Friday, August 05, 2011

Composure (flash fiction)

I received in the mail yesterday a challenge for a flash fiction contest, which resulted in the anecdote below.  The requirement was a thousand words or less.  I hope this little diversion brings a chuckle to your brain.


It was another day at the walk-in clinic in a poor section of Santa Ana where I struggled to communicate with Latino families, and where my Irish Catholic boss was the worst I’d had. He was building a bowling alley in his house while refusing to provide hand soap in the examining rooms, so I used to carry a bar around in my pocket to wash between patients. By concentrating on the needs of patients I was able to put the substandard working conditions out of my mind, though I later became so enraged that I quit.

A black woman in her mid-twenties pushed open the glass door of the entrance and came to the reception desk to register. She was neatly dressed in a yellow polo shirt and sharply creased jeans. Brand new Nikes completed her outfit. Her undyed curls were of moderate length, she wore eye shadow and mascara but no lipstick, foundation or blush. Maybe 5’4”, she was curvaceous without being given over to pulchritude. After a short wait the nurse took her to an examining room and recorded her vitals. In my long white coat with a stethoscope hung about my neck, the equivalent of a priest’s collar, I entered the room. I sat down on the swiveling stool while she sat high on the examining table.

“So what brings you into the clinic today?” I began.

A look of brief disappointment passed over her face, quickly deflating into a grim resolve. Lucent brown eyes fixed me levelly as she said, “I have a discharge.”

“Oh,” I said, in my professionally compassionate voice, not yet tainted by greed or constant overwork. I was too young for that and hoped I always would be. “How long have you had it?”

“About a week.”

“Is it getting better or worse?”

“If it was getting better you think I’d be here?” she said.

“It’s always wise to come in,” I said in mollification, hoping she did not think me too dense. “Can you describe it?”

She glanced at the crotch of her jeans as if this might remind her.

“It’s kind of yellowish and thick.”

“Any odor?”

“Doesn’t it usually smell down there, Doctor?” she said without embarrassment, though a smile pulled at her lips. I wanted to laugh but maintained my professional composure.

“Are you in any pain?” I continued. “Does it burn when you urinate?”

“Not really,” she said.

“Is intercourse painful?”

“I haven’t had any since this started.” She twisted her neck and rubbed it.

“Have you had any new sexual partners recently?” I asked routinely.

She gave me an emphatic “No!”, shaking her head in disgust.

“Well then,” I said, “We’ll have to take a look. The nurse will be in to get you ready OK?”

“OK,” she said, rolling her eyes. I left the room. When I returned she was up on the table with her pale heels in the stirrups, her legs spread wide and a blue paper drape lined with clear plastic covering her legs and groin. I pulled on my gloves, the nurse warmed the speculum and I gently inserted it in the bluish vulva before the pink vaginal folds all races have in common appeared. The discharge was obvious, thick and purulent, typical for gonorrhea. I looked up at the cervical os, and the discharge was ultimately coming from her uterus. I took a culture and swabbed a slide for a gram stain, but the diagnosis was not really in question. There are only so many kinds of vaginal discharge and this one was as old as the oldest profession.

While the speculum was still inserted she asked expectantly, “So what do you think it is?”

In my bluntly lighthearted manner I told her, “It’s not something you get from toilet seats.”

“So I assumed,” she said coldly. She tilted her head back and stared at the acoustic ceiling tiles, her lips pursed in disgust. (Being tall I could see her face above the drape.) “Damn!” she said. “Damn, damn, damn! And I trusted him! And he swore he’d been faithful! Damn his skinny little black ass!”

“I’m sorry,” I said, preparing to remove the speculum, when she blurted, “You know, Doctor, sometimes I wish you would just sew it up! See-oo-ww it up!”

I laughed so hard that the speculum clattered to the floor and the nurse joined in and finally Marie did, too, although her laughter was different, more a sarcastic confirmation than any belly laugh. Embarrassed but only slightly, I picked up the speculum and handed it to the nurse, my hand still shaking from laughter. I thought I might collapse on the floor. It’s the only time I remember laughing during a pelvic.



Thursday, August 04, 2011

Brainstorm, continued...

It's been a year since my mania began; it was on August 3rd, 2010, when I experienced an unexpected healing in a shamanic ceremony, led by a local who specializes in such things.

I had an out-of-body experience and saw my body dissected down to muscle and the yellow fat flowing down to drip off of my feet.  In the ensuing mania I lost fifty pounds, thirty of which I've since regained in my depression.  Later the shaman told me that sound, on occasion, could ignite a mania--he heard this from a fellow student at a course in the use of music spiritually.  But by that time I was already gone, so it couldn't have been this event that launched me.

This is a problem in mania; sometimes real things do appear to happen, as in my weight loss, something I'd wanted for a long time in my fight against the metabolic changes wrought by simple belly fat--"the metabolic syndrome."  It could as easily be called "the retribution of abdominal obesity," but the word "obesity" could offend the afflicted, so like most terms in medicine it has been sanitized into a syndrome--which results, of course, from lifestyle--overeating and a sedentary existence.

In any case, if we call that the beginning of my mania, the whole thing lasted five months, a personal record.  It was, per usual, interrupted briefly by a forced hospitalization when I was transferred to the hospital in handcuffs.  I've been forcibly arrested and incarcerated for mania thrice, though I've had other minor brushes with the law not related to mania.  The longest term I spent was forty days and forty nights in hospital and prison back in August of 1987. 

Curiously one daughter maintains that a close relation, also bipolar, has had a tendency towards mania in August, which raises the suspicion of Seasonal Affective Disorder as another provocation for the outbreak of the up side of the illness.  Of my three protracted manias, two began in the late summer and continued into the fall, but another began in the spring, the one that resulted in my forty-day incarceration-- when I had my only experience of prison (as opposed to temporary jailing).   But I digress, which is a good sign, since in depression I am usually afflicted with a paucity of thought.

Back to the reality of mania: Besides the weight loss I had a number of supernatural experiences, some confirmed by witnesses.  For instance, one night from the bluff a friend and I witnessed a Viking boat lit up with lights heading southwest at night.  We saw the same boat on another occasion, and he will swear to its reality.  But there is no Viking boat in Mendocino, so was it a shared delusion or was it real?  On another occasion, standing on the apron of rock that makes up our shores, a rogue wave seized me and I was transported upwards and entirely disappeared from my friends, suspended in a tube of whitewater where I spun like a cat and landed, mainly unharmed, in another place  on the rocks.  I disappeared from sight in the wave.  Whether my manic reflexes saved me or I was just lucky, I don't know.  But the episode certainly approached the supernatural, or at least supernaturally luck.  I could have easily broken my neck and drowned.  In my subsequent depression I have often wished that were the case!

Of course, what goes up must come down--"Riding high in April, shot down in May"--and I had a great crash in January that eventually necessitated hospitalization because I was acutely suicidal.  I have rarely felt so bad, and considering the source, that means very bad.  I was hospitalized for 45 days, including 12 EC T treatments, with little benefit save that when I was discharged I was no longer "actively suicidal" though I suffered greatly from suicidal thoughts and have since. 

Which brings me to the present, which often seems an eternity in my intense dysphoria.  I like that word, "dysphoria."  It means mental hell of such depth that it is indescribable to those who have never experienced clinical depression.  But there should be a better word.  William Styron, in "Darkness Visible," agreed that "depression" is hardly adequate to describe such a state, and compared it to a seizure or brainstorm--a complete failure of the normal neuronal circuits so that the mind turns to itself in an orgy of self-destruction.  Is there a better word?  Global revulsion?   The bell jar just won't cut it--feeling disconnected is one symptom, but disconnected and thoroughly suicidal is another depth.  There is no adequate word for depression, but I have a poem that explores the subject, maybe my best poem about it:

Eternal Recurrence

Psychologists call mania
a defense against depression
but I find that silly.
There is no defense
against depression
and no adequate metaphor
for its recurrence, but I’ll try:

You love someone with all your heart.
They are brutally murdered.
After an interminable grief
they magically reappear
and you fall down on your knees
and thank God with tears.

The second time is worse.

After the third funeral
you dread their resurrection
as much as their death
and love becomes a poisonous thing.
You would drive a stake
through their heart
if only you could.


Yesterday I saw my psychiatrist and finally persuaded him to put me on a stimulant in addition to all my other medications.  He had been reluctant to do so, fearing mania.  But I promised to see him weekly after I started it so he could satisfy himself that the risk was decreased.

Incidentally I just read a new review of the treatment of bipolar depression in the Psychiatric Times, and there is really nothing new and no good treatment for the malady, why there are so many treatments--the proportion of treatments of a disease are proportional to the inadequacy of such treatments.  Nevertheless, in a couple of trials, Modafinil, a new type of stimulant, proved somewhat helpful, so maybe my review of the research led my psychiatrist to relent.

Another thing that helps short-term is sleep deprivation, so I tried to stay up last night and got very little sleep, followed by my first dose of the stimulant, why I had the courage to blog this morning, so it seems.  But my fragility is intense--if I get a couple of days feeling slightly better I start to make plans, which immediately fail me when the darkness returns.  This is intensely frustrating.

In my last post-manic depression writing helped me rise out of it, especially when I started getting published a great deal, and the literary Net became my sustenance.  Perhaps returning to workshops there might be of some benefit to me, but I have nothing to post and limited confidence in my critiques, though likely enough to participate.  Anything that occupies my mind is welcome, however much the struggle.  For the most part I've been reading semi-trashy novels and "cowering in my cubicle," a phrase invented by my good friend, Ralph.  Most tasks I initiate I can't complete and are then forgotten.  This morning I summoned the courage to face my backlog of e-mails but found myself blogging instead.  Whether I have any remaining readership is not important, only that I write something.

Perhaps daily blogging will help, but I won't demand of myself to do it daily--presently it is a huge burden to even shower, and I've been failing at flossing, often my last boundary before complete oblivion.  I have never achieved a catatonic state, where the patient cannot respond to anything and goes completely silent and may cease to function altogether, soiling themselves and as helpless as a newborn--though I imagine there is some relief in that infantilization.  My ego, though tattered, is too strong, I believe, to descend to such a state, at least so far.  In "Noonday Demon," a book I strongly recommend to those interested in my malady, the author at times could not even feed himself and his father had to cut up his food and fork it into his son's mouth.  I haven't been that bad behaviorally, but I have certainly been that bad internally.  I can't tell you how painful this illness is--refer back to the poem above--and only suicide promises an end to pain, though who knows?  Certainly medieval thought reserved a special purgatory for such an act, but at least purgatory ultimately holds the hope of salvation, something a severely depressed person cannot imagine.  Having some hope is better than none at all.  If I knew there were an end to my torment I could suffer it more stoically, perhaps, and I remind myself that this is a cyclic illness and I will likely get better someday--perhaps even today!  Still, with every recurrence there is greater chance of recurrence, and autopsies reveal that those who have suffered severe, recurrent depression suffer loss of brain tissue, particularly the amygdala, an important organ in regulating mood and many other important synthesizing operations.  I fear my amygdala has shrunk, and I suppose the amount is proportional to the amount of shrinking I have required to survive.

Here ends my epistle for the day.




It’s not for flaw of character I weep
But for a flaw of chemistry, my dear.
Inside the gyri of my brain it creeps
Infecting all connections, engineer
Of all the darkest petals of the mind
Blighted and browned, hideous to behold,
A monster to myself, a worthless rind
Upon a garbage heap informed by mold.
The green fuzz on the peel is the thing.
But shouldn’t fungus more concern the dead?
I feel its hyphae in my reasoning;
Can’t someone suck this poison from my head?
If brain were foot I’d apply fungal cream
Or perhaps I should begin with trephining.

Tuesday, August 02, 2011

On and On....

I'm four and a half months out the institution where I spent 45 days and finally, as medications did not improve my state, underwent 12 ECT treatments. 

For those who think the procedure horrible, it's really humane and the only side effect for me, besides feeling a little fuzzy, was a headache.

Unfortunately they did not work, just as my medications are not working.

Altogether in my life I've had 33 ECT treatments.  At thirty, when I was first diagnosed, they worked and I went back to a life, my life.  The last two courses--March of 2008 and this year--did little or nothing.  I left the hospital no longer "actively suicidal" but still profoundly depressed, as I am now.

I take an antipsychotic, a mood stabilizer, an anti-anxiety medication and an antidepressant.  So much my cocktail.  But my dysphoria (the polar opposite of euphoria) is still intense, and the pressing, circular thoughts of suicide daily afflict me.  I make bargains with myself--I won't do it until my next AA meeting, yada yada yada yada.  Thus I forestall my self-destruction, though I pursue it through lesser means like chain-smoking.  What most prevents me is the sorrow it would cause my loved ones, and their faces parade before me when I feel utterly forsaken.  This struggle is not new.  I've weathered it before.  This is a cyclic illness and I must remind myself of that.  Someday I will feel better.  In fact, just recently, I had a four-day uplift in mood which quickly slipped through my mind's fingers.  During that time I briefly developed ambitions--volunteer work, a musical project.  But with the return of the albatross all seemed lost. 

I believe this is the worst disease to afflict mankind, and furthermore, in the history of Christian philosophy, no sin is greater than despair.  In a way, depression--sloth, accidie, melancholy (to use more medieval terms)--is also a sin of pride.  The great "NO" one speaks to the world is a narcissistic collapse of pride, proving that one's self-esteem was a chimera to begin with.  Although one feels no pride in this state, one can assign it--to say to God that you are incurable and that he made a mistake, to wish you were aborted as Job did--is an inverted sort of pride (although I take no pride in it).  Still, shall the creature say to his creator that his life is of no account?  And cancel the phantom debt by dissolution? 

"To be or not to be."  At what degree of psychic pain is it permissible to end one's life?  It has been argued that chronic, unremitting physical pain is a moral justification for suicide.  If so, doesn't psychic pain, which I find much more difficult to endure, qualify as an even better justification? 

I spoke recently with a dear friend who haltingly tried to formulate her sentiment towards me.  It amounted to this: she wouldn't blame me if I did commit suicide.  Having had brushes with severe depression, she could only imagine the suffering I endure, or rather she found it unimaginable.  In any case it was as if she granted me permission.  But she is not God or fate; she is simply an example of extreme Christian charity in my view.  God bless her for her understanding.  Tearfully I received it.  I told her it was the most charitable thing anyone had ever said to me.

But I will not do it.  I must hold to hope.  I have weathered this storm before and I will do so again.  I probably ought to be hospitalized or institutionalized but have no desire to return to those puke-yellow walls or gray carpeting or the smile of psychiatric nurses trying to understand when they have no idea of the burden such patients suffer.

Am I being self-indulgent?  Probably.  Is it a sin?  I don't know.  I don't have the gumption to do anything beside read brain candy (as in mystery novels) and take out the trash and walk the dog and floss my teeth and try to attend AA meetings and to make a pact not to raise my hand against myself until the next therapy appointment, the next meeting, my next visit to my psychiatrist.  I am blessed to have so much help but cursed in that I do not benefit from it in any tangible way I can perceive.  I ought to join a monastery if they would take me, or the Peace Corps, but my chronic back pain won't allow me to participate fully in life or live the rigors of such commitments.  Still, to have my life regimented by some other authority would be a great blessing. 

I wish I could offer the reader, if I still have any readers, more hope.  But I have always stated in this blog that my idea was to help others endure depression more than anything.  Although some go to their grave depressed, most recover in time.  I pray I might be one of the lucky ones.  I can't imagine living like this for another twenty years when every day seems like an eternity already.

Enough blathering.  Here's Dark Sonnet XIII, revised:


You want to die more than you want to live
And smile tightly, trying not to let on.
With luck you’ll pass for normal, forced to give
A weak impression than you’ve not withdrawn
Entirely. Get up, get dressed and shave
And go to work and earn your daily bread.
Each day is one day closer to the grave--
Still on you clomp as if your shoes were lead.
You’re only doing what you have to do
To engineer some cheer to fool your friends
Into believing you’re no more than blue
Or else distracted by important ends.
This dedicated sham can last for years
If you hide the embarrassment of tears.



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