Thursday, March 12, 2009

The Thing Is

to love life, to love it even
when you have no stomach for it
and everything you've held dear
crumbles like burnt paper in your hands,
your throat filled with the silt of it.
When grief sits with you, its tropical heat
thickening the air, heavy as water
more fit for gills than lungs;
when grief weights you like your own flesh
only more of it, an obesity of grief,
you think, How can a body withstand this?
Then you hold life like a face
between your palms, a plain face,
no charming smile, no violet eyes,
and you say, yes, I will take you
I will love you, again.

~ Ellen Bas

"negativity and the positivity"

This body that we have, this very body that’s sitting here right now in this room, this very body that perhaps aches, and this mind that we have at this very moment, are exactly what we need to be fully human, fully awake, and fully alive. Furthermore, the emotions that we have right now, the negativity and the positivity, are what we actually need. It is just as if we looked around to find out what would be the greatest wealth that we could possibly possess in order to lead to a decent, good, completely fulfilling, energetic, inspired life, and found it right here.
Pema Chödrön

The Winter of my Discontent

Every year, with the falling of the leaves, it sneaks up into bed with me. It follows me around and twists it's cool long fingers into my thoughts. It hides behind doors and comes out when I'm alone--when thoughts are idle. And then it curls up at my feet and follows me around like a loyal but loathsome pet. And I don't even see it's there.

Ever since college I get into a funk during the winter. At first I thought it was the grey skies of Tacoma. When nothing I could think of would make me happy and one morning I woke up and couldn't remember the last time I had laughed. So I moved to Santa Cruz. Then I thought it was the relationship there ending. It followed me from Santa Cruz to Davis--a shadow of dysthymia and disproportionate irritation. Then to Cincinnati when in the solitude of my second year I didn't go to class for weeks, showing up only for exams and slinking away afterward so I wouldn't have to talk to anyone. Hardening myself against the world from the inside out so I could at least function in my studies and my work. Taking the only solace I knew in doing well with my learning.

And here it is again, here, in Sunny San Diego. I've felt off for months. It came slowly up, like it always does. And had given me a year of forgetting and of lowering my guard and relearning sensation. I didn't even know it was there until today. But looking back I wonder how I could have been so fooled and so blinded to my own frigid bed partner.

Szilvie visited in January. She cried and wanted me to share more. I couldn't. I hadn't with anyone. Part of me knew that if I did it would all flood out in tears I couldn't handle and didn't want to start. So I reassured her that it wasn't her. I got angry and held myself further away, telling myself I shouldn't get close to people who care about me because then my aloof protection strategy hurt more than just myself. And I didn't want that.

Simultaneously, Ali started to get angry with me about not sharing with him--not talking--not smiling like I did. "For months, now," he told me last night, "your smile seems fake and wrong. You have a flat affect." He doesn't sleep well when I'm distant. He doesn't understand. I don't understand. "Nothing makes me happy," I told him at one point in an attempt to communicate. But he takes it personally and sees it as his problem and his failure. "It's not," I tell him, but I can see that he doesn't believe me. He doesn't sleep well a lot.

And all I want to do is sleep. I get to places 20 minutes early and the thought of dragging myself in and having extra time for people to ask me questions feeds the anxious doldrums, so I crawl into the back seat of my car, behind the limo-tinted dark windows and I sleep. I sleep for 15 minutes. I slept once for 21 hours in my bed. I sleep early and I sleep late. I tell myself it is my schedule. Or it's my lupus. Or my prednisone is dosed too low.

Or it's that I miss Pop (those times I cry myself to sleep). I dream about him a lot still. In my last dream, he tells me I've been sad for 37 days. He says I don't need to be sad anymore. In another he comes back to life, but he has tubes and lines in him and he's sick. I wonder now if he felt like he needed to come back to fight off the demons that always fled for me before his unconditional and infinite smile and joy just to share a few words with someone he loved. And he loved me.

Or it's about work, when I fret for days over something I think I should have done better. Something I should have known faster. Something I should have taught the med students better. Or done more to make call bearable for my interns. Or admit a patient on a moonlighting night who I wanted more time to evaluate before rushing on to the next four waiting for me to see them. Or, longer term, wondering if i should go on to study rheumatology (and see my own lupus magnified days after day) or endocrine, or stick with primary care and hope that I don't miss diagnoses.

Or I should do my taxes or check my patient list at the VA or go for a run or read more or write more or study more. I work myself into a fretting funk and the shadow smiles gleefully, feeding on my fears and my worries.

Bernie told a story that he'd heard in church the other day about two wolves in Cherokee tale (is it really always the Cherokee, or is that just the American Indian group who's name we can best pronounce and remember?):

"One evening an old Cherokee told his grandson about a battle that goes on inside people.

"He said, "My son, the battle is between two "wolves" inside us all.

"One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.

"The other is Good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith."

"The grandson thought about it for a minute and then asked his grandfather: "Which wolf wins?"

"His grandfather answered "The one you feed the most."

I was back in coumadin clinic the other day and my INR is way to high. Twice what it should be, which means that, while it's keeping the clots in my brian from getting bigger, it is also putting me at higher than necessary risk of a major bleed. Even as I was telling the clinician about my doses, I found that I didn't really care what they were. I tried to picture what I'd been refilling my pill boxes with and when I added up the milligrams, it seemed like I'd been taking too much for weeks without even realizing it. And I'd been forgetting the vitamin K I have to take at night to balance and counteract the effect of the blood thinner. I made excuses like, "I was on call for 30 hours." "I've been tired." "I didn't have time." "I've been sick." "I forgot." All of which are true, but tonight, when I step back, I see the fog has put my life back on the line. It has pushed and pushed and sneaked and contrived and grown so strong that bad things start to happen.

I knew something was wrong, despite feeling blind to cause, something has been off.

The other night my mom started crying and telling me that I don't share with her. That we're not friends anymore--not close like we used to me. I couldn't even remember a time when we were. My memory is shot. I couldn't remember a time when it was easy for me to smile and laugh. A time when I didn't cringe to be around other people who might ask me personal questions that I don't want to consider, with mom being the lead offender in that self-imposed isolation. When she started talking to me, I forced myself to sit down when all I wanted to do was run away. I listened, barely comprehending the words, and having almost all of the emotion lost on me--so distant had I become to myself even. She cried and I didn't even know how to begin to respond. I didn't want to be responsible for that. I can't even hold myself together sometimes. I can't be responsible for others' sadness too.

When my aunt, uncle, and cousins came over for dinner the other night, I had to force myself to come out of my room. I'd worked the whole night before so I had an excuse for being tired, despite trying to act normal and interested. I felt as if I couldn't remember how.

This weekend I tried to go a few blocks down the road for a pedicure and headed for the door a couple times only to turn around and stay in the safety of the house.

Today I had my biannual evaluation with my program director, the same one who pulled me out from the immediate post-strokes confusion and helped get me the help I needed and the eventual diagnoses that I never wanted nor thought possible, the same one who quietly supports me when I flare or fall apart. She read to me my evaluations from the last six months. "Shawna is a pleasure to work with. One med student commented that she is a physician role-model. She is thorough and thoughtful in her patient care. She is responsive to feedback." It felt like she was reading about a different person. It was nice to hear, but I just kept thinking of this last month on wards when I'd been so distant and easily irritated. I knew I was off, so I was extra careful with checking on the patients and the interns and making time to teach and be in touch with the right people. I went through all the motions, correctly, but the shadow tagged along, larger and stronger each day.

When she finished reading my evaluations to me, she said there was something else she wanted to talk about. They had had a conference about the residents at Children's-something I didn't even know they did--and the chiefs had been worried about me. She said the couldn't describe it, that my patient care was good, that nothing big or bad had happened, but that I seemed "off," or like I was "in a fog," or "flat." Very different from my demeanor in June. The attending I had worked with agreed. My program director asked me to see my doctor about it. Maybe restart the lexapro, or at least start it in October, the next time the monster was scheduled to slink into my life.

I left her office and wandered down to the cafeteria where none of the food looked good. I forced myself to eat something as it was hours past lunch time and went to check on a few patients in the computer, but had forgotten my log-on. I ate and concentrated on not crying, as I ran through in my mind all the things that I'd let slip away over the past months. I walked back to my car blinking furiously and glad I had dark sunglasses on. I sat in the front seat before again crawling into the back to sleep before journal club that night. I wasn't sure how I would be around people. I tried.

Ali called when I got home. I told him I wanted to write so he got mad again. I told him he doesn't understand and I don't have the energy to explain and I'm sorry. I am sorry. I'm sorry for feeling this way. I'm sorry it so affects the people who care about me. I feel foolish for not seeing it sooner. I worry that now, as I'm in a rotation that may lead to my future career, that I need to be at my best at I apparently can't even fake it anymore as people at work and home both see my shadow.

My only solace is that I've been here before, and before I've emerged, and so odds are I will again.

I need to somehow figure out how to feed the other wolf.