Achievement and Being

I suppose if I just start writing it will turn into some kind of a post I  can eventually title, but such faith in one's blathering may be misplaced, if one only prattles to blather and blathers to bloviate.  Then these are wind-up sentences, just as the opening of a poem is rarely worth preserving, it is a warm-up for what follows, and the poet must have the wherewithal to recognize where the poem actually starts and practice has ceased.  Perhaps the same applies to prose.

In my human self-centeredness I ask, "Where am I today?"  I really have no idea.  I feel somewhat calmer since the doctor added an antidepressant over the weekend, but today, when I reached for the bottle, I broke into tears.  The tears said something like: "Why should I have to take this medicine?  Why should there be something wrong with me?"  As if I were the only human with this feeling!  It extends to the cancer victim, to the amputee, to the least and greatest of us.  But is such a feeling merely self-pity or a form of compassion?  I don't know.  The best reply I ever heard to a confession of being bipolar was a man who said, "Oh.  Bad luck!"  That's really what it boils down to.  Statistics are inutile unless you become one.  About 1% of the population is bipolar I.  Who am I to gainsay the odds?  Bad luck indeed.

Yet I am lucky in much more, in being loved by a good woman I don't deserve, and by my children and siblings and friends.  I sometimes wonder if these people love me unconditionally--for who I am, whatever that means--or if my achievements matter to them at all.  I like to think they don't.  Nevertheless I have never been able to separate my self-worth from achievement; I was programmed to achieve at a young age else I fear I would feel no worth at all. 

It is not wrong to sorrow for ourselves or our deficits.  It is hard to imagine us being who we are without our deficits, in fact.  As my wife says, "My deafness made me."  In a similar way I can opine, "My manic-depression made me."  And how?

Without it I could not have driven myself, I think, to have been a doctor by age 25, already married with two children.  This is inconceivable to my present mind, but this ambition and adjustment occurred before I was ever diagnosed.  Since being diagnosed I have had good years, ambitious ones where much was accomplished, and bad ones, where my chief value was survival.  That is what severe depression reduces one to: survival.  Asking more is asking too much.  Not to commit suicide seems the height of heroism in such a state.  I may flatter myself and the disease, but I think not. 

Right now I am somewhat suspended between pole and tropic, action and inaction.  I have an ambition to have my medical license restored, but do not know how much work I could tolerate, and if so, whether part-time work would provide enough for us to live, as any return to medicine would end the support of disability.  The first thing is to get the license restored, for which I need 50 current continuing medical education units, something I could attain online or through conferences (though I prefer the learning method of conferences--with real speakers and real interaction--though I know some of this is possible on the web).  And what subjects should I undertake?  Obviously a full review of primary care practices, perhaps with some geriatrics and hospice care courses thrown in, as through my volunteering as a hospice worker I have developed quite an interest in it.

I had no ambition today to do anything concrete; usually I have, at least, some small goal, as yesterday I accomplished something (though I've already forgotten it--perhaps it was finishing my page-turner novel, "Likeness"?). 

For a non-sequitir, here's a new poem whose origins escape me, something about grief:

Inhabit the Wind


The dying face the furnace in hospital hallways,
in the faces of family through flames of annihilating truth.
Oneself, once faced, ceases to be the monster feared

but the living cannot see this; new loss is too present
to be overcome by psychology; no amount of angels
can comfort the freshly bereaved as they mourn

the being lost to themselves, how they were cheapened,
as if a nanogram of spirit had been siphoned
from their own, and that particular emptiness

in the shape of a lover or daughter or beloved uncle
can never be replaced. “O dark dark dark.
They all go into to the dark” while we remain,

fisting strings to the ether where the kites fled,
amazed at how grief alone holds up the lines
to lost faces never again to inhabit the wind.

Don't know where that poem came from, but the loss of my daughter Rachel in 2007 is never far from me.  In fact, death seems always near, perhaps heightened by hospice work.  And "memento mori" is a sobering background mantra in the face of daily tasks, though if one concentrates too much upon it it can rob the present of importance.  It can take the color right out of your Polaroid.  Better to think of it as the frame around the picture, not the content or meaning of the scene.  That we all must die is no reason to despair.  What we do between our beginning and end is what matters--whom we loved, how we contributed, our attachments, our art.   Will my art outlast me?  On paper and on the web, surely, but as a living testimony--likely not.  I do not live with the illusion that my death will bring my poetry or music to any greater notice.  But I'm proud of what I've done, I've worked hard and said much.  Best are the poems that resulted in personal letters, as one from a grandfather who appreciated my take on fame in the case of young girls idolizing Barbies and pop icons.  Despite all the warnings, however, all studies agree on this: the greatest influences in one's life are parents, or those who function as parents.  That should give all parents and grandparents hope.  The television and Net are not all; they will be seen through the lattice of values we inculcate in our offspring independent of media.

I have practiced medicine before while in the grips of depression, and it was barely endurable, but I never endangered any patients, indeed in my short career of fifteen years was never directly sued while seeing 30 patients/day.  Luck or?  I like to think some skill is involved.

Likewise I know if I were to attempt to return to medicine, I could not predict when or for how long I might suffer depression, the soul-killer, which is not a good state in which to practice, as one loses hope of cure for others since one feels incurable.  To say the condition is temporary is true, but temporary in my case has lasted up to two years.  I can't imagine practicing medicine under such conditions, though I have in the past because I knew no way out.  No combination of medications has rendered me ultimately stable.  I have no guarantees.  It would be one big crap shoot where, if I lost my disability and felt I again required it, I might not be able to get it back. 

There is also my back to consider.  The pain is distracting, even as I write this.  How much could I endure as a family doctor, which requires a lot of sitting and standing and walking in hospitals?  At home, unless writing, I usually am recumbent to rest my disks unless I go walking.  I don't know how a full day of doctoring would affect me; obviously my pain would increase, and would that necessitate an increase in medications, and would that increase still permit me to function?  All of these questions gnaw at me.  And I know some are premature.  The main thing is to restore my license and then look at some volunteer possibilities, perhaps, that do not require too much work or time.  After that, if my disability insurance cooperated, I might be able to segue to paid part-time and receive disability for half-time. 

When I last tried that, before opting for full disability, it proved quite difficult.  Am I just fooling myself with these medical ambitions?  Am I scratching for self-esteem among the relics of my past?  I don't know.  I want to be a useful engine, as Thomas the Tank likes to say.   Milton said, "They also serve who only stand and wait."  But it takes a great deal of inner convincing to believe that.  Standing and waiting do not feel like achievements.

I will say that hospice training has encouraged my sense of being and being with others, as opposed to doing and doing for others.  I realize now how important it is just to be with people, no agenda, simply present and open.  This is the kind of support relatives often can't provide, being too caught up with the person in question.  Too often I assume the responsibility for my existence when it might be wiser just to wait and see what life brings.  On the other hand, if you only wait you tempt a sort of pointlessness that satisfies no one and requires great faith on the part of the inactive.

What I need is balance, balance between science and art, work and play.  At this age all work is play and all play, work.  But this human machine is so designed that it needs to see progress, i.e. some effect upon its physical circumstances to feel good about itself.  This can happen with gardening, with writing a new song or poem, with discharging some responsibility regarding car or bicycle repair, etc., etc.--anything that changes the face of reality vis a vis the individual in need of accomplishment. 
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When I think of my greatest accomplishments, not committing suicide has to be near the top.  I've never attempted it.  This may not sound like heroism to most, but to those who have suffered clinical depression for over a year at a time, I think it qualifies.  Providing for my family and caring for my daughters over the years would have to rank second.  Third would be the pursuit and capture of my one true love, Kathleen; I was willing to risk everything to attain her, and I've never regretted my actions.   As any who have glanced at the love poems in my book know, she is of inestimable importance to my heart and mind and soul.

Funny, none of the above have anything to do with medicine, music or poetry, the endeavors in which I've excelled.  People come first; they must else all religion is deceit. 

Enough rambling for a day.  My back hurts too much to continue.

Au revoir.3 Kilorats,

CE