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Archive for November, 2011

Still

The last few days have felt both frighteningly familiar, and brand-new, all at once. On the one hand, it seems like every day brings more confirmation that I’m ill again, and yes, I am afraid of being back here, of falling down again. I am afraid.

However, now that I’ve accepted my lapse, and done the practical things (doctors app, seeing ‘the dragon’ today), I’m in a bit of a stalemate  now. Unlike this time last year, when I wasn’t really willing to accept just how bad I was, this time, I’m putting things in place. It’s almost out of my hands now – until I’ve seen the doctor and talked things through, all I can do is keep going and hope for the best. That’s not saying I’m giving up and spending a week with my head under a blanket – but just that there’s not much more I can actively do, now, aside from try to keep things ticking over.

I met L after meeting the dragon today (the phrase ‘glutton for punishment’, comes to mind) and am feeling pretty bulldozered by it. She seemed to start panicking when I told her I knew I was going downhill again, and said maybe I should see someone else – which is ridiculous as I’ve only got a few more weeks till we break for Christmas, after which I’m going to Nepal – and I didn’t really know what to say to that, apart from feeling pretty cross and upset as I wasn’t quite expecting that reaction. I sort of rely on her to NOT panic and be calm – and it threw me off. It’s the first time I’ve felt angry with her. And then she started going on about church healing rooms and suggesting I think about it – which also confused me as I’m really not one for asking for people I know to pray for me, let alone strangers, and to be honest, it sounded like a last resort – as though I’m in need of a last resort. It’s nothing to do with my faith in God not being strong enough, to find healing in these places – it’s that (as she knows) people have inflicted quite a lot of damage by using prayer to say things they had no right or reason to say, and I don’t trust other people with my faith, especially when I’m vulnerable. Not at the moment. And what I needed was for someone who has heard my reasons for fearing medication, to encourage me and tell me that I’ve done right in making these appointments and gearing myself up to try them again. I didn’t need that decision glossing over and marginalising. Her suggestion was so completely out of my range that it makes me wonder if she’s been listening at all, these last few months. Feeling like a lost cause, is never a good thing.

And yes, it’s just this latest drop that making me feel as though the rest of my life is going to characterised by many more troughs than peaks, and yes, it’s just this depression that makes me feel so relentlessly unable to fathom how I’ll manage that – but it’s how I feel, today. It’s how I was feeling after seeing the dragon and being up since 6am after a sleepless night. It’s how I was feeling after finding church on Sunday more painful than its been for such a long time. It’s how I was feeling, as I realised how much I’m playing for at the moment.

I know, that mulling over things isn’t going to help and that there is no gain in regretting past decisions or thinking over mistakes I made – but if I can’t rock up at counselling after a crap week with a pretty big realisation, and cry and say that I don’t know where to go from here, and how I’ll get through another period as black as last year if it comes my way, where can I say that? I have acted to sort this out as quickly as possible, but that doesn’t mean that my mood hasn’t plummeted, and it doesn’t mean that I’m not devastated at the moment by this latest change.

I’m not sure what I’ll do next week. Part of me doesn’t want to see L again. Part of knows that I probably need someone keeping an eye one me. It’s hard, sometimes.

Thanks to all who’ve been thinking and praying for me. It helps.

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So – I’ve now got a doctor’s appointment but it’s not till Dec 6th which is a bit annoying – I’m not a good one for waiting, particularly when it’s something I’m already anxious about. I’ve decided to see a different GP this time too, as I didn’t feel like the man I saw last year was really listening to me – so also have that issue to think about.

I’ve also emailed ‘the dragon’, at the medical school, which was difficult, but am meeting her next week. This is probably sensible, as I know, if I’m honest, that my working ability isn’t great right now – the apathy is coming back with avengance, and it has nothing to do with paeds, which I love – but it’s still there. I can’t sit and concentrate. I can’t work my way down a to-do list, which is pretty big at the moment. The paeds department make you tick off a lot of things on attachment, just because we haven’t had much exposure to the specialty yet, so there’s a lot of stress to get assessed regularly, and be proactive. On a community attachment, whe’re I’m in a different part of the city, with a different team who to be honest don’t really notice if I’m there or not, every single day, it’s quite hard to keep keen as you never integrate and never feel valued.

Once again, things feel ironic – this time last year, was when I was running seminars for the first year medics on ‘coping at university’ – whilst falling apart. On Monday, the medical school mentoring team I have set up and chair, met with members of the pastoral care team, which includes a psychiatrist who was consulted (without my consent) about my lack of compliance with medication. I feel like I have one foot in two very different camps. Having met these members of staff essentially as an equal, also makes me keen not to have to plug in to medschool services, myself. I don’t want to have to flag myself up to them, and lose face. Sometimes, if not most of the time, I almost hate being someone who is driven, and builds projects, and follows up ideas. It complicates everything. It muddies the waters. And yes, I love the mentoring scheme – but at the moment, I feel like a fraud again. How far I am from the person who should be leading that sort of venture, how changed.

Going back on medication seems like a huge and daunting decision – the endless GP appointments, the endless checking in, the  constant reminder of needing something external to control my soul and quieten my thoughts. And even though I’ve personally told people that a bad response to one drug doesn’t mean another will be the same, and I know that it’s unlikely – I’m terrified. I’m scared that I’ll give meds another go, and before I know it, I’ll be low enough that I’ll once again be itching to get out of my skin and out of my life in order to stop the thoughts flooding in. I’m scared that if I sink low enough, there won’t be anything holding me back. I’m scared that I’ll lose any sense or hold on reality and certainty, and that I’ll lose everything I fought so hard for last year. And that’s not easy to say to a GP who doesn’t know you. It’s not easy to say to anyone. I’m not usually the panicker – I’m always the one leading and chairing and organising. But now, I’m panicking. I don’t know if this is a good idea. I’m tying myself to a minimum of 18 months on treatment, which is a long time. I hate being a patient. I would literally rather gouge out my own eyes, than be in the patient role. And I wish that there had been someone there six months ago chasing me up and making me take medication and keeping an eye on me – so that this relapse might not have happened and I wouldn’t be back beyond square one again, with all of these decisions to make anew.

And again, I look back and realise I’ve not been singing or talking or praying, as I should be. Again, I feel pretty tarred and marked by this, a stain that is never going to leave me. And I wonder what it is that draws me towards this state and the reason for it – but there is no reason, which makes it all the harder. There is no reason, apart from bad genes and bad luck. There is no answer lurking behind this. This is just the hand I’ve been dealt. I don’t want to play it.

 

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It’s becoming increasingly clear that  at the moment, I’m just not ‘quite right’. I’m feeling a lot more apathetic and tearful, and just can’t quite be bothered with a lot of things. I’m struggling to work productively and find myself crying a lot more than I have for some time. I find myself thinking about things I haven’t thought of since my last ‘fall’. I can’t sing at church either, which seems to be quite a good signpost for things not being right.

In short, I think I’ve officially lost the race against depression again.

This isn’t really that surprising – after all, I’ve had a good five months of recovery after the last and worst dip, but doing these things cold with no medication, is not the best way. And no matter how much I argue that it was ‘best for me’ and ‘the only way I could manage’, it probably wasn’t. I should have pushed to be put on something that didn’t make me so suicidal.  I should have had more courage. I should have realised that like everything on this earth, depression isn’t something you can beat using your own willpower alone. Apathy is my greatest enemy, at times.

The defining moment was realising that my thoughts are getting progressively more negative and dangerous, and although I suppose it’s a good thing that I recognise that they’re coming from an illness which has a solution, and not myself, I’m pretty devastated. I feel like I’ve failed. I feel like I’ve lost the war, at last.

The thing is, I’m afraid to try medication again. I’m going to Nepal for my elective in January, to work in hospitals there, for two months, so there’s not much time to play with drugs and doses. Last time, no one, let alone myself, quite made the connection between how ill I was, and fluoxetine. This was one time when being the eternal perseverer, did not have a good outcome for me. I can’t feel like that again. I’m terrified of feeling like that again – but I’m not sure I have any options left. I feel like a total hypocrite after spending so much time convincing my flatmate to try them, but it feels inevitable. I’m also not really looking forward to going back to the doctors after spectacularly failing to refer myself to the psychiatrist/renew prescriptions/do what patients are supposed to do. It feels like this is all my fault, and that if I’d been just a little less brick-headed, just a little less obstinate, or, dare I say, it, just a little less depressed and incapable, this fall back might not have happened.

I’ve not got much time to play with as I’ve got two essays that need writing in the next fortnight, and there’s a lot to learn in paediatrics too – so I know that I need to act quickly. I know I need to stand up to this and stop thinking I can do it on my own. I know I need to accede the point and then start again from the beginning. It’s like a dreadful homecoming, an unwanted baseline. It makes me wonder if this pattern is going to be all I know, now, of a few months rising and then, repeatedly, falling back and losing everything I managed to salvage. This is a house I don’t want to be in, a party I don’t want to crash, and yet, here I am. I’m stuck  inside the walls again. I’m looking for God in this, and not really finding him.

So – let’s see what happens. I hope all my readers are having a better week than I am.

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I realise I’ve not written too much about my counselling with L of late – mostly just because other things seem to have subsumed them, or my posts haven’t gone up soon after a session.

It still seems odd as the longer I know (as much as you can ‘know’ your counsellor, anyway), the more it seems that if we’d met in other circumstances, we’d probably have got on very well. It’s like that Thomas Hardy poem, ‘the man he killed’ – except unlike in the Boer war, bloodshed is very much frowned upon in therapeutic circles…. The concept is the same though – in other times, in other places, on different terms, our relationship might have been more equal, more balanced. I’ve thought a bit this week about how I’m now past the mid-point in counselling as once I leave for two months in a Nepalese hospital in January, L and I will probably never meet again. I also had an email this week from an old teacher at school, which has also made me think a great deal, as she was the first person I ever told about my dad’s drinking, after I came into school one morning after sitting overnight in A and E, and just completely broke down. She was the first person who listened to me – and when I refused point blank to try any form of counselling, she didn’t push me, and supported me through my final years of school by giving me books (she was a very stoic English teacher and very much subscribed to ‘reading through the pain’ – as do I) and generally being lovely. She also never breathed a word to my parents, which must have been a hard decision to make, but one I am eternally grateful for.

I was sixteen, then. It took another seven years for me to get myself into a counsellors office and capable of staying there. Growing up in a substance misusing household changes your perception of risk, gain, and potential for harm. For me, the risks of opening up were just to great, for too long. I’d lived under the shadow of a tabboo topic and couldn’t break it. There was too much at stake, and too many ways that it threatened to push me over the edge. By the time I had no choice but to go, I was already as far over that edge, that I could go. And it’s taken more courage, each week, every week, than I can often describe.

Yesterday, I hadn’t been thinking too much about what to talk about, but then had an extra half hour to waste as I headed over as I got away early from the childrens hospital, and as I was walking, realised that I’ve felt pretty flat recently. And yes, I’ve been busy and harrassed, and busy again – but I’ve also been a little numb, a little flat, in a way that being busy and somewhat misguidedly listening to the latest deathcab for cutie album,  just doesn’t quite explain (everyone has a band they should have outgrown, but never will – deathcab are mine). I was already crying, by the time I got there. I was already crying, and wasn’t even that sure why. It’s that feeling of mourning something, that I can’t quite shake off, that feeling of being without something, of being tired out and work out and desperate for some relief from the heavy days and all of their requests. I can cry in front of L, now. It does get easier.

Part of it is that I’m over-reacting a bit about a meeting I’m chairing next week for the medical school mentoring scheme that I set up (it’s going very well, which is nice) – and asked for a member of the medical school’s pastoral care counsel to come along to speak to us. The person they allocated is a psychiatrist that the student support person (aka ‘the dragon’, for longterm readers) told about my depression, without my consent, when I took myself off medication and went more than a bit haywire. And although I should be able to say that he’s a psychiatrist and this is what he does for a living, and that he probably won’t remember me by name alone anyway, I’m also terrified that he will and will say something, and I’ll start crying. I’m fed up of feeling as though every single time I feel like I’m getting past all of this stuff, something jerks me back. I’m fed up of feeling like I’m tattooed for life. I’m fed up of feeling as though I will always be judged first on my history of depression, before anything else comes into play.

L was pretty good about all of this, and I do find that I trust her opinion, which after six months, is a good thing. Counselling still leaves me exhausted though – it’s not as simple as being a release, or an outlet. It wears me out. Sometimes everything just feels so dramatic and difficult. Simplicity is a wonderful, enviable thing.

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Elegy to autumn

Now, I’m pretty used to be analytical, and most of medicine is about comparison, either with ‘the norm’, or the other side of the body. To find a pleural effusion, you’re looking at how one lung base sounds compared to the same spot on the other side. To work out if a knee is swollen, you look at the uninjured one. To assess a child’s development, you compare them against what a child of their age and experience ought to be doing.

Perhaps this is why I find myself referring to last year constantly at the moment. This run up to Christmas was the hardest time, in many ways, of all of my time with depression. There were a lot of painful moments, this time last year. I was pretty deadened. The changing leaves didn’t make me look closer for their beauty, but for their relationship to dying, as that was all I was thinking about. Everything was empty. Now, after a week of 9-5 lectures, I appreciate being able to concentrate in a way I couldn’t do for months, last year. I appreciate waking up and feeling exhausted, but not wishing I’d not woken at all. In the last month or so, I’ve got my ‘medical mojo’ back – I can approach patients and speak with them, and examine, without feeling like I’m having a panic attack or that I’m distinctly substandard. When my depression was both in its early, middle and late stages, I had real problems with that – as though patients could see my diagnosis and would assume I was useless, or that I was useless, and would never ever be a good doctor. You have to have a certain level of confidence to go and talk to someone with terminal cancer, or a sick child, or ask to do a pelvic examination. Medicine is no place for wallflowers, and my confidence is taking a long time to come back.

This time of year always makes me nostalgic, probably because it has so much packed in that a lot of my childhood memories are of walking home from school in the twilight, or waving sparklers, or carving pumpkins, or picking apples from the garden to make crumbles. The cold, clear autumn days are my favourites of all the year. They remind me that change isn’t always bad, or forever, and that all phases and stages, both good and painful, end at some time. We move on. We grow.

It was early autumn 2003 when my dad went to rehab for the first time, and deep winter when he came out. When we picked him up, we had to bring his winter jacket as he’d gone in with just a jumper. It was autumn 2005 when I applied to medical school, had my first set of interviews, and felt like my chance of escape was growing closer. It was autumn 2006 when I started medical school, which really was my lifeline, and what had got me through the previous three years at home. In 2007, I lost my last grandparent as the leaves were falling, spoke at a funeral for the first time, and mourned the loss of a generation. This week two years ago in 2009 marks my change, at last, after months of questionning and wondering and fear, from plaintive agnostic, to quiet, startled Christian (this is a post in itself). This week, last year, marks the anniversary of the day one conversation with a person I misguidedly trusted, led me closer to death than I hope to be again until I am old and worn and ready.

The autumn for me is a time of heartsome remembrance, an elegy to what has changed, and what starkly refuses to alter. This year, I am two years into faith and those two years have hardly been easy or straightforward. I remember the wounds of last year, and carry them with me. Those autumn days where my mood was hibernating, marked me. However, my years of faith have marked me more. My faith has survived, my prayers are still stumbling, my heart is still learning. Eight seasons on, I am still singing. Eight seasons on, I still see God when I look at the changing leaves and see the death of the year beginning, in all its glory. Eight seasons on, I can see how much ground I’ve covered, and am able to look forward and wonder where I will be in another eight seasons. This is my favourite time of year.

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I kind of feel like I’ve stepped back into the fire since I got back from my trip away – as though a week of peace tricked me into a false sense of stability, and that letting things go for a week just made them come back amplified when I turned my attention to them once again.

In church on Sunday evening, I found myself crying and crowded out, the first time I’ve had that total, overbearing feeling of weight, that leaves me short of breath and panicking,  thinking,   pleasegodjustmakeeverythingstopandslowdownbecauseimjustnotbigenoughforthisanditstoomuch

I’m finding it hard at the moment with F and her depression, alongside trying to get myself as firmly sorted as I can. It’s exhausting. And sometimes, just sometimes, I can’t bear to be kind and clear and brave and supportive when she talks about ‘not wanting to give in’ and go for counselling, or ‘being strong enough to not need or benefit from it’. Sometimes, after cheering her up and stopping her crying, it’s me that ends up crying next door – I’m not nice enough to fully accept that she doesn’t mean to cause offence or that it’s not a personal gibe at me and my issues. Part of me just wants to start yelling that if she thinks I ‘gave up’ last year, she’s bloody wrong. If she thinks it’s an easy option, she’s wrong. If she thinks it takes more courage to bury her head and not try something that’s pretty well evidenced to work, than give it a shot, she’s wrong. Sometimes I get so annoyed that I can’t get away from depression at all, whether its mine or someone elses. I just want it to leave me alone. I just want to have a few months where it doesn’t rule every thing I do and think about, and choose. I’m no saint. I’m running dry again. I wish I could handle this better.

I’ve also realised that the last few weeks have been so busy and irregular and stressful, that once again, I’ve got myself off the right road and I’m feeling lost. I’m panicking. I stopped fixing on God, and lost sight of him. There’s been so much to think about that I didn’t notice when I stopped praying and stopped talking. And although I know it should be easy to get back, for some reason I just feel blocked off and shut off, shut out. And I feel like I need someone who knows me and know about last year to pray for me, and pray the right things, but there’s no-one at church I trust enough with it, not after last year. I feel like I need to find the way back home, back to God, but I can’t see it. It doesn’t feel right. I usually hate being prayed for, due to a combination of hating feeling like I’m the ‘centre of attention’ (please don’t look me in the eye, God), and other reasons. But right now, I feel like I need it. Right now, I feel like I need someone alongside.

As of next week, I will have been a Christian for two years, and yet so often I still feel so green and uncertain. After last year, depression moved my faith backwards and I had to unravel all of the wrong things it fed me. My faith is a panicking faith, an onmygoodnesspleasehelpgodpleasehelp faith. My faith, and the things depression did with it, almost killed me last year. My faith, and all the things God did with me, got me through, last year. And yet, at the moment, I feel like I’m shouting against white noise, into the wind. I’m trying to be still, and know. I’m still learning. I have so much to learn. I have too much, to learn.

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I am just back from a lovely break up North, which was all the more wonderful as I’ve been hosting an American friend, and her grandmother, for the week. My friend S is one of those people who seem to have a tattoo across their forehead that says ‘world-changer’. We met working at an American summer camp for people with special needs, four years ago. She is awesome. Sorry for being off the radar, but we’ve not had internet since heading off on Wednesday. This is a little rambly – sorry!

They arrived last Sunday and after getting them settled in, S and I went for icecream (I like that this is the most American thing I have done in living memory) and talked. One of the things I love about her, is that unlike the vast majority of people I know, she has absolutely no fear of the word ‘depression’. She uses it where it should be used. She does not dress is up and make it tapdance so it seems less threatening. She does not brush it off. She does not refer to it as a habit I fell into, or a path I mistakenly went down, or a series of bad judgements. And, in doing this, she makes me feel more separate from depression than I have for so long; often, I think my close friends still mentally prefix me as ‘depressed-Char’, or see it as part of who I am, a part that is here to stay. In naming it so frankly, S called it out. She gave it parameters and borders and drew a line, where depression starts and I began. This is crucial, as for so long, depression made me think that it was indeed, here to stay, that the chapters without it in my life had ended, and that my future was just one bad, sad day after another. It’s taken so long to feel as though I’ve ‘come back’, and returned from wherever depression banished all of my drive and passions and sense of self.

She is also much more frank, and direct than any of my other friends, who know about this year. Not one of my close friends has ever asked me where I’m standing with alcohol when I pass over the wine bottle, or turn in early from yet another party. No one has ever had the courage, or gumption, or wherewithal, to ask where and how I am. In being direct, S made me feel a little less like a modern-day leper, turning away from societal norms. She made me feel like just another person with just another set of issues, rather than someone standing out from the crowd due to everyone else giving a wide berth and ignoring the elephant in the room. S was pretty much riding that elephant, metaphorically speaking. She made me feel less like a problem, and more like a person, with a problem. I am grateful for this. S has been reading this blog, and came halfway across the world to check in with me. If that’s not an expression of friendship, I don’t know what is. So often, depression (and recovery) leaves me feeling alone and bereft, and despised. Friendships like these, are the antidote to that. I’m not sure you can get through depression, or any mental health problem, without a cheer squad.

Depression causes so many problems as we all have our brand of misery, and people who have not met it personally, struggle so greatly to grasp that depression isn’t just a bad day, or even a bad week; it casts a false impression as, afterall, we have all been sad, have we not? We have all cried, and surely, depression isn’t too different from that? And yet, this feeling of false understanding is often the most damaging to people living with it, as we cannot explain how it hurts and scars and takes an age to heal. It’s not just a bad day or a bad week. It’s so much more. My flatmates and close friends are brilliant, but didn’t know how to approach my depression, and as a result, didn’t know how to approach me when I had it. Because of this, I was ashamed, and took to hiding. Having someone who understands that I am separate from it was invaluable. Having someone who understands what it means, helped me begin to heal.

As a firm lover of period dramas, I am still fairly convinced that I truly belong in the eighteenth century, dancing with men in regimentals and doing charitable works in whatever time isn’t spent making jam and embroidering cushions, but I also love that I am living in an age where I can have a friend on the other side of the world, and see them every now and then. I love that I live in a time where ‘goodbye’ rarely means forever, and au revoirs are entirely possible. In just under a year, I will (fingers crossed etc) finally be earning and out of student-dom forever. I’m looking forward to being able to bring home the bacon on some au-revoirs.

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