fucking 10. She's a disaster waiting to happen, and I'm not managing her pregnancy, so step the fuck up. They're repeating labwork tonight and hopefully her numbers continue to suck more so they'll do something about it. I swear to god, for every MD I've had not listen to me lately, I've had to put out a lot of fire due to an MD not following standard of care.

[sorbussitchensis]

Surbus sitchensis

Also known as the Mountain Ash, or Rowan, was in the front yard. My goal was the back yard and the hawthorn tree. I suddenly decided I needed to make an oxymel and elderberry wine for christmas gifts, so in the first true downpour of fall we went out to harvest. I don't have a hawthorn tree, but my 4 year old goes to preschool with a family that does. I don't think it's weird to ask for plant bits that they would have raked and composted otherwise, but now that it's evening I think maybe it comes across weird. The only time the other preschool mom and I could make our schedules work was at 7:30 this morning. So at the crack of dawn, all 3 kids and I and she and her kid made our way to harvest the red berries, mealy and a little past prime but still in season. Water ran off the branches and down the sleeves of my outstretched arms. An hour of picking, breaking up preschool shenanigans, and soothing the bumps of learning to walk later, we picked 5 cups of berries. Hardly anything when the seeds are out. I still took them, but I crossed cordials off of my list. It's not like I can go buy more in season hawthorn, and with the kids I won't get out again before it's too late. Home, to the baby's nap and to my 4 year old incessantly asking when he can watch a show. Piles of laundry. Then out again directly, off to another event that I'm overcommitted for in the pouring rain I love the rain, but I love it differently with 3 sets of boots walking through puddles and 3 people complaining that they're cold and 3 people talking though the autumn air. Hours later and commitments over I'm hiding in my room, listening to the rain, taking a breather from the kids, who are doing their level best to drive me nuts. I can hear my partner yelling "get off if that, you'll break it", the words rising up the stairs and interrupting the few more seconds I've got before he needs to get ready to work the night shift. I just need some space to listen to the rain. My internet spaces got too crowded and my house is too crowded and there are too many things I can't talk about in too many spaces, now. So here I am. Talking into the internet where no one can hear me.