Best of: In the Hospital; My first ECT Treatment

From 2/7/08, where hope was premature. In retrospect what surprises me is the persistent humor of this post while beginning ECT. Guess it's just my personality, but it has sort of a detective-voice detachment from the proceedings going on.


I was just rudely awakened at 5 AM from a pleasant dream where I was laughing in a bar with my brother. The dream also involved, without carnal coupling, a lovely young woman whom I knew was to replace my first wife. The nightmares of my first marriage recur from time to time, though my nightmares of being a doctor and medical student are more frequent when depressed—if I dream at all. I can't remember when I laughed in a dream.

The nurse took my pulse and her face registered displeasure because my pulse was only 48. She asked me if this was normal for me and I told her yes, that bradycardia was normal. It's funny that when I use medical terms with staff they are never curious about how I know them. I assume my slow pulse may be in part from my aerobic exercise, though I have fallen off of late. Still, swimming a mile within the last two weeks might have some lingering benefits. Else I am unlike the grandfather clock, and instead of keeping good time and coming to an abrupt end, I am slowly winding down. If only life were that gradual! Mine has always been composed of starts and stops; I've been either ahead or behind. What would it be like to have a life of gradual transitions, say get married at 30 instead of 19 and not already be a doctor and father times two at 25? I've always felt pushed by some invisible hand, propelled to excel, whether from anxiety and inferiority (most likely) or some innate property of my disease—I've always been in a hurry to get to the next step, even if the next step is undesirable. I have been the proverbial hare to the tortoise, and let me tell you, the tortoise, though slower, does a much better job at life, though not as well at E-Harmony.

After my vitals the nurse gave me a shot of Rubinol in my left upper ass. It didn't burn much but began to itch afterwards, slightly. She explained the drug was to dry my secretions and prevent nausea for the procedure. I'm sure that's what they told Soviet dissidents.

Afterwards came the hospital gown, a puzzle I'd never solved before. But in remembering how my wife puts on her bra, I tied it in front then took it off and reversed it. I was proud of myself for such a neat solution. Too bad the gown is designed for someone much smaller. If I don't get another one, more than my crack will be out in the breeze; the moon will likely be half full.

I didn't wake up crying today. One change, even before the procedure, is that glimmer of hope. I know I'm getting what I need and I hope never to find myself in a position again where I need ECT but cannot obtain it. Depression is a a severe brownout and full power needs to be restored.

Last night I watched a video for patients on ECT. Patients kept repeating how their memory was fine. I thought they'd never stop.

Actually the memory loss of ECT is consistent with the “post-ictal” phase of naturally occurring seizures. Memory of the procedure itself remains fuzzy not just because of the seizure but but because of the anesthesia. Long-term memory is not affected, but please don't ask me my date of birth.

My roommate, who had ECT in September of 2006 and is here for it again, is a pleasant fellow who resembles Jon Stewart. He was admitted after turning the gas on in his apartment at night. The only problem was that he had roommates, but no one was hurt. He now regrets that oversight. The ghost of Sylvia Plath must have been watching over him. Unlike her, he didn't stick his head in the oven but just let the gas run. That's certainly a sign of depression--the laziness in carrying out a procedure. When depressed, no matter how well you do, it is never right, so you often end up doing a shitty job out of despair. But that tendency can apply in general to a life like mine, always taking things too far in overcorrection. In second grade, for instance, I pushed the crayons so hard against the paper that they broke and the picture smeared. I marveled at he girls who colored so lightly and neatly. Maximum intensity of color was what I sought, maximum effect. The result was sloppy, I admit in retrospect, but it reflected my nature, just as my love of purple and red reflect my romance with the far limits of the spectrum, just as I was born manic-depressive.

Oh, and my MRI was “normal” except that I have sinusitis. Since I don't have any symptoms, I assume that is the effect of weeping too much and too frequently. Maybe the Rubinol will dry my sinuses out. It's certainly drying my tongue out as I write.

Dressed in one hospital gown but with the advantage of a pair of underwear to civilize the view of my posterior—(that's periphrasis, btw—“to cover my ass” would be better English), my escort arrived with the obligatory wheelchair to take me down to the dungeons, as most surgical theaters are located in the basement of hospitals. Why, I don't know. In case of war? Because you can't get any lower? For ease of a sterile environment? To best protect all the expensive equipment? One thing I do know. As we descended on the elevator to lowest floor the air became at least ten degrees cooler. The only thing colder is the morgue, and that's convenient since one can easily lead to the other.

The ECT staff was quite solicitous. They wrapped me in heated blankets. (I asked for a facial but there wasn't time.) They hooked me up to the monitors and I got to follow my pulse, oxygen saturation and blood pressure at my leisure. It wasn't Katie Couric in the morning but I don't much go for cuteness anyway. They also stuck oxygen prongs in my nose, which I found slightly uncomfortable, like snot freezing inside your nostrils on a very cold day.

The anesthesiologist and treating psychiatrist came by my bedside briefly to explain the procedure. The shrink was surprised, like all have been here, at the answer to “How long has it been since you had ECT?” “24 years.” The general consensus is that I had a good run, but the truth is that there were three times I could have used it since the initial treatment instead of fooling around with expensive pills. An ounce of electricity is worth a pound of medicine.

After my roommate emerged from the treatment room I was wheeled in on the bed. The ECT nurse put an oxygen mask to my face over the prongs, the usual hospital redundancy, just as I have been asked at least ten times since admission if I am diabetic. The anesthesiologist started an IV in my left arm while the psychiatrist fastened the rubber strap with large, steel electrodes around my head. Afterwards he took over holding the oxygen mask to my face, which he did so tightly I couldn't breathe (likely why he became a psychiatrist). I asked him to loosen it and he moved it so far away I don't know if it was doing any good. The idea is, I'm sure, that extra oxygen might prevent the death of brain cells. I know of no study to prove this but it seems like a nice precaution.

“Breathe deep four times,” the anesthesiologist said. I was hoping he'd say, “I'm going to inject you now and you will go to sleep in one... two... three... four seconds.” I like to know when my drugs are having their effects so I don't lose out on a new experience, but it was not to be. The next thing I knew I was recumbent and awake inside the recovery room, and the nurse said to me “It's over.” There are better words to utter to a depressive but I knew her intent. I couldn't count the times I've wished it were really “over!”

It seemed as if little or no time had passed when I awoke, though the return to consciousness was not as alacritous as from Diprivan, or “milk of amnesia,” which I recommend to all depressed persons as an excellent treatment (yet to be approved). After staying in recovery for a brief time I was wheeled back in the bed up to the ward on the third floor, I left the bed under my own power while a nurse hurriedly added a second gown to hide my posterior, despite the underwear. Then I was positioned in a large, blue vinyl chair facing the nursing station, along with my roommate, and served breakfast, though not the one I ordered, naturally. I turned in my choices yesterday but the hamburger of efficiency is sometimes slowly ground at a hospital. The nurses then observed us, presumably to make sure that we didn't choke on our food. I was in more danger of choking from the psychiatrist's heavy hand with the oxygen mask.

I felt tired and groggy but not mentally impaired--I remembered my new landlord's phone number to call him and my sister's as well. The retrieval of my sister's number, which I know so well, did take a little longer in my internal Googling, but I snagged it.

Supposedly I'll be discharged tomorrow and ECT will be continued next Tuesday, February 12. How I will stay amused between now and then will be my biggest challenge. The writing helps. Oh, and there's basketball to watch!

Unrated,

CE